IAS: Treatment-related side-effects, sexual dysfunction and parental disapproval linked to sexual risk-taking in gay HIV-positive men

A French study presented in a poster session on Monday at the Third International AIDS Society Conference on HIV pathogenesis and treatment in Rio de Janeiro has found that gay, HIV-positive men are more likely to take sexual risks if they have poor mental heath-related quality of life (HRQoL) scores. Specifically, a low mental HRQoL score was more frequently found among men reporting discrimination from parents, those who were bothered by treatment side-effects, and those who had experienced sexual dysfunction since starting anti-HIV treatment.

Aware of the increase in sexual risk-taking since the late 1990s amongst gay men, investigators from 102 HIV outpatient clinics in France sought to study the influence of lifestyle characteristics and health-related quality of life on risky sex with casual partners in a representative sample of HIV-infected gay and bisexual men.

In 2003, a total of 1117 gay and bisexual men participated in a survey that included a face-to-face questionnaire featuring 398 questions dealing with all aspects of their daily life, the socio-economic conditions in which they lived, their sexual behaviour in the previous twelve months, and their alcohol and drug use in the previous twelve months. A self-completed HRQoL questionnaire (SF-36) assessed four areas of physical (physical function, bodily pain, general health perception, and physical-related role limitation) and mental (social functioning, emotional-related role limitation, general mental health, and vitality) functioning.

Risky sex was defined as reporting at least one occasion of unprotected anal intercourse (UAI) with a casual partner in the previous twelve months. However, the investigators did not ask about, nor differentiate between, partners who were known to be HIV-positive, and those of unknown or HIV-negative status. Binge-drinking was defined as having at least six drinks of alcohol in one occasion at least once a month.

Of the 1117 gay and bisexual men who participated in the study, 965 reported having sexual activity in the previous twelve months: 399 (35.7%) had sex with casual partners only and 301 (26.9%) had sex with both steady and casual partners. Of the 700 who had sex with at least one casual partner in the past twelve months, 607 completed the SF-36 questionnaire. There was no difference in demographics or health markers between those who did and did not complete the questionnaire.

A total of 121 (20%) reported engaging in UAI with casual partners, with a median of ten partners in the previous twelve months. The most common method of meeting partners was through the internet (31%), although 20% met their casual sexual partners through social or workplace settings. Binge-drinking was reported by 13%, and 23% had used mild tranquillisers in the previous twelve months. A very high number were assessed as having a poor health-related quality of life: 68% had a poor mental HRQoL and 73% had a poor physical HRQoL.

In univariate analysis, the following factors were associated with sexual risk-taking:

• More than 15 sexual partners in the previous twelve months (p>0.001).
• Use of internet, phone, saunas, backrooms, or sex clubs (p>0.001).
• Trading sex for money (p=0.003).
• Use of poppers (p=0.001).
• Occasional or daily use of cannabis (p=0.025).
• Use of anxiolytics (mild tranquillisers) (p=0.009).
• Binge-drinking (p=0.005).
• Poor mental HRQoL (p>0.001).

In contrast, socio-demographic factors, having a steady partner, reporting bisexuality, CD4 count, viral load, anti-HIV treatment history, and depression and anxiety scores were not associated with risky sex.

In multivariate analysis, more than 15 sexual partners in the previous twelve months (Adjusted Odds Ratio, 4.9; 95% CI, 2.8-8.4), finding partners through the internet (AOR, 2.0; 95% CI, 1.3-3.2) and poor mental HRQoL (AOR, 2.7; 95% CI, 1.5-4.6) remained significant risk factors

Unlike physical HRQoL, a poor mental HRQoL was found to be independently associated with sexual risk-taking even after multiple adjustment for number of partners, use of internet/phone network to meet partners, binge-drinking, and anxiolytics use. Poor mental health-related QoL was more frequently found among individuals reporting discrimination from parents (AOR 2.0; 95% CI, 1.1-4.0), those who found treatment side-effects disturbing (AOR 2.3-7.8) and those who experienced sexual dysfunction since treatment initiation (AOR 3.2, 95% CI, 1.7-9.1).

The investigators conclude that risky sexual behaviour with casual partners remains frequent among gay men. In addition to other well-known factors, sexual risk-taking appears to be related to poor mental HRQoL, and they strongly suggest that identification of factors that may address and ameliorate poor mental HRQoL of HIV-positive gay men require further investigation.