Men May Engage in Riskier Sex in the Era of HIV Treatment as Prevention

Survey findings that indicate a rise in condomless sex among men who have sex with men (MSM) suggest that access to revolutionary antiretroviral therapies (ART) has caused complacency when practicing safe sex, according to a study.

In a study published in the Archives of Sexual Behavior, investigators analyzed surveys conducted at the Atlanta Gay Pride Festival in 1997, 2005, 2006, and 2015. There were 1831 MSMs who partook in the survey, which included questions regarding sexual behavior, beliefs about HIV treatment, substance use, and how they perceived sexual risks related to HIV treatment status of potential sex partners.

The results of the analysis showed that condomless anal sex increased from 43% in 1997 to 61% in 2015 among uninfected men and those who were unaware of their HIV status. Individuals who responded to having multiple sex partners increased from 9% in 1997 to 33% in 2015. The pattern was also reflected among HIV-positive men.

There was an increase in condomless anal sex from 25% in 1997 to 67% in 2015. In 1997, only 9% of men in this group reportedly had unprotected sex with 2 or more partners 6 months prior to the survey. But by 2015, this number increased substantially to 52%.

Condoms were used approximately 8 of 10 times (82%) in 1997 when HIV-positive men had intercourse, however, by 2015 it dropped to less than 1 of 2 times (47%).

According to the authors, these shifts in behavior increased the risk for sexually transmitted infections, which can result in the increased risk of HIV transmission.

The findings suggest that in the era of new HIV treatments, HIV-positive men, as well as those who have not tested positive, have increasing beliefs that ART prevents HIV, therefore making condomless anal sex safe. Furthermore, they believed the risk of contracting HIV to be significantly lower when their partner had an undetectable blood plasma viral load.

“Treatment-related behavioral beliefs in this study paralleled a resurgence in condomless anal sex among men who have sex with men measured over nearly 2 decades,” said author Seth Kalichman. “The current study adds to the mounting evidence that substantial changes have occurred in community-held beliefs that condomless anal sex is safer in the era of HIV treatment as prevention.”