Research That Matters (January 17 - 20, 2008)

Background and Purpose: Gay and bisexual men (GBM) continue to account for the largest percentage (49%) of people diagnosed with HIV. Research is needed to improve our understanding of the factors that are associated with ongoing risk in this population. This study sought to analyze the effects of optimism regarding HIV treatment upon risky sexual behavior among HIV-positive GBM (HGBM). The aims of the study were 1)to create and validate a treatment optimism scale, and 2) to examine the relationship between participant demographics, HIV treatment history and psychosocial factors upon treatment optimism and sexual risk among HGBM.

Methods: This study included the development of a Treatment Optimism scale for HGBM using baseline data drawn from participants of an intervention designed to reduce sexual risk among HGBM who were currently on HIV treatment. Quota sampling was used to ensure a racially diverse sample (74% non-Caucasian). A pre-intervention questionnaire included items regarding optimistic beliefs about HIV treatment, demographics, psychosocial factors, HIV treatment history and sexual risk defined as serodiscordant unprotected anal intercourse, (SDUAI). A Factor Analysis of the treatment optimism items resulted in three separate scales: Susceptibility (the belief that HIV is less transmissible while on treatment, á = .86), Severity (the belief that HIV is a less severe condition, á = .84) and Condom Motivation (a belief that one is less motivated to use condoms, á = .71). These scales were analyzed for association with SDUAI as well as three domains of independent variables: demographics (age, race, education, income, city), psychosocial factors (depression/anxiety, alcohol/drug use, comfort with sexual orientation), and HIV treatment history (time since diagnoses, time on treatment, impact of HIV on daily life and viral load).

Results: Among HGBM, an increased belief in the diminished transmissibility of HIV because of treatment (Susceptibility) was associated with SDUAI (O.R. 1.02, 95% CI 1.00, 1.04, p < .01). Demographic factors, treatment history and psychosocial factors were not mediating this association. A decrease in Condom Motivation, and a belief that HIV is less severe now that we have treatment (Severity) were not significantly associated with SDUAI.

Conclusions and Implications: Beliefs that HIV is less transmissible as a result of being on HIV treatment are associated with increased SDUAI among this population and these beliefs are not mediated by demographics, HIV treatment history or psychosocial factors. Social workers need to be aware that beliefs that HIV is less transmissible may be an important sexual risk factor for some HGBM engaging in SDUAI. Implications for policy include the need to provide current, relevant and accessible information about HIV transmissibility while on treatment to HIV-positive GBM and their providers. Implications for research include the need to analyze other factors associated with sexual risk among HGBM. Research is needed to understand the accuracy and accessibility of venues HGBM utilize to get information about risks of HIV transmission while on treatment. Research is needed to evaluate the capacity of social workers to provide useful and relevant HIV prevention interventions to this at-risk population.