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A Longitudinal Analysis of Treatment Optimism and HIV Acquisition and Transmission Risk Behaviors Among Black Men Who Have Sex with Men in HPTN 061

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Abstract

Little is known about HIV treatment optimism and risk behaviors among Black men who have sex with men (BMSM). Using longitudinal data from BMSM in the HPTN 061 study, we examined participants’ self-reported comfort with having condomless sex due to optimistic beliefs regarding HIV treatment. We assessed correlates of treatment optimism and its association with subsequent risk behaviors for HIV acquisition or transmission using multivariable logistic regression with generalized estimating equations. Independent correlates of treatment optimism included age ≥35 years, annual household income <$20,000, depressive symptoms, high HIV conspiracy beliefs, problematic alcohol use, and previous HIV diagnosis. Treatment optimism was independently associated with subsequent condomless anal sex with a male partner of serodiscordant/unknown HIV status among HIV-infected men, but this association was not statistically significant among HIV-uninfected men. HIV providers should engage men in counseling conversations to assess and minimize willingness to have condomless sex that is rooted in optimistic treatment beliefs without knowledge of viral suppression.

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Acknowledgements

The authors would like to thank HPTN 061 Study Participants; Emory University (Ponce de Leon Center & Hope Clinic Clinical Research Sites): Carlos del Rio, Paula Frew, Christin Root, Jermel L. Wallace; Fenway Institute at Fenway Health: Kenneth Mayer, Benjamin Perkins, Kelvin Powell, Benny Vega; George Washington University Milken Institute School of Public Health: Manya Magnus, Alan Greenberg, Jeanne Jordan, Irene Kuo, Gregory Phillips II, Christopher Watson; Harlem Prevention Center: Sharon Mannheimer, Avelino Loquere Jr.; New York Blood Center: Beryl Koblin, Krista Goodman, Hong Van Tieu; San Francisco Department of Public Health: Susan P. Buchbinder, Michael Arnold, Chadwick Campbell, Mathew Sanchez; University of California Los Angeles (UCLA): Steven J. Shoptaw, Christopher Hucks-Ortiz; HPTN Coordinating and Operations Center (CORE), FHI 360: Sam Griffith, Erica Hamilton, LaShawn Jones, Georgette King, Jonathan Paul Lucas, Teresa Nelson; HPTN Network Laboratory, Johns Hopkins Medical Institute: Sue Eshleman, Vanessa Cummings; HPTN Statistical and Data Management Center, Statistical Center for HIV/AIDS Research and Prevention (SCHARP): Lei Wang, Corey Kelly, Ting-Yuan Liu; Division of AIDS (DAIDS) at the U.S. National Institutes of Health (NIH): Jane Bupp, Vanessa Elharrar; Additional HPTN 061 Protocol Team Members: Darrell Wheeler (co-chair), Sheldon Fields, Kaijson Noilmar, Steven Wakefield; Other HPTN 061 Contributors: Black Gay Research Group, HPTN Black Caucus, Kate MacQueen, Leo Wilton. HPTN 061 grant support was provided by the National Institute of Allergy and Infectious Disease (NIAID), National Institute on Drug Abuse (NIDA) and National Institute of Mental Health (NIMH): Cooperative Agreements UM1 AI068619, UM1 AI068617, and UM1 AI068613. Additional site funding—Fenway Institute CRS: Harvard University CFAR (P30 AI060354) and CTU for HIV Prevention and Microbicide Research (UM1 AI069480); George Washington University CRS: District of Columbia Developmental CFAR (P30 AI087714); Harlem Prevention Center CRS and NY Blood Center/Union Square CRS: Columbia University CTU (5U01 AI069466) and ARRA funding (3U01 AI069466-03S1); Hope Clinic of the Emory Vaccine Center CRS and The Ponce de Leon Center CRS: Emory University HIV/AIDS CTU (5U01 AI069418), CFAR (P30 AI050409) and CTSA (UL1 RR025008); San Francisco Vaccine and Prevention CRS: ARRA funding (3U01 AI069496-03S1, 3U01 AI069496-03S2); UCLA Vine Street CRS: UCLA Department of Medicine, Division of Infectious Diseases CTU (U01 AI069424) and The Center for HIV, Identification, Prevention and Treatment Services (P30 MH058107).

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave NW, 5th Floor, Washington, DC, USA

    Matthew E. Levy, Manya Magnus & Irene Kuo

  2. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Gregory Phillips II

  3. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Geetha Beauchamp & Lynda Emel

  4. Division of HIV Prevention and Care, John Wesley Community Health Institute, Los Angeles, CA, USA

    Christopher Hucks-Ortiz

  5. Science Facilitation Department, FHI 360, Durham, NC, USA

    Erica L. Hamilton

  6. Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA

    Leo Wilton

  7. Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa

    Leo Wilton

  8. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Iris Chen

  9. Department of Medicine, Harlem Hospital and Columbia University Medical Center, New York, NY, USA

    Sharon Mannheimer

  10. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Sharon Mannheimer

  11. Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA

    Hong-Van Tieu

  12. Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA

    Hong-Van Tieu

  13. Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA

    Hyman Scott

  14. Nicole Weirtheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA

    Sheldon D. Fields

  15. Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA

    Carlos del Rio

  16. Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA

    Carlos del Rio

  17. Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Steven Shoptaw

  18. Fenway Health, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, MA, USA

    Kenneth Mayer

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  1. Matthew E. Levy
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  2. Gregory Phillips II
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  3. Manya Magnus
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  10. Iris Chen
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  17. Kenneth Mayer
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Correspondence to Matthew E. Levy.

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Conflict of interest

Iris Chen contributed to this article in her personal capacity. The views expressed are her own and do not represent the views of the Health Resources and Services Administration or the United States Government.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Levy, M.E., Phillips, G., Magnus, M. et al. A Longitudinal Analysis of Treatment Optimism and HIV Acquisition and Transmission Risk Behaviors Among Black Men Who Have Sex with Men in HPTN 061. AIDS Behav 21, 2958–2972 (2017). https://doi.org/10.1007/s10461-017-1756-z

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