|
 This talk was presented
at the 10th Annual Canadian Conference on HIV/AIDS Research in
Toronto in June 2001.
Relationship between HIV optimism and sexual risk
behaviour in a cohort of gay men in Vancouver:
Evidence of complacency?
Kevin J.P. Craib,
Steve Martindale, Keith Chan, Mary Lou Miller, Martin T. Schechter,
Robert S. Hogg.
The Vanguard Project, British Columbia Centre
for Excellence in HIV/AIDS, University of British Columbia, Vancouver,Canada.
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presentation in Adobe PDF format
ABSTRACT:
OBJECTIVE: To
examine optimism in light of new HIV drug therapies and its association
with sexual risk behaviour among gay and bisexual men in Vancouver.
METHODS: Between
11/99 and 12/00, 431 participants completed self-administered
questionnaires eliciting data regarding socio-demographics, HIV
status, unprotected anal intercourse (UAI) with regular (i.e.
at least once/month) or casual (i.e. less than once/month) partners
during the past year, and responses to measures of HIV-related
optimism. Responses to these measures of optimism by men who
reported engaging in UAI were compared with those of men who
reported always using condoms in the past year.
RESULTS: The
median age of respondents was 28 years (range: 17-36). The majority
was university/college educated (77%) and employed (73%). Ninety-four
percent of respondents were HIV-negative. A total of 321 (75%)
men reported having one or more regular or casual sexual partners
in the past year. Among men who reported engaging in receptive
anal intercourse with their regular partners (n=241), 163 (68%)
reported not using condoms at least once during the past year.
Men who reported insertive UAI with their regular partners were
less likely to agree with the statement: "Until there is
a complete cure for HIV/AIDS, prevention is still the best practice,"
compared to men who always used condoms during this practice
(p=0.021). A total of 95 (46%) of 205 men reported engaging in
insertive anal intercourse with casual partners. Men who reported
insertive UAI with their casual partners were more likely to
agree with the statement: "If a cure for AIDS were announced,
I would stop practicing safe sex," compared to men who always
used condoms during this practice (p=0.004).
CONCLUSIONS:
This study suggests that HIV optimism may be associated with
higher levels of unprotected anal intercourse among young gay
and bisexual men in Vancouver.
Objectives
- To examine optimism in light of new HIV drug therapies and
its association with sexual risk behaviour among gay and bisexual
men in Vancouver
- To compare HIV optimism scores among gay men surveyed in
Vancouver, London, Sydney & Melbourne, and Paris.
The Vanguard Project: Eligibility Criteria
- 18 to 30 years old at enrolment
- Living in Greater Vancouver area
- Gay, bisexual, and/or MSM
- No previous HIV-positive test result
Methods (1)
- Vancouver participants completed a self-administered questionnaire
between November 1999 and December 2000 (n=431)
- Data regarding demographic variables, HIV status, sexual
behaviours, unprotected anal intercourse.
Methods (2)
- London: 792 gay men surveyed in central London gyms in February-March
2000
- Sydney-Melbourne: 3593 gay men surveyed in gay community
venues in February 2000
- Paris-Banli: 1970 gay men surveyed gay community venues in
April-May 2000.
HIV Optimism
- To assess beliefs related to HIV prevention and risks in
light of the new drug therapies available to treat HIV
- 14-item questionnaire
- 4-point Likert scale
- Total score (Minimum = 14, Maximum = 56)
- 4 items available for international comparisons
HIV Optimism Items
- A person with undetectable viral load cannot pass on the
virus.
- I'm less worried about HIV infection than I used to be.
- New HIV treatments will take the worry out of sex.
- If every HIV-positive person took the new treatments, the
AIDS epidemic would be over.
- If a cure for AIDS were announced, I would stop practicing
safe sex.
- People with undetectable viral load don't need to worry
so much about infecting others with HIV.
- Until there is a complete cure for HIV/AIDS, prevention
is still the best practice.
- HIV is less of a threat because the epidemic is on
the decline.
- HIV is less of a threat than it used to be because of new
treatments.
- It's never safe to fuck without a condom regardless of
viral load.
- Because of new treatments, fewer people are becoming infected
with HIV.
- I believe that new drug therapies make people with HIV
less infectious.
- I am less worried about HIV infection now that treatments
have improved.
- The availability of PEP makes safe sex less important.
