Younger injecting drug users and gay men optimistic about HAART likely to have safer sex fatigue

Younger injecting drug users and gay men who are optimistic about the success of HAART are more likely to express fatigue with HIV prevention messages, according to a study conducted in San Francisco and published in the April 1^st edition of the Journal of Acquired Immune Deficiency Syndromes. "Prevention fatigue" was not associated with a greater likelihood of unprotected sex, but was associated with greater sharing of drug injecting equipment.

Investigators analysed responses provided by 303 HIV-negative individuals at high risk of HIV who participated in the anonymous 2001 HIV Testing Survey (HITS). The study sample included 105 gay men recruited from gay bars, 99 heterosexuals recruited from public sexual health clinics, and 99 injecting drug users who were recruited from street locations in areas known to be associated with drug use.

Participants were asked how strongly they agreed or disagreed with six questions relating to their beliefs about HIV. Their answers were then graded to assess their HIV prevention fatigue. The maximum possible score, indicating a high degree of prevention fatigue, was 3.67, and the minimum score 1.00.

Across all the risk groups, the mean score was 2.02. Although there were no significant differences according to race, gender or monthly income, individuals with less than a college education were more likely to express prevention fatigue (p=0.022).

To assess if individuals had prevention fatigue, they were asked if they were "burned out thinking about HIV", if they were "tired or being safe", if they had stopped listening to HIV prevention messages, if they didn't want to hear anymore about HIV, if they were "tired of being careful" and if they thought HIV was "somebody else's" problem.

The level of prevention fatigue also varied between and within risk groups. Injecting drug users had a higher level of fatigue than heterosexuals (p<0.001), and injecting drug users under 25 expressed more fatigue than older injecting drug users (p=0.012).

Although prevention fatigue was not associated with unprotected anal sex between gay men or unprotected vaginal sex in heterosexuals, the investigators did find that injecting drug users expressing prevention fatigue were more likely to share injecting equipment (p=0.020).

Further, the investigators found that gay men expressing optimism about HAART were more likely to score highly on the prevention fatigue scale (p<0.001).

The investigators conclude, “our data suggest that prevention fatigue may be a concern for certain populations at risk of acquiring HIV… or transmitting HIV to others.”

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Safer sex fatigue and HAART optimism explain rise in US bareback sex - news story