Changing patterns of sexual behaviour in the era of highly active antiretroviral therapy

Abstract

The review reminds us of the complexity of human and sexual behaviour. Among gay men, sexual behaviour in the era of highly active antiretroviral therapy has been characterized by risk reduction and stabilization as well as increasing risk. These changing patterns provide a new challenge as well as new opportunities for HIV prevention.

Increase in HIV diagnoses among men who have sex with men in New Zealand from a stable low period

“…36 In this respect, the rise in HIV diagnoses in 2001-05 and the elevated plateau in 2006-08, need to be interpreted in the context of coincident increases in HIV diagnoses among MSM communities throughout the world, 7-13 factors such as highly active antiretroviral therapy, 12,37 internet dating 12,37 and the previously low penetration of HIV into New Zealand MSM communities described above.…”

Recently acquired HIV infection in men who have sex with men (MSM) in France, 2003-2008

“…In the early 1990s, MSM in most countries adopted strategies for reducing the risk of HIV transmission. But since 1996, an increase in sexual risk practices has been observed in North America, Australia and most Western European countries [1][2][3][4]. An increase in frequency of unprotected anal intercourse (UAI) was observed for the first time in France in 2000, through the "Enquête Presse Gay" (EPG survey), a behavioural survey that has been conducted since 1985 among readers of the gay press in France (increase of UAI in the last 12 months with a casual partner from 19% to 26% between 1997 and 2000) [5].…”

Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys

“…We think the diminished threat of HIV (and greater optimism about avoiding transmission) as a result of treatments has contributed to the rise in condomless sex, although it is by no means the only explanation. 16,34,39 The increase in condomless sex between casual male partners appears to be the main reason that HIV notifications have increased among GBM in Australia. 11,13 This is despite the increase in HIV treatment and undetectable viral load, the decline in partner numbers, the relatively high level of ongoing condom use and the increase in use of risk-reduction strategies such as serosorting during condomless anal sex.…”

“…13,14 This differs from other jurisdictions (such as the United States) in which sex between regular or steady male partners has been reported as the main source of infections. 15 As in other high income countries, 16,17 since the late 1990s, Australia has seen a gradual but steady increase in the proportion of GBM reporting condomless anal intercourse with casual partners, 18,19 and the number of annual HIV diagnoses has also increased, returning to levels not seen since the early 1990s. 11 In 1999, there were 718 new HIV diagnoses in Australia, 73% of which occurred as a result of homosexual sex.…”