Correlates of Unprotected Anal Intercourse in HIV Positive Men Attending an HIV/AIDS Clinic in Sydney§

Abstract

We examined the impact of cognitive and biomedical variables on unprotected anal intercourse between HIV-1 infected men and casual sexual partners in a Sydney-based cohort. Participants answered questionnaires examining insertive and receptive intercourse with and without ejaculation. They completed a modified optimism-scepticism scale, a sexual beliefs scale and a clinical/demographics questionnaire. CD4 count, blood and semen VL were assessed. 43 of 109 reported anal intercourse with HIV+ partners, 33 with HIV- partners and 38 with partners of unknown status. With HIV+ partners past sexually transmittable infections were associated with receptive intercourse without ejaculation (p = 0.03) and insertive intercourse without ejaculation (p = 0.06) while sexual beliefs were associated with insertive intercourse without ejaculation (p = 0.038), receptive intercourse with ejaculation (p = 0.016) and insertive intercourse with ejaculation (p = 0.077). Sexual beliefs were found to have some association with unprotected receptive intercourse without ejaculation with HIV- partners (p = 0.071). With unknown serostatus partners, treatment-optimism (p = 0.026) had association with insertive intercourse with ejaculation while optimism (p = 0.002), sexual beliefs (p = 0.039) and recent VL (p = 0.059) had associations with insertive intercourse without ejaculation. Current STI had association with receptive intercourse with ejaculation with unknown status partners (p = 0.014). We found between-group differences in variables associated with different types of unprotected anal intercourse that may guide the development of prevention strategies.

Factors associated with unprotected anal intercourse between HIV-positive men and regular male partners in a Sydney cohort

“…In a recent study of UAI between HIV-positive men in this cohort and their casual male partners (HIV negative or unknown serostatus), we found that cognitive factors (treatment optimism and sexual beliefs) and biomedical factors (recent blood plasma HIV-RNA load [BPVL] and current sexually transmissible infection [STI]) were associated with different types of UAI. 6 Cognitive variables were predominately associated with UAI in that study. The current analysis was undertaken to determine whether similar variables predicted different types of UAI with regular partners in the same cohort.…”

Versatility and HIV Vulnerability: Investigating the Proportion of Australian Gay Men Having Both Insertive and Receptive Anal Intercourse

“…While a number of empirical papers have published data on rates of IAI and RAI separately [13–15], we found few that reported rates of versatility. Most of those we found were based on data from the 1980s and early 1990s and reported what were considered at the time to be high levels of versatility, including 31% among U.S. MSM [16], 40% among British gay men [17], and 61% and 43% in two studies among Dutch gay men [10].…”

Rectal Microbicide Development

“…Unfortunately, a significant proportion of RAI among MSM is unprotected (Begley et al 2008; Chen et al 2003) and contributes to the growing number of new infections among MSM (Beyrer et al 2010). More recent data have clearly identified at risk MSM in the Global South (Baral et al 2012; Beyrer et al 2012).…”