Implications of HIV treatment advances for behavioral research on AIDS: Protease inhibitors and new challenges in HIV secondary prevention.

Kelly, Jeffrey A.; Otto‐Salaj, Laura L.; Sikkema, Kathleen J.; Pinkerton, Steven D.; Bloom, Frederick R.

doi:10.1037/0278-6133.17.4.310

Cited by 101 publications

(62 citation statements)

References 57 publications

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“…[32][33][34][35] The current study found that self-identified barebackers had higher levels of HIV treatment optimism than MSM who did not identify as barebackers. Suarez and Miller have differentiated "rational" from "irrational" risk takers, asserting that some MSM consider risky sexual behavior to be "rational" insofar as they perceive benefits derived from unsafe sex outweigh the possible risk of contracting HIV.…”

Section: Discussionmentioning

confidence: 72%

Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men

et al. 2008

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Studies have found that between 14% and 46% of US men who have sex with men (MSM) consistently report "barebacking" behavior (i.e., intentional unprotected anal intercourse) with other men. This is of public health significance because MSM continue to constitute more than 50% of new HIV infections in the USA. Men who self-identify as barebackers may represent a different and unique subset of MSM with distinct HIV prevention needs. In 2007, 227 HIV seronegative MSM recruited through modified respondent-driven sampling completed an intervieweradministered survey which assessed barebacker identity (i.e., personally identifying with the barebacker scene), demographics, sexual risk behaviors, psychosocial variables, and drug/alcohol use. Bivariate and multivariable logistic regression procedures were used to examine predictors of barebacker identity in relation to HIV risk behavior. Overall, 31% of participants identified as a barebacker. In bivariate analyses, lower education (OR=1.76; 95% CI=0.99-3.13; pG0.05), a current drinking problem (OR=2.34, 95% CI=1.29-4.23; pG0.01), higher levels of HIV treatment optimism (OR=1.06; 95% CI= 1.01-1.12; pG0.05), meeting sexual partners at private sex parties (OR=2.47; 95% CI=1.28-4.74; pG0.01) or at bars/cubs (OR=1.97; 95% CI=1.10-3.52; pG0.05), and engaging in serodiscordant unprotected insertive anal sex (OR=3.42; 95% CI=1.27-9.21; pG0.01) significantly predicted barebacker identification compared to those with no barebacker identification. In a multivariable model, barebackers were more likely to screen in for alcohol abuse (adjusted OR=2.16; 95% CI=1.09-4.27; pG0.05) and engage in serodiscordant unprotected insertive anal sex (adjusted OR=3.17; 95% CI=1.09-9.20; pG0.05) compared to their non-barebacker counterparts. No significant differences were found in serodiscordant unprotected receptive anal sex between barebackers and nonbarebackers. These findings suggest that barebacker identity is related to intentional HIV sexual risk taking and alcohol abuse. Furthermore, strategic positioning (i.e., engaging in insertive rather than receptive sex) might be associated with barebacker identification and may indicate a harm-reduction strategy being used among some HIV-uninfected MSM to reduce their risk of becoming infected. Additional research is warranted to understand the social identity of barebacking among MSM in order to develop more nuanced prevention strategies.

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Section: Discussionmentioning

confidence: 72%

Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men

et al. 2008

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“…Such perceptions might serve to justify continued or relapse of HIV riskbehaviors as has been observed in some studies in the US and Europe (Elford et al 2002;Kelly et al 1998;Osmond et al 2007). The construction of HIV/AIDS knowledge and risk models is often dependent upon not only on what people know about the virus, but also on what they believe they know (Smith 2003;Vanable et al 2000).…”

Section: Introductionmentioning

confidence: 86%

Two-Year Follow-Up of Sexual Behavior Among HIV-Uninfected Household Members of Adults Taking Antiretroviral Therapy in Uganda: No Evidence of Disinhibition

et al. 2008

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This paper examines HIV risk behavior among HIV-uninfected adults living with people taking antiretroviral therapy (ART) in Uganda. A prospective cohort of 455 HIV-uninfected non-spousal household members of ART patients receiving home-based AIDS care was enrolled. Sexual behavior, HIV risk perceptions, AIDS-related anxiety, and the perception that AIDS is curable were assessed at baseline, 6, 12 and 24 months. Generalized linear mixture models were used to model risk behavior over time and to identify behavioral correlates. Overall, risky sex decreased from 29% at baseline to 15% at 24-months. Among women, risky sex decreased from 31% at baseline to 10% at 6 months and 15% at 24 months. Among men, risky sex decreased from 30% at baseline to 8% at 6 months and 13% at 24 months. Perceiving HIV/AIDS as curable and lower AIDS-related anxiety were independently associated with risky sex. No evidence of behavioral disinhibition was observed. Concerns regarding behavioral disinhibition should not slow down efforts to increase ART access in Africa.

