mental health AIDS

Winter 2007 Newsletter / Volume 8, Issue 2

HIV Prevention News

About Men Who Have Sex With Men

Rosario, Schrimshaw, and Hunter (2006) interviewed an ethnically diverse sample of 80 young gay and bisexual men in New York City on three occasions (baseline, 6 months, 12 months). "As hypothesized, more negative attitudes toward homosexuality, more substance abuse symptoms, and poorer intentions for safer sex were directly associated with a greater likelihood of unprotected anal sex over the following year. Furthermore, lower self-esteem, more anxious symptoms, and childhood sexual abuse were related to more unprotected anal sex indirectly through more sexual partners, sexual encounters, and substance abuse symptoms" (p. 444). Rosario and colleagues point out that "interventions to address sexual risk behaviors must also address the mental health and substance abuse concerns of this population. ... [These] data suggest that by addressing the self-esteem and [negative] attitudes toward homosexuality … of young gay and bisexual men, interventions may indirectly serve to improve the youths' mental health and reduce their subsequent sexual risk behaviors" (p. 456). Additionally, "[p]sychotherapeutic interventions directly targeting gay and bisexual men with a history of childhood sexual abuse may be needed to address the long-term impact of this abuse on sexual risk behaviors" (p. 457).

Guzman et al. (2006) analyzed survey data from a diverse sample of 199 San Francisco men who have sex with men who knew their HIV status (130 [65%] were HIV-positive, 69 [35%] were HIV-negative), were familiar with the term "viral load," and had a serodiscordant sex partner in the preceding year. "A majority (n=111, 56%) discussed [viral load] in the prior year with serodiscordant partners specifically to guide decisions about sexual risk behaviour. Discussion was more common among HIV-positive than HIV-negative participants ... , and African Americans compared to whites ... . HIV-negative men who discussed [viral load] were more concerned about becoming infected, but also more willing to engage in risky behaviour with a partner whose [viral load] is undetectable, than men not discussing [viral load]" (p. 983). The investigators suggest that "[s]ome HIV-negative men may be discussing [viral load] to engage in higher risk behaviour upon learning of an HIV-positive partner's undetectable [viral load]" (p. 983). For this reason, Guzman and colleagues urge clinicians "to inquire with ... clients about their knowledge and beliefs related to [viral load] and transmission risk. It is important to correct any misconceptions and acknowledge that data generally ... [suggest] that HIV is relatively less transmissible when one's blood viral load is low or undetectable ... [.] However, providers must also explain that using condoms for anal sex in the setting of an undetectable [viral load] is likely to further diminish risk of HIV transmission as well as lower risk for other sexually transmitted infections [STIs]" (p. 987).

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