About one-third of HIV-positive adults have recently engaged in sexual behavior that could put others at risk for infection, but the factors associated with such behavior differ for women, heterosexual men, and men who have sex with men, according to a new study.
“We have set out to deliver a small contribution to understanding sexual risk behavior among men and women living with HIV, as we believe this is an important contribution to support them, both in preventing onward HIV transmission as well as in improving their sexual and reproductive health.” Lead author, said at the International AIDS Conference.
The cross-sectional study was conducted at 16 HIV treatment sites in 13 European countries. The investigators developed an anonymous questionnaire on factors potentially affecting sexual risk and protective behavior and administered it to consecutive individuals visiting the treatment sites in 2007. The investigators also analyzed the results of focus group discussions conducted among HIV-positive individuals, said,head of health promotion at the Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.
The response rate was 39, yielding a sample of 1,212 respondents. About 24% were women, 18% were heterosexual men, and 58% were men who had sex with men. Their median ages ranged from 38 to 43 years.
About 30 % of women, 25% of heterosexual men, and 37% of men who had sex with men reported at least one instance of sexual risk behavior (unprotected vaginal or anal intercourse) in the previous 6 months, a significant difference.
In bivariate analyses, women were significantly more likely to have engaged in sexual risk behavior if they were younger, used marijuana, wanted a child, of had a main partner who was also HIV positive.
Heterosexual men were significantly more likely to have had risky sex if they had less education, had been HIV positive for a shorter period of time, or had an HIV-positive main partner, whereas they were significantly less likely to have done so if they had higher levels of anxiety or stress.
Finally, men who had sex with men were significantly more likely to have engaged in sexual risk behavior if they were younger, had a job, used erection-enhancing medication or recreational drugs, were not on highly active antiretrovinal therapy, had an HIV-positive main partner, or had greater perceived satisfaction with sexual desire.
In a multivariate analysis, respondents were significantly less likely to have engaged in risky sexual behavior if they had a detectable viral load versus an unknown one (odds ratio, 0.35), if they intended to use condoms at the next sexual encounter (odds ratio, 0.58), and if they had peers or partners who supported condom use (odds ratio, 0.83).
The findings, which are similar to those of other studies on risk behavior, suggest that “sexual risk behavior in different target groups is associated with quite different factors that act as mediators, and intervention strategies should take these mediators into account. For example, greater integration of HIV care with reproductive health services may be needed for HIV-positive women who want children.
“Counseling strategies should also target the variables that have been shown to lead to behavior change, such as intention to use condoms or peer norms related to condom use.”