Statistical Methods
- Comparisons of mean optimism scores between men who reported
unprotected anal sex with those who did not
- Wilcoxon rank-sum test
- Kruskal-Wallis test
Demographics (1)
|
n |
% |
| Sexual Orientation |
| Gay/Homosexual |
346 |
80.3 |
| Bisexual |
41 |
9.5 |
| Heterosexual |
12 |
2.8 |
| Transgendered |
5 |
1.2 |
| Other |
23 |
5.3 |
| Unknown |
4 |
0.9 |
| TOTAL |
431 |
100.0 |
| Education |
| High
School or less |
89 |
20.6 |
| Some University/College/Trade
School |
331 |
76.8 |
| University/College
Degree |
11 |
2.6 |
| TOTAL |
431 |
100.0 |
| Current employment |
| Yes |
313 |
72.6 |
| No |
112 |
26.0 |
| Unknown |
6 |
1.4 |
| TOTAL |
431 |
100.0 |
Demographics (2)
| Annual Income |
$Can. |
| Mean |
37,394 |
| Standard deviation |
39.086 |
| 25th percentile |
20,000 |
| Median |
30,000 |
| 75th percentile |
43,000 |
| Range |
1,000-500,000 |
|
| Age |
Years |
| Mean |
27.7 |
| Standard deviation |
4.3 |
| 25th percentile |
25.0 |
| Median |
28.0 |
| 75th percentile |
31.0 |
| Range |
17.0-36.0 |
Sexual Relationships
- 223 (52%) of 431 participants reported they were currently
involved in a relationship.
- 321 (75%) men had at least one 'regular' and at least one
'casual' sexual partner.
- Median number of regular partners = 1 (Range 1 - 30)
- Median number of casual partners = 5 (Range 1-1000)
Unprotected Sex with REGULAR Male Sex Partners
- 241 participants reported engaging in receptive or insertive
anal intercourse with their regular partners
- 163 (68%) reported unprotected receptive anal intercourse
with regular partners
- 162 (67%) reported unprotected insertive anal intercourse
with regular partners
Unprotected Sex with CASUAL Male Sex Partners
- 241 participants reported engaging in receptive or insertive
anal intercourse with casual partners
- 61 (37%) reported unprotected receptive anal intercourse
with casual partners
- 95 (46%) reported unprotected insertive anal intercourse
with casual partners
Unprotected Anal Intercourse (RECEPTIVE) with
REGULAR Partner(s):
Comparison of Optimism Scores
| Descriptive Statistic |
YES |
NO |
p-value |
| n |
159 |
75 |
0.232 |
| Mean |
21.5 |
21.1 |
| Standard deviation |
3.8 |
3.9 |
| 25th percentile |
18.0 |
18.0 |
| Median |
22.0 |
21.0 |
| 75th percentile |
24.0 |
23.0 |
| Range |
14.0-30.0 |
14.0-32.0 |
Unprotected Anal Intercourse (INSERTIVE) with
REGULAR Partner(s):
Comparison of Optimism Scores
| Descriptive Statistic |
YES |
NO |
p-value |
| n |
157 |
74 |
0.041 |
| Mean |
21.7 |
20.6 |
| Standard deviation |
4.1 |
3.9 |
| 25th percentile |
18.0 |
18.0 |
| Median |
22.0 |
20.0 |
| 75th percentile |
24.0 |
23.0 |
| Range |
14.0-41.0 |
14.0-30.0 |
Unprotected Anal Intercourse (RECEPTIVE) with
CASUAL Partner(s):
Comparison of Optimism Scores
| Descriptive Statistic |
YES |
NO |
p-value |
| n |
58 |
102 |
0.432 |
| Mean |
21.4 |
21.1 |
| Standard deviation |
3.9 |
4.1 |
| 25th percentile |
19.0 |
18.0 |
| Median |
22.0 |
21.0 |
| 75th percentile |
24.0 |
23.0 |
| Range |
14.0-32.0 |
14.0-32.0 |
Unprotected Anal Intercourse (INSERTIVE) with
CASUAL Partner(s):
Comparison of Optimism Scores
| Descriptive Statistic |
YES |
NO |
p-value |
| n |
90 |
104 |
0.042 |
| Mean |
22.2 |
21.0 |
| Standard deviation |
4.5 |
4.0 |
| 25th percentile |
19.0 |
18.0 |
| Median |
22.0 |
20.0 |
| 75th percentile |
25.0 |
24.0 |
| Range |
14.0-41.0 |
14.0-32.0 |
Comparison of mean score on 4-item HIV optimism
scale between serologic groups and international sites
|
UAI with regular partners
only |
UAI with casual partners |
No UAI |
| Vancouver |
| HIV positive (21) |
8.0 |
7.0 |
7.3 |
| HIV negative (405) |
6.6 |
6.8 |
6.7 |
| Melbourne/Sydney |
| HIV positive
(465) |
6.6 |
6.9 |
6.1 |
| HIV negative (2676) |
6.3 |
6.9 |
6.2 |
| London |
| HIV positive
(126) |
6.2 |
6.5 |
6.3 |
| HIV negative (477) |
6.5 |
6.8 |
6.1 |
| Paris/Banli |
| HIV positive
(300) |
5.9 |
5.8 |
5.1 |
| HIV negative (1374) |
5.0 |
5.3 |
4.8 |
Limitations
- Non-probability sample
- Temporality
Conclusions
- In Vancouver, HIV optimism scores tended to be higher among
men who reported engaging in unprotected (insertive) anal intercourse
with their regular or casual partners.
- Geographic heterogeneity with respect to HIV optimism. Higher
mean scores observed in Vancouver and Melbourne-Sydney.
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