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“…As HAART has increasingly become accessible across the developing world, the relationship between ART and sexual risk-taking behaviours has become more important. As ART significantly reduces a patient's viral load and leads to improvements in physical health and quality of life, studies from the developed world have suggested that ARTexperienced individuals may be more likely to resume sexual activity, including unsafe sex, as a result of 'treatment optimism' [1,5,37]. However, ART also reduces the infectiousness of individuals who receive therapy, which could prevent new infections and have important ramifications on the future course of the HIV epidemic [38].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for HIV transmission among heterosexual discordant couples in South India^*

et al. 2010

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ObjectiveTo assess the risk factors associated with heterosexual HIV transmission among South Indian discordant couples enrolled in clinical care. MethodsA nested matched case-control study of serodiscordant couples in which the HIV-infected partner (index case) was enrolled in care. Demographic and clinical characteristics, sexual behaviours, CD4 cell count and plasma HIV-1 RNA loads were measured at enrolment and longitudinally over 12 months of follow-up. The study included 70 cases who seroconverted during study follow-up and 167 matched controls who remained persistently serodiscordant. ResultsThe incidence of HIV infection among the initially seronegative partners was 6.52 per 100 personyears. Persistently discordant patients were more likely to have initiated highly active antiretroviral therapy (HAART) than patients in seroconverting relationships (62.9% vs. 42.9%) (P50.001). Patients in seroconverting relationships had significantly higher plasma viral loads (PVLs) than patients in discordant relationships at enrolment, at 6 months and at 12 months (Po0.05). Patients in seroconverting relationships were less likely to use condoms with their primary partners than patients in discordant relationships (Po0.05). Patients in relationships that seroconverted between 6 and 12 months were diagnosed more often with genital Herpes simplex than patients in discordant relationships (P50.001). In the univariate and multivariate logistic regression, the following variables were associated with seroconversion: PVL 4100 000 [odds ratio (OR): 1.82; 95% confidence interval (CI): 1.1-2.8], non-disclosure of HIV status (OR: 5.5; 95% CI: 4.3-6.2) and not using condoms (OR: 2.8; 95% CI: 2.4-3.6). ConclusionsCouples-based intervention models are crucial in preventing HIV transmission to seronegative spouses. Providing early treatment for sexually transmitted infections, HAART and enhancing condom use and disclosure could potentially decrease the risk of HIV transmission within Indian married couples. IntroductionAn increasing focus of HIV preventive strategies has been to move away from solely reducing the risk-taking behaviours of HIV-uninfected individuals to focusing on HIV-infected individuals who may continue to practice HIV risk-taking behaviours [1]. Studies from the developed and developing world have documented that a sizeable number of HIV-infected individuals continue to engage in unprotected sexual intercourse with HIV-serodiscordant partners [2][3][4][5][6]. Unprotected intercourse may be more common among HIV-infected individuals in steady or regular relationships than in casual or non-regular sexual *The first two authors contributed equally to this manuscript. [19]. The typical route of HIV transmission has been through unprotected heterosexual intercourse [20]; however, data about the incidence and risk factors associated with HIV transmission through heterosexual intercourse in India remains very limited [21]. The social construct of gender in India, which has evolved over many centuries, makes women highl...

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Implications of HIV treatment advances for behavioral research on AIDS: Protease inhibitors and new challenges in HIV secondary prevention.

Cited by 101 publications

References 57 publications

Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men

Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men

Two-Year Follow-Up of Sexual Behavior Among HIV-Uninfected Household Members of Adults Taking Antiretroviral Therapy in Uganda: No Evidence of Disinhibition

Risk factors for HIV transmission among heterosexual discordant couples in South India^*

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Implications of HIV treatment advances for behavioral research on AIDS: Protease inhibitors and new challenges in HIV secondary prevention.

Cited by 101 publications

References 57 publications

Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men

Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men

Two-Year Follow-Up of Sexual Behavior Among HIV-Uninfected Household Members of Adults Taking Antiretroviral Therapy in Uganda: No Evidence of Disinhibition

Risk factors for HIV transmission among heterosexual discordant couples in South India*

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Risk factors for HIV transmission among heterosexual discordant couples in South India^*