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Association Between ‘Safer Sex Fatigue’ and Rectal Gonorrhea Is Mediated by Unsafe Sex With Casual Partners Among HIV-Positive Homosexual Men

Stolte, Ineke G. MSc*; de Wit, John B. F. PhD; Kolader, Marion MD; Fennema, Han PhD; Coutinho, Roel A. Prof*§∥; Dukers, Nicole H. T. M. PhD

Sexually Transmitted Diseases: April 2006 - Volume 33 - Issue 4 - p 201-208
doi: 10.1097/01.olq.0000194596.78637.8e

Objective: The objective of this study was to investigate whether and what sexual risk behavior is a mediator of associations between rectal gonorrhea (RG) and highly active antiretroviral therapy-related beliefs, safer sex fatigue, or sexual sensation-seeking among homosexual men.

Study Design: This study consisted of a cross-sectional survey between March 2002 and December 2003 among homosexual visitors of the Amsterdam sexually transmitted disease clinic.

Methods: In total, 1568 men answered a written questionnaire. Associations were determined using logistic regression corrected for repeated measurements.

Results: The RG infection rate was high among homosexual men who were HIV-positive (16%) compared with those with negative or unknown HIV status. Mediation could be confirmed among HIV-positive men only. Those who experienced higher levels of safer sex fatigue were more likely to be positive for RG. This association was mediated by unprotected anal intercourse (UAI) with casual partners.

Conclusion: Addressing safer sex fatigue might help prevent UAI with casual partners and possibly also RG among HIV-positive homosexual men.

A study among homosexual visitors of the Amsterdam sexually transmitted disease clinic found that HIV-positive men experiencing safer sex fatigue had higher rates of rectal gonorrhea. Unprotected anal intercourse with casual partners mediated this association.

From the *Cluster of Infectious Diseases, HIV & STD Research, Municipal Health Service, Amsterdam, The Netherlands; the † Department of Social and Organizational Psychology, University of Utrecht, Utrecht, The Netherlands; the ‡ Cluster of Infectious Diseases, STD-Clinic, Municipal Health Service, Amsterdam, The Netherlands; the § Department of Human Retrovirology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and the ∥ National Institute of Public Health and the Environment, Bilthoven, The Netherlands

The authors thank Titia Heijman and the other staff of the STD clinic for their contribution in data collection; the staff of the Public Health Laboratory of the Municipal Health Service for laboratory support; Ronald Geskus and Maria Prins for critically reading the manuscript; and Lucy Phillips for editing the final manuscript.

Grant no. 4014 from AIDS Fonds Netherlands has funded this research.

Correspondence: Ineke G. Stolte, MSc (Health Sciences), Municipal Health Service Amsterdam, Cluster of Infectious Diseases, HIV & STD Research, Nieuwe Achtergracht 100, PO Box 2200 1000 CE Amsterdam, The Netherlands. E-mail:

Received for publication June 27, 2005, and accepted September 2, 2005.

© Copyright 2006 American Sexually Transmitted Diseases Association