For the first time in Canada, a study of gay and bisexual men has drawn a link between beliefs about HIV/AIDS medication and risky sexual activity.
Among the findings, the study says HIV-positive men who believe drug treatments make it more difficult to transmit the virus were six times more likely to engage in unprotected anal sex with a casual partner.
The study, led by Trevor Hart, a clinical psychologist and professor at York University, echoes some earlier studies done in the US and Australia. The researchers analyzed the relationship between beliefs about highly active antiretroviral therapy (HAART), a drug cocktail in use since 1996, and sexual behaviour. In addition to the Canadian angle, Hart specifically examined men engaging in unprotected sex with partners of opposite or unknown HIV status. He also differentiated between topping and bottoming — accepting as fact, unlike many researchers, that unprotected bottoming is riskier than unprotected topping.
The preliminary results (more analysis is planned for the months ahead) were presented at the International AIDS Conference last month and confirm the study’s hypothesis: “People’s beliefs about HIV medications would be associated with the extent that they engage in risky sex.”
“Common between HIV-negative and HIV-positive men… it was really the transmissibility belief,” Hart explains. “If you believed that it is harder to get or to give HIV because of the medication, you are much more likely to have engaged in unprotected sex.”
Not only that, but the men often took the sexual role more likely to spread HIV. “For HIV-positive men, it was much more associated with insertive unprotected sex, topping. HIV-negative men were much more associated with receptive sex, being the bottom.”
In an age of condom fatigue and barebacking, the study does not attempt to explain the findings.
“We can’t say whether the beliefs cause the behaviour or the behaviour led you to have certain beliefs, or if… there’s a two-way process.”
The survey of 554 men took place at Toronto’s Pride in 2005. Hart says understanding the reasons behind the unprotected sex would involve drilling down through another survey over a longer period, perhaps six months.
What does it mean? Hart says that people have some knowledge of HIV meds and their benefits (eg, decreased viral load), but are defeating those benefits by increasing their risk since blood and semen can have different viral loads.
“It’s important that we don’t take a little bit of knowledge and go and engage in more risky sex,” says Hart.
Hart says health professionals should remind their patients, both HIV-positive and -negative, that HAART and other medications cannot totally prevent HIV transmission and that condoms are still necessary.