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

  • Matthew E. Levy
  • Gregory PhillipsII
  • Manya Magnus
  • Irene Kuo
  • Geetha Beauchamp
  • Lynda Emel
  • Christopher Hucks-Ortiz
  • Erica L. Hamilton
  • Leo Wilton
  • Iris Chen
  • Sharon Mannheimer
  • Hong-Van Tieu
  • Hyman Scott
  • Sheldon D. Fields
  • Carlos del Rio
  • Steven Shoptaw
  • Kenneth Mayer
Original Paper

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.

Keywords

HIV Treatment optimism Black men who have sex with men Condom use Sexual risk behaviors 

References

  1. 1.
    Matthews DD, Herrick A, Coulter RW, et al. Running backwards: consequences of current HIV incidence rates for the next generation of black MSM in the United States. AIDS Behav. 2016;20(1):7–16.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Hess KL, Hu X, Lansky A, Mermin J, Hall HI. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol. 2017. doi:10.1016/j.annepidem.2017.02.003.PubMedGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2014. HIV AIDS Surveill Rep. 2015;26. http://www.cdc.gov/hiv/library/reports/surveillance.
  4. 4.
    Sullivan PS, Peterson J, Rosenberg ES, et al. Understanding racial HIV/STI disparities in black and white men who have sex with men: a multilevel approach. PLoS ONE. 2014;9(3):e90514.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Millett GA, Peterson JL, Flores SA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380(9839):341–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Chen Y. Treatment-related optimistic beliefs and risk of HIV transmission: a review of recent findings (2009-2012) in an era of treatment as prevention. Curr HIV/AIDS Rep. 2013;10(1):79–88.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Valdiserri RO. Mapping the roots of HIV/AIDS complacency: implications for program and policy development. AIDS Educ Prev. 2004;16(5):426–39.CrossRefPubMedGoogle Scholar
  8. 8.
    Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior: a meta-analytic review. JAMA. 2004;292(2):224–36.CrossRefPubMedGoogle Scholar
  9. 9.
    International Collaboration on HIV Optimism. HIV treatments optimism among gay men: an international perspective. J Acquir Immune Defic Syndr. 2003;32(5):545–50.CrossRefGoogle Scholar
  10. 10.
    Remien R, Smith RA. HIV prevention in the era of HAART: implications for providers. AIDS Read. 2000;10(4):247–51.PubMedGoogle Scholar
  11. 11.
    MacKellar DA, Hou SI, Whalen CC, et al. A plausible causal model of HAART-efficacy beliefs, HIV/AIDS complacency, and HIV-acquisition risk behavior among young men who have sex with men. AIDS Behav. 2011;15(4):788–804.CrossRefPubMedGoogle Scholar
  12. 12.
    MacKellar DA, Hou S-I, Whalen CC, et al. HIV/AIDS complacency and HIV infection among young men who have sex with men, and the race-specific influence of underlying HAART beliefs. Sex Transm Dis. 2011;38(8):755–63.PubMedGoogle Scholar
  13. 13.
    Kalichman SC, Eaton L, Cain D, Cherry C, Pope H, Kalichman M. HIV treatment beliefs and sexual transmission risk behaviors among HIV positive men and women. J Behav Med. 2006;29(5):401–10.CrossRefPubMedGoogle Scholar
  14. 14.
    Hanif H, Bastos FI, Malta M, Bertoni N, Winch PJ, Kerrigan D. Where does treatment optimism fit in? Examining factors associated with consistent condom use among people receiving antiretroviral treatment in Rio de Janeiro, Brazil. AIDS Behav. 2014;18(10):1945–54.CrossRefPubMedGoogle Scholar
  15. 15.
    Peterson JL, Miner MH, Brennan DJ, Rosser BS. HIV treatment optimism and sexual risk behaviors among HIV positive African American men who have sex with men. AIDS Educ Prev. 2012;24(2):91–101.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Brennan DJ, Welles SL, Miner MH, Ross MW, Rosser BS. Positive connections Team. HIV treatment optimism and unsafe anal intercourse among HIV-positive men who have sex with men: findings from the positive connections study. AIDS Educ Prev. 2010;22(2):126–37.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Hart TA, James CA, Hagan CM, Boucher E. HIV optimism and high-risk sexual behavior in two cohorts of men who have sex with men. J Assoc Nurses AIDS Care. 2010;21(5):439–43.CrossRefPubMedGoogle Scholar
  18. 18.
    Prestage G, Down IA, Bradley J, et al. Is optimism enough? Gay men’s beliefs about HIV and their perspectives on risk and pleasure. Sex Transm Dis. 2012;39(3):167–72.CrossRefPubMedGoogle Scholar
  19. 19.
    Cassell MM, Halperin DT, Shelton JD, Stanton D. Risk compensation: the Achilles’ heel of innovations in HIV prevention. BMJ. 2006;332(7541):605–7.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81.CrossRefPubMedGoogle Scholar
  21. 21.
    Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375(9):830–9.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Rosenberg ES, Millett GA, Sullivan PS, Del Rio C, Curran JW. Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: a modelling study. Lancet HIV. 2014;1(3):e112–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Van Den Boom W, Stolte IG, Witlox R, Sandfort T, Prins M, Davidovich U. Undetectable viral load and the decision to engage in unprotected anal intercourse among HIV-positive MSM. AIDS Behav. 2013;17(6):2136–42.CrossRefGoogle Scholar
  24. 24.
    Mustanski B, D’Aquila R, Newcomb M, RADAR Cohort Study Group. Detectable viral loads among those who self-report being undetectable in the RADAR cohort of young MSM – implications for treatment as prevention. HIV Research for Prevention 2016: AIDS Vaccine, Microbicide, and ARV-based Prevention Science. 2016 Oct 17-21; Chicago, IL.Google Scholar
  25. 25.
    Conroy AA, Gamarel KE, Neilands TB, et al. Partner reports of HIV viral suppression predict sexual behavior in serodiscordant male couples. J Acquir Immune Defic Syndr. 2016;73(2):e31–3.CrossRefPubMedGoogle Scholar
  26. 26.
    Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Bush S, Magnuson D, Rawlings M, et al. Racial characteristics of FTC/TDF for pre-exposure prophylaxis users in the US. Boston, MA: ASM Microbe; 2016 Jun 16–20.Google Scholar
  28. 28.
    Eaton LA, Driffin DD, Bauermeister J, Smith H, Conway-Washington C. Minimal awareness and stalled uptake of pre-exposure prophylaxis (PrEP) among at risk, HIV-negative, black men who have sex with men. AIDS Patient Care STDS. 2015;29(8):423–9.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Kelley CF, Kahle E, Siegler A, et al. Applying a PrEP continuum of care for men who have sex with men in Atlanta. GA. Clin Infect Dis. 2015;61(10):1590–7.CrossRefGoogle Scholar
  30. 30.
    Gilmore HJ, Liu A, Koester KA, et al. Participant experiences and facilitators and barriers to pill use among men who have sex with men in the iPrEx pre-exposure prophylaxis trial in San Francisco. AIDS Patient Care STDS. 2013;27(10):560–6.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Sullivan PS, Drake AJ, Sanchez TH. Prevalence of treatment optimism-related risk behavior and associated factors among men who have sex with men in 11 states, 2000–2001. AIDS Behav. 2007;11(1):123–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Vosvick M, Fritz S, Henry D, Prybutok V, Sheu S, Poe J. Correlates and racial/ethnic differences in bareback sex among men who have sex with men with unknown or negative HIV serostatus. AIDS Behav. 2016;20(12):2798–811.CrossRefPubMedGoogle Scholar
  33. 33.
    Koblin BA, Mayer KH, Eshleman SH, et al. Correlates of HIV acquisition in a cohort of black men who have sex with men in the United States: HIV Prevention Trials Network (HPTN) 061. PLoS ONE. 2013;8(7):e70413.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Mayer KH, Wang L, Koblin B, et al. Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among black men who have sex with men in 6 U.S. cities. PLoS ONE. 2014;9(1):e87298.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Ayala G, Bingham T, Kim J, Wheeler DP, Millett GA. Modeling the impact of social discrimination and financial hardship on the sexual risk of HIV among Latino and Black men who have sex with men. Am J Public Health. 2012;102(Suppl 2):S242–9.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRefGoogle Scholar
  37. 37.
    Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol. 1979;109(2):186–204.CrossRefPubMedGoogle Scholar
  38. 38.
    Herek G, Glunt EK. Identity and community among gay and bisexual men in the AIDS era: preliminary findings from the Sacramento Men’s Health Study. In: Herek GM, Greene B, editors. AIDS, identity, and community: the HIV epidemic and lesbians and gay men. Thousand Oaks: Sage Publications Inc; 1995.CrossRefGoogle Scholar
  39. 39.
    Harrell SP, Merchant MA, Young SA. Psychometric properties of the racism and life experiences scales (RaLES). Chicago: Annual Meeting of the American Psychological Association; 1997.Google Scholar
  40. 40.
    Sayles JN, Hays RD, Sarkisian CA, Mahajan AP, Spritzer KL, Cunningham WE. Development and psychometric assessment of a multidimensional measure of internalized HIV stigma in a sample of HIV-positive adults. AIDS Behav. 2008;12(5):748–58.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Bogart LM, Thorburn S. Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans? J Acquir Immune Defic Syndr. 2005;38(2):213–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Williams JK, Wilton L, Magnus M, et al. Relation of childhood sexual abuse, intimate partner violence, and depression to risk factors for HIV among black men who have sex with men in 6 US cities. Am J Public Health. 2015;105(12):2473–81.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804.CrossRefPubMedGoogle Scholar
