Confidence in Drugs Linked to Unsafe Sex

ATLANTA—A survey of homosexual men in California suggests that the more strongly a man believes in the effectiveness of HIV drug regimens to prolong life and prevent transmission to partners, the more likely he may be to engage in unsafe sex.

“We’ve heard rumors about increases in unprotected sex, but this is the first actual data that show increases in risky behavior, such as having more sexual partners, as a result of this sort of optimism,” Sheila Murphy, a psychologist at the University of Southern California and one of the study authors, said at the National HIV Prevention Conference.

The researchers surveyed 410 homosexual men in West Hollywood, California, who said they were aware of the use of protease inhibitor combination regimens in suppressing HIV infection. The men were then asked about their confidence in the ability of the protease inhibitors to control HIV infection.

Of the 346 men who were HIV negative, those who believed the drugs were effective said they used condoms about 74% of the time during anal sex. In contrast, those who had less confidence in the drugs said they used condoms 85% of the time.

Similarly, of the 64 men who were HIV positive, those who were optimistic about the drugs said they used condoms 66% of the time vs 85% condom use among those who were less confident.

Furthermore, fewer of the optimistic men said they were monogamous. Among HIV-infected respondents, 35% of the optimists said they had only one partner vs 43% of the less optimistic men. Among the HIV-negative men surveyed, 50% of the more optimistic men vs 59% of the less optimistic men said they were in a monogamous relationship.

An increase in unsafe sex practices, whether due to this optimism about drug treatments or other causes, appears to be behind a recent resurgence in sexually transmitted disease among homosexual men in King County, Washington. Hunter H. Handsfield, MD, of Public Health-Seattle, reported that cases of infectious syphilis rose from 0 in 1996 to 46 in the first 6 months of 1999. The proportion of cases in homosexual men increased from 21% in 1997 to 85% in 1998/1999. Of 63 homosexual men with syphilis who gave data on sex partners, 50 (79%) reported at least one anonymous partner.