A belief that HAART reduces the risk of passing on HIV increases the chance that HIV-positive drug users will have unprotected sex, according to a US study published in the September 5th edition of AIDS. Investigators also established that “safer injecting fatigue” increased the chances that HIV-infected injecting drug users would share syringes and needles.
Earlier studies have produced conflicting evidence about whether optimism about the success of anti-HIV treatments has led to an increase in unprotected sex amongst HIV-positive gay men (see links below). The impact of HAART on the attitudes of injecting drug users towards unprotected sex and drug use has, however, received little attention.
Accordingly, investigators involved in the AIDS Link to Intravenous Experiences (ALIVE) Study, a longitudinal study involving nearly 3,000 injecting drug users in Baltimore, designed a study to see if a belief that anti-HIV treatments made a person with HIV less infectious, and fatigue with safer sex and safer injecting, led to more unprotected sex and drug taking.
The investigators recruited 593 HIV infected injecting drug users and 338 HIV-negative drug users to the study between December 2000 and July 2001. Study participants were asked to complete a 27-item questionnaire to assess attitudes towards HIV treatments and sexual and drug taking risk behaviour. The questionnaire also included items designed to assess fatigue with safer sex and injecting. The questions relating to sexual risk were based on those previously used by the Multi-centre AIDS Cohort Study of gay and bisexual men.
Over 61% of HIV-positive injecting drug users reported unprotected sex and 48% reported sharing injecting equipment, as did similar proportions of HIV-negative individuals.
HIV-positive drug users were significantly more likely than uninfected injecting drug users to believe that treatments made the transmission of HIV during unprotected sex less likely (p=0.009). They were also significantly more likely to believe that treatments meant that they were less likely to pass on HIV if sharing needles (p=0.003).
In addition, HIV-infected drug users were also significantly more likely than their uninfected peers to report safer sex fatigue (p=0.02) and safer injecting fatigue (p=0.006).
Safer injecting fatigue was independently associated with sharing needles and syringes amongst HIV-positive drug users (adjusted odds ratio [AOR]) 6.55, 95% CI, 1.69 – 25.39), and amongst HIV-negative injecting drug users both sharing injecting equipment and unprotected sex were independently associated with unsafe injecting and sex (AOR 3.12 and 2.33 respectively).
The investigators comment, “the results from this study indicate that the use and knowledge of HAART appears to have had an impact on IDU’s perceptions of HIV transmissibility among HIV-infected drug users. Further, safer injection and safer sex fatigue, which were associated with high-risk sexual and injection behaviours, were common in this drug injecting population.”
They add that their data support concerns that “high-risk populations have become complacent about their behaviours that reduce the risk of transmission of HIV”.
Interventions are needed to educate high-risk populations about the continuing need for safer sex and injecting regardless of effective HIV treatments conclude the investigators.
Further information on this website
No link found between undetectable HIV viral load and unsafe sex in Swiss cohort - news story
Gay men realistic, not optimistic about HAART says study - news story
Safer sex fatigue and HAART optimism explain rise in US bareback sex - news story
The dark side of HAART optimism? More unsafe sex and poor adherence - news story
Tun W et al. Attitudes toward HIV treatments influence unsafe sexual and injection practices among injecting drug users. AIDS 17: 1953 – 1962, 2003.