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Homosexual men change to risky sex when perceiving less threat of HIV/AIDS since availability of highly active antiretroviral therapy: a longitudinal study

Stolte, Ineke Ga; Dukers, Nicole HTMa; Geskus, Ronald Ba; Coutinho, Roel Aa,b; Wit, John BFdea,c

Epidemiology &: Social

Objective: To investigate longitudinally the association between highly active antiretroviral therapy (HAART)-related beliefs and the change from protected to unprotected anal intercourse with casual partners on an individual level.

Methods: The study population included 217 HIV-negative homosexual men participating in the Amsterdam Cohort Study from September 1999 to May 2002, including five data waves with a 6-month interval. The selection criteria were: being under 31 years of age, having had anal sex with casual partners in the preceding 6 months, and participating in at least two data waves. Information was collected on the individual change from protected to unprotected receptive anal intercourse (URAI) and unprotected insertive anal intercourse (UIAI) and the level of agreement with different HAART-related beliefs.

Results: The majority of men disagreed with the three treatment-belief factors that resulted from the principal component analysis: perceiving less HIV/AIDS threat since HAART, perceiving less need for safe sex since HAART, and perceiving high effectiveness of HAART in curing HIV/AIDS. Multivariate analyses revealed that the more men inclined to agree with the belief ‘perceiving less HIV/AIDS threat', the more likely they were to change to URAI (adjusted OR 1.60; 95% CI 1.16–2.22).

Conclusion: Homosexual men are quite realistic about the effectiveness of HAART, the continued need for condom use, and the HIV/AIDS threat since HAART. However, a tendency towards agreement with ‘perceiving less HIV/AIDS threat’ was found to predict an individuals’ change to URAI. This finding supports the hypothesis of a causal relationship between decreased HIV/AIDS threat since HAART and a change to URAI.

Author Information

From the aCluster of Infectious Diseases, HIV and STI Research, Municipal Health Service, Amsterdam, the Netherlands; bDepartment of Human Retrovirology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; and cDepartment of Social and Organizational Psychology, University of Utrecht, Utrecht, the Netherlands.

Correspondence to: Ineke G. Stolte, MSc (Health Sciences), Municipal Health Service Amsterdam, Cluster of Infectious Diseases, HIV and STI Research, Nieuwe Achtergracht 100, PO Box 2200 1000 CE, Amsterdam, the Netherlands.

Tel: +31 20 555 5362; fax: +31 20 555 5533; e-mail:

Received: 11 February 2003; revised: 18 June 2003; accepted: 7 July 2003.

© 2004 Lippincott Williams & Wilkins, Inc.