A survey spanning 19 years of participants at a gay pride event in the US notes a consistent increase in the occurrence of condomless anal sex among men, as well as a rise in how many sex partners they have. Condomless receptive anal sex among HIV uninfected men has doubled, while insertive condomless anal sex has more than tripled among HIV-positive men. The findings show that, although antiretroviral therapies (ART) have revolutionized the treatment and prevention of HIV infections, knowing that they have ART as a protective back-up against contracting or transmitting the disease makes people complacent. This complacency can lead to increased risks when it comes to sex and their health, says study leader Seth Kalichman of the University of Connecticut in an article in Springer's journal Archives of Sexual Behavior.
Trials have shown that early treatment with ART prevents HIV transmission. This shifted the focus of HIV prevention campaigns away from condom use as a form of protection toward detecting and treating those already infected. Despite these efforts there have not yet been significant reductions in new HIV infections in major cities, for instance. In addition, HIV infections remain stable or are rising among gay men in countries that have scaled-up HIV testing programs and access to ART.
Kalichman and his team analyzed surveys conducted in 1997, 2005, 2006, and 2015 at the Atlanta Gay Pride Festival. Through self-administered surveys 1,831 gay men provided anonymous information about their substance use, sexual behavior, beliefs about HIV treatment, and how they perceive sexual risks in relation to the HIV treatment status of potential sex partners.
Among uninfected men and those who did not know their HIV status, condomless anal sex increased from 43 percent in 1997 to 61 percent in 2015. The number of those having multiple sex partners also rose from9 percent in 1997 to 33 percent in 2015. This pattern is also reflected among HIV-positive men. Condomless anal sex increased from 25 percent in 1997 to 67 percent in 2015. In 1997 only 9 percent of men in this group reported having had unprotected intercourse with two or more partners in the six months before the survey. By 2015 this figure rose to 52 percent. In 1997 condoms were used about eight out of ten times (82 percent) when HIV-positive men had intercourse, but it dropped by 2015 to less than one in two (47 percent) instances. These shifts in behavior create increased risks for sexually transmitted infections, which in turn can increase risks for HIV transmission.
HIV-positive men as well as those who had not tested positive held increased beliefs reflecting public health messages that ART prevents HIV and therefore make condomless anal sex safe. Also consistent with public health messaging, they believed their risk of contracting HIV to be much lower when their partner had an undetectable blood plasma viral load.
"Treatment-related behavioral beliefs in this study paralleled a resurgence in condomless anal sex among men who have sex with men measured over nearly two decades," explains Kalichman. "The current study adds to the mounting evidence that substantial changes have occurred in community-held beliefs that condomless anal sex is safer in the era of HIV treatment as prevention."
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Seth C. Kalichman et al, Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997–2015, Archives of Sexual Behavior (2017). DOI: 10.1007/s10508-016-0934-9