Beliefs About Transmission Risk and Vulnerability, Treatment Adherence and Sexual Risk Behavior Among a Sample of HIV-Positive MSM

Optimistic beliefs about HIV transmission risk and STD vulnerability that are generated by advances in HIV treatment can influence motivation to practice safer sex. The current study's authors sought to understand the relationships between these beliefs and various types of sexual risk behavior. In addition, the researchers hoped to determine the association between treatment adherence and sexual risk behaviors.

The study's subjects were 842 HIV-positive men who have sex with men (MSM) who were on treatment; data on the men were collected and examined. Eleven questions were asked to measure beliefs regarding HIV transmission risk and vulnerability to other infections or negative health outcomes. The main outcomes were concordant and discordant unprotected anal sex (UAS) with main and non-main male partners.

The results indicated that 34 percent of the MSM reported concordant UAS and 41 percent reported discordant UAS in the previous three months. Discordant insertive UAS was reported by 26 percent. At least one belief item remained statistically significant in all multivariate logistic regression models predicting sexual risk behaviors. Across partner type and serostatus, different patterns of associations between beliefs and sexual risk were observed.

"Compared to transmission risk beliefs, more vulnerability beliefs were associated with sexual risk," the authors wrote. Having missed at least one treatment dose in the preceding month was associated with concordant and discordant sexual risk behavior with non-main partners, while intentionally missing a dose was associated with only discordant risk with non-main partners. The potential interaction between beliefs and adherence was explored by post hoc moderator analysis. The belief that a low viral load lowers HIV transmission risk was found to be positively associated with discordant sex with non-main partners only among those who intentionally missed a dose.

"These results underscore the complex relationship between HIV transmission risk and vulnerability beliefs and sexual behavior with different types of partners," the authors concluded. "Prevention programs should carefully consider how to craft and tailor messages about medical advances while at the same time reinforcing the need for continued sexual safety."