Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997–2015

Abstract

Community-wide awareness that ART provides protection against HIV has the potential to increase perceived safety and thereby increase condomless anal sex among men who have sex with men (MSM). Furthermore, reductions in condom use can increase exposure to sexually transmitted infections, which in turn can reduce the protective effects of ART on HIV transmission. The current study extends previous community-based behavioral surveillance research on beliefs regarding use of ART for HIV prevention and sexual practices among MSM. Anonymous cross-sectional community surveys were collected from 1831 men at the same Gay pride event in Atlanta, GA four times over nearly two decades; 1997, 2005–2006 (the 2006 survey over-sampled African Americans to diversify the study), and 2015. Results indicate clear and consistent trends of increasing beliefs that HIV treatments reduce HIV transmission risks, reflecting the dissemination of HIV prevention research findings. Changes in treatment beliefs coincide with increased rates of condomless anal intercourse. Increased beliefs that treatments prevent HIV and increased condomless anal sex were observed for both HIV positive men and men who had not tested HIV positive. Results illustrate the emergence of an era where ART is the focus of HIV prevention and community-held beliefs and behaviors regarding definitions of risk create a new and potentially problematic environment for HIV transmission.

HIV Prioritization and Risk Perception Among an Online Sample of Men Who Have Sex With Men in the United States

“…Underestimation of HIV risk has been reported as a significant predictor of both CAS and underutilization of HIV testing ( Golub & Gamarel, 2013 ; Stephenson, White, Darbes, Hoff, & Sullivan, 2015 ; White & Stephenson, 2016 ). HIV risk perception, particularly among young MSM, may be declining, partly due to “treatment optimism,” the awareness that antiretroviral treatments are highly effective in reducing HIV viremia ( Huebner, Rebchook, & Kegeles, 2004 ), along with the introduction of pre-exposure prophylaxis (PrEP), the use of antiretroviral medications among HIV to lower risk of HIV infection ( Chen, 2013 ; Kalichman et al, 2017 ). Studies have identified increases in condomless sex and higher rates of sexually transmitted infection among PrEP users, suggesting a potential association between prevention optimism and risk compensation related to PrEP ( Holt & Murphy, 2017 ; Traeger et al, 2018 ).…”

High-risk behaviors and their association with awareness of HIV status among participants of a large-scale prevention intervention in Athens, Greece

“…In our study, although HIV-positive females who were aware of their serostatus were more likely to report condom use by their male partners at their first visit, their sexual behavior did not change throughout Aristotle. This could be explained perhaps by the fact that PWID who were informed of their infection and initiated antiretroviral treatment developed a perception of safety due to treatment receipt and thereby increased condomless sex [51,52] despite counseling. Generally, condom use is remarkably low in stable relationships as opposed in commercial or casual sexual encounters, where is typically high [53,54].…”

Sexual risk taking and the HIV care continuum in an online sample of men who have sex with men

“…Previous research has found that 30.2% of HIV transmissions per year are attributable to undiagnosed individuals living with HIV (Skarbinski, et al, 2015). Importantly, among a community-based sample of MSM, a recent study found that an increased belief that HIV treatment reduces transmission risk coincided with increased rates of CAS (Kalichman et al, 2017). In an age when ART is at the center of HIV prevention, such findings suggest a potentially problematic belief in treatment optimism and perceived lower infectivity among those who may not be virally suppressed.…”