  44. 44.
    Yuan Y. Multiple imputation using SAS software. J Stat Softw. 2011;45(6):1–25.CrossRefGoogle Scholar
  45. 45.
    Xie F, Paik MC. Multiple imputation methods for the missing covariates in generalized estimating equation. Biometrics. 1997;53(4):1538–46.CrossRefPubMedGoogle Scholar
  46. 46.
    Yeatman S, Dovel K, Conroy A, Namadingo H. HIV treatment optimism and its predictors among young adults in southern Malawi. AIDS Care. 2013;25(8):1018–25.CrossRefPubMedGoogle Scholar
  47. 47.
    Mustanski B, Newcomb ME. Older sexual partners may contribute to racial disparities in HIV among young men who have sex with men (MSM). J Adolesc Health. 2013;52(6):666–7.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Newcomb ME, Mustanski B. Racial differences in same-race partnering and the effects of sexual partnership characteristics on HIV risk in MSM: a prospective sexual diary study. J Acquir Immune Defic Syndr. 2013;62(3):329–33.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Sullivan PS, Rosenberg ES, Sanchez TH, et al. Explaining racial disparities in HIV incidence in a prospective cohort of black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. Ann Epidemiol. 2015;25(6):445–54.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Bogart LM, Galvan FH, Wagner GJ, Klein DJ. Longitudinal association of HIV conspiracy beliefs with sexual risk among black males living with HIV. AIDS Behav. 2011;15(6):1180–6.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Allen VC Jr, Myers HF, Ray L. The association between alcohol consumption and condom use: considering correlates of HIV risk among black men who have sex with men. AIDS Behav. 2015;19(9):1689–700.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Yi H, Sandfort TG, Shidlo A. Effects of disengagement coping with HIV risk on unprotected sex among HIV-negative gay men in New York City. Health Psychol. 2010;29(2):205–14.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Vanable PA, Ostrow DG, McKirnan DJ, Taywaditep KJ, Hope BA. Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health Psychol. 2000;19(2):134–45.CrossRefPubMedGoogle Scholar
  54. 54.
    Koblin BA, Bonner S, Powell B, et al. A randomized trial of a behavioral intervention for black men who have sex with men: the DiSH Study. AIDS. 2012;26(4):483–8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Matthew E. Levy
    • 1
  • Gregory PhillipsII
    • 2
  • Manya Magnus
    • 1
  • Irene Kuo
    • 1
  • Geetha Beauchamp
    • 3
  • Lynda Emel
    • 3
  • Christopher Hucks-Ortiz
    • 4
  • Erica L. Hamilton
    • 5
  • Leo Wilton
    • 6
    • 7
  • Iris Chen
    • 8
  • Sharon Mannheimer
    • 9
    • 10
  • Hong-Van Tieu
    • 11
    • 12
  • Hyman Scott
    • 13
  • Sheldon D. Fields
    • 14
  • Carlos del Rio
    • 15
    • 16
  • Steven Shoptaw
    • 17
  • Kenneth Mayer
    • 18
  1. 1.Department of Epidemiology and BiostatisticsMilken Institute School of Public Health at the George Washington UniversityWashingtonUSA
  2. 2.Department of Medical Social Sciences, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  3. 3.Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleUSA
  4. 4.Division of HIV Prevention and CareJohn Wesley Community Health InstituteLos AngelesUSA
  5. 5.Science Facilitation DepartmentFHI 360DurhamUSA
  6. 6.Department of Human DevelopmentState University of New York at BinghamtonBinghamtonUSA
  7. 7.Faculty of HumanitiesUniversity of JohannesburgJohannesburgSouth Africa
  8. 8.Department of PathologyJohns Hopkins University School of MedicineBaltimoreUSA
  9. 9.Department of MedicineHarlem Hospital and Columbia University Medical CenterNew YorkUSA
  10. 10.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  11. 11.Laboratory of Infectious Disease PreventionNew York Blood CenterNew YorkUSA
  12. 12.Division of Infectious Diseases, Department of MedicineColumbia University Medical CenterNew YorkUSA
  13. 13.Bridge HIVSan Francisco Department of Public HealthSan FranciscoUSA
  14. 14.Nicole Weirtheim College of Nursing and Health SciencesFlorida International UniversityMiamiUSA
  15. 15.Department of Global HealthRollins School of Public HealthAtlantaUSA
  16. 16.Department of Medicine, Division of Infectious DiseasesEmory University School of MedicineAtlantaUSA
  17. 17.Department of Family MedicineUniversity of California, Los AngelesLos AngelesUSA
  18. 18.Fenway Health, Harvard Medical School, and Beth Israel Deaconess Medical CenterBostonUSA

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