Skip to main content
PMC home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2003 Feb;79(1):7–10. doi: 10.1136/sti.79.1.7

Is use of antiretroviral therapy among homosexual men associated with increased risk of transmission of HIV infection?

J Stephenson 1, J Imrie 1, M Davis 1, C Mercer 1, S Black 1, A Copas 1, G Hart 1, O Davidson 1, I Williams 1
PMCID: PMC1744584  PMID: 12576605

Abstract

Background/objective: There is concern that use of highly active antiretroviral therapy (HAART) may be linked to increased sexual risk behaviour among homosexual men. We investigated sexual risk behaviour in HIV positive homosexual men and the relation between use of HAART and risk of HIV transmission.

Methods: A cross sectional study of 420 HIV positive homosexual men attending a London outpatient clinic. Individual data were collected from computer assisted self interview, STI screening, and clinical and laboratory databases.

Results: Among all men, sexual behaviour associated with a high risk of HIV transmission was commonly reported. The most frequently reported type of partnership was casual partners only, and 22% reported unprotected anal intercourse with one or more new partners in the past month. Analysis of crude data showed that men on HAART had fewer sexual partners (median 9 versus 20, p=0.28), less unprotected anal intercourse (for example, 36% versus 27% had insertive unprotected anal intercourse with a new partner in the past year, p=0.03) and fewer acute sexually transmitted infections (33% versus 19%, p=0.004 in the past 12 months) than men not on HAART. Self assessed health status was similar between the two groups: 72% on HAART and 75% not on HAART rated their health as very or fairly good, (p=0.55). In multivariate analysis, differences in sexual risk behaviour between men on HAART and men not on HAART were attenuated by adjustment for age, time since HIV infection. CD4 count and self assessed health status.

Conclusion: HIV positive homosexual men attending a London outpatient clinic commonly reported sexual behaviour with a high risk of HIV transmission. However, behavioural and clinical risk factors for HIV transmission were consistently lower in men on HAART than men not on HAART. Although use of HAART by homosexual men with generally good health is not associated with higher risk behaviours, effective risk reduction interventions targeting known HIV positive homosexual men are still urgently needed.

Full Text

The Full Text of this article is available as a PDF (104.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Detels R., Muñoz A., McFarlane G., Kingsley L. A., Margolick J. B., Giorgi J., Schrager L. K., Phair J. P. Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Study Investigators. JAMA. 1998 Nov 4;280(17):1497–1503. doi: 10.1001/jama.280.17.1497. [DOI] [PubMed] [Google Scholar]
  2. Dilley J. W., Woods W. J., McFarland W. Are advances in treatment changing views about high-risk sex? N Engl J Med. 1997 Aug 14;337(7):501–502. doi: 10.1056/NEJM199708143370715. [DOI] [PubMed] [Google Scholar]
  3. Dodds J. P., Nardone A., Mercey D. E., Johnson A. M. Increase in high risk sexual behaviour among homosexual men, London 1996-8: cross sectional, questionnaire study. BMJ. 2000 Jun 3;320(7248):1510–1511. doi: 10.1136/bmj.320.7248.1510. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dukers N. H., Goudsmit J., de Wit J. B., Prins M., Weverling G. J., Coutinho R. A. Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS. 2001 Feb 16;15(3):369–378. doi: 10.1097/00002030-200102160-00010. [DOI] [PubMed] [Google Scholar]
  5. Grosskurth H., Mosha F., Todd J., Mwijarubi E., Klokke A., Senkoro K., Mayaud P., Changalucha J., Nicoll A., ka-Gina G. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet. 1995 Aug 26;346(8974):530–536. doi: 10.1016/s0140-6736(95)91380-7. [DOI] [PubMed] [Google Scholar]
  6. Imrie J., Stephenson J. M., Cowan F. M., Wanigaratne S., Billington A. J., Copas A. J., French L., French P. D., Johnson A. M., Behavioural Intervention in Gay Men Project Study Group A cognitive behavioural intervention to reduce sexually transmitted infections among gay men: randomised trial. BMJ. 2001 Jun 16;322(7300):1451–1456. doi: 10.1136/bmj.322.7300.1451. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Kelly J. A., Hoffman R. G., Rompa D., Gray M. Protease inhibitor combination therapies and perceptions of gay men regarding AIDS severity and the need to maintain safer sex. AIDS. 1998 Jul 9;12(10):F91–F95. doi: 10.1097/00002030-199810000-00001. [DOI] [PubMed] [Google Scholar]
  8. King-Spooner S. HIV prevention and the positive population. Int J STD AIDS. 1999 Mar;10(3):141–150. doi: 10.1258/0956462991913763. [DOI] [PubMed] [Google Scholar]
  9. Miller M., Meyer L., Boufassa F., Persoz A., Sarr A., Robain M., Spira A. Sexual behavior changes and protease inhibitor therapy. SEROCO Study Group. AIDS. 2000 Mar 10;14(4):F33–F39. doi: 10.1097/00002030-200003100-00001. [DOI] [PubMed] [Google Scholar]
  10. Palella F. J., Jr, Delaney K. M., Moorman A. C., Loveless M. O., Fuhrer J., Satten G. A., Aschman D. J., Holmberg S. D. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998 Mar 26;338(13):853–860. doi: 10.1056/NEJM199803263381301. [DOI] [PubMed] [Google Scholar]
  11. Quinn T. C., Wawer M. J., Sewankambo N., Serwadda D., Li C., Wabwire-Mangen F., Meehan M. O., Lutalo T., Gray R. H. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med. 2000 Mar 30;342(13):921–929. doi: 10.1056/NEJM200003303421303. [DOI] [PubMed] [Google Scholar]
  12. Scheer S., Chu P. L., Klausner J. D., Katz M. H., Schwarcz S. K. Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS. Lancet. 2001 Feb 10;357(9254):432–435. doi: 10.1016/S0140-6736(00)04007-1. [DOI] [PubMed] [Google Scholar]
  13. Van de Ven P., Kippax S., Knox S., Prestage G., Crawford J. HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne. AIDS. 1999 Nov 12;13(16):2289–2294. doi: 10.1097/00002030-199911120-00011. [DOI] [PubMed] [Google Scholar]
  14. Young H., Moyes A., McKenna J. G., McMillan A. Rectal gonorrhoea and unsafe sex. Lancet. 1991 Apr 6;337(8745):853–853. doi: 10.1016/0140-6736(91)92561-f. [DOI] [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES