Belief in a Cure for HIV Infection Associated with Greater HIV Risk Behaviour among HIV Positive Men Who Have Sex with Men
Misovich, Stephen J., Fisher, Jeffrey D., Fisher, William A., The Canadian Journal of Human Sexuality
ABSTRACT: The increasingly prevalent belief that HIV infection can now be cured through highly active antiretroviral therapy (HAART) regimens may contribute to elevated levels of HIV risk behaviours among HIV seropositive individuals. This study assessed the extent to which a sample of HIV seropositive men who have sex with men believed that HIV is now, or will soon, be curable. The association between respondents' degree of agreement with this belief, their levels of HIV-risk behaviours (including unprotected insertive and receptive anal sex, and unprotected oral sex to ejaculation), and behavioural intentions regarding performing these behaviours, was assessed. Analyses indicated that belief in a cure for HIV was significantly, positively related to levels of risky behaviour, and significantly positively related to levels of behavioural intentions to perform HIV risk behaviours in the future. As advanced treatments for HIV become more widespread, the potential exists for individuals to decide that HIV preventive behaviours may no longer be necessary. This new source of HIV risk must be addressed through interventions designed to increase HIV+ individuals' awareness of the continuing dangers of unprotected sexual activity.
Key words: HIV prevention HIV risk HIV seropositives Men who have sex with men HIV beliefs
To date, the majority of HIV prevention programs have focused on identifying the factors associated with HIV risk behaviour, and reducing HIV risk behaviours, among individuals who are either HIV negative or of unknown HIV status (for reviews, see Choi & Coates, 1994; Reppucci, Woolard, & Fried, 1999). More recently, increasing emphasis has been placed on strategies for reducing the risk behaviour of individuals who are aware that they are HIV positive (Fisher, Kimble, Misovich, & Weinstein, 1998; Fisher, Misovich, Kimble, & Weinstein, 1999; Heckman, Kelly, & Somlai, 1998). Because HIV is transmitted primarily through unprotected sexual intercourse or needle-sharing with a seropositive person (Centers for Disease Control, 1999), focusing on risk reduction among individuals known to be HIV infected should be an effective strategy to reduce the spread of HIV.
HIV continues to pose a serious health threat. Although the rate of deaths from HIV infection in North America decreased significantly during the late 1990s, this trend has levelled off, and decreases have not been observed among all racial and ethnic groups.
In addition, the rate of new HIV infections does not appear to be diminishing substantially, indicating continued transmission of HIV from seropositive individuals to their sexual partners or through needle-sharing (Centers for Disease Control, 1999). Finally, while new HIV treatments may reduce the viral load in the bloodstream, it is not yet certain that individuals who respond positively to treatments become correspondingly less infective for others (CDC, 1999). This is in part because viral load in the bloodstream does not always correspond to levels of the virus in sexual fluids (e.g., Vernazza et al., 1997). Discovering factors that associated with HIV risk behaviours by HIV positive individuals is therefore an essential component of effective HIV risk reduction campaigns (e.g., NIH Consensus Statement, 1997).
For the most part, individuals tend to reduce their HIV risk behaviours substantially among discovering that they are infected with HIV (cf. Kalichman, Kelly, & Rompa, 1997). However, some HIV seropositive persons continue to engage in HIV risk behaviours after becoming aware of their HIV status. Many studies document significant ongoing HIV risk behaviour among HIV + men who have sex with men (MSM; e.g., Darrow, Webster, Kurtz, Buckley, Patel, & Stempel, 1998; Fisher et al., 1998, 1999; Heckman et al., 1998; Kalichman, 1996; Kalichman et al., 1997; Posner & Marks, 1996). For example, Kalichman et al. …