Current HIV/AIDS Reports

, Volume 10, Issue 1, pp 79–88 | Cite as

Treatment-Related Optimistic Beliefs and Risk of HIV Transmission: A Review of Recent Findings (2009-2012) in an Era of Treatment as Prevention

The Science of Prevention (S Kalichman, Section Editor)

Abstract

The promising outlook for HIV treatment as prevention (TasP) offered by the recent success in clinical trials has highlighted the need for effort against over-optimism toward anti-retroviral therapy (ART). It has been of a central concern that such optimistic beliefs may fuel an increase in risk behaviors to counter the protective effect of ART on reducing overall transmissibility of HIV. The current review was conducted to provide an updated look at the potential impact of treatment-related optimistic beliefs on the risk of HIV transmission. The review yielded a total of 14 studies published during the past 4 years that have examined the role of treatment-related optimistic beliefs in changing people’s adoption of sexual risk behaviors. Findings from quantitative studies were largely in support of an association between optimistic beliefs and risk of HIV transmission. Results from qualitative studies discovered additional information concealed under the numerical associations, and pointed to the need of more rigorous and comprehensive examination of the relationship between optimistic beliefs and HIV transmission risk. Gaps in the current literature were identified and suggestions for future research were provided.

Keywords

HIV/AIDS Treatment-related optimistic beliefs Highly active anti-retroviral therapy (HAART) HIV treatment as prevention (TasP) HIV transmission Anti-retroviral therapy (ART) Sexual risks Systematic review 

Notes

Acknowledgments

Preparation of this article was supported by the National Institute of Mental Health (NIMH) training grant T32-MH074387. The author would like to offer special thanks Dr. Seth C. Kalichman from University of Connecticut for his strong support in the preparation of this manuscript.

Disclosure

No potential conflicts of interest relevant to this article were reported.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Van de Ven P, et al. A scale of optimism-skepticism in the context of HIV treatments. AIDS Care. 2000;12:171–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Cohen MS, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.PubMedCrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. Act against AIDS campaign. http://www.cdc.gov/hiv/aaa/index.htm.
  4. 4.
    Hogg R, et al. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008;372:293–9.CrossRefGoogle Scholar
  5. 5.
    Joseph HA, et al. Beliefs about transmission risk and vulnerability, treatment adherence, and sexual risk behavior among a sample of HIV-positive men who have sex with men. AIDS Care. 2010;22:29–39.PubMedCrossRefGoogle Scholar
  6. 6.
    Alcorn K. Treatment is prevention: HPTN 052 study shows 96% reduction in transmission when HIV-positive partner starts treatment early. 2011 Available at: http://www.aidsmap.com/Treatment-is-prevention-HPTN-052-study-shows-96-reduction-in-transmission-when-HIV-positive-partner-starts-treatment-early/page/1879665/. Accessed 18 Sep 2012.
  7. 7.
    Forsyth AD, Valdiserri RO. Reaping the prevention benefits of highly active antiretroviral treatment: policy implications of HIV Prevention Trials Network 052. Curr Opin HIV Aids. 2012;7:111–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Valdiserri RO. Mapping the roots of HIV/AIDS complacency: implications for program and policy development. Aids Educ Prevent. 2004;16:426–39.CrossRefGoogle Scholar
  9. 9.
    Blower SM, Gershengorn HB, Grant RM. A tale of two futures: HIV and antiretroviral therapy in San Francisco. Science. 2000;287:650–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Boily MC, et al. Changes in the transmission dynamics of the HIV epidemic after the wide-scale use of antiretroviral therapy could explain increases in sexually transmitted infections—results from mathematical models. Sex Transmit Diss. 2004;31:100–12.CrossRefGoogle Scholar
  11. 11.
    Charebois ED, Havlir DV. “A Bird in the Hand … ” A Commentary on the Test and Treat Approach for HIV. Arch Intern Med. 2010;170:1354–6.CrossRefGoogle Scholar
  12. 12.
    Gray RH, et al. Stochastic simulation of the impact of antiretroviral therapy and HIV vaccines on HIV transmission; Rakai. Uganda AIDS. 2003;17:1941–51.CrossRefGoogle Scholar
  13. 13.
    McCormick AW, et al. The effect of antiretroviral therapy on secondary transmission of HIV among men who have sex with men. Clin Infect Dis. 2007;44:1115–22.PubMedCrossRefGoogle Scholar
  14. 14.
    Velasco-Hernandez JX, Gershengorn HB, Blower SM. Could widespread use of combination antiretroviral therapy eradicate HIV epidemics? Lancet Infect Dis. 2002;2:487–93.PubMedCrossRefGoogle Scholar
  15. 15.
    Vanable PA, et al. Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health Psychol. 2000;19:134–45.PubMedCrossRefGoogle Scholar
  16. 16.
    • Hasse B, et al. Frequency and determinants of unprotected sex among HIV-infected persons: the Swiss HIV Cohort Study. Clin Infect Dis. 2010;51:1314–22. This is the only prospective study available in recent years. The study looked at the potential influence of the Swiss Statement, which can be viewed as a proxy measure for treatment-related infectivity beliefs.PubMedCrossRefGoogle Scholar
  17. 17.
    Begley K, et al. Factors associated with unprotected anal intercourse between HIV-positive men and regular male partners in a Sydney cohort. Int J STD AIDS. 2009;20:704–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Brennan DJ, et al. HIV treatment optimism and unsafe anal intercourse among HIV-positive men who have sex with men: findings from the Positive Connections Study. AIDS Educ Prevent. 2010;22:126–37.CrossRefGoogle Scholar
  19. 19.
    Kalichman SC, Eaton L, Cherry C. Sexually transmitted infections and infectiousness beliefs among people living with HIV/AIDS: implications for HIV treatment as prevention. HIV Med. 2010;11:502–9.PubMedGoogle Scholar
  20. 20.
    Castro DR, et al. The “Swiss Statement”. Who knows about it? How do they know? What are its effects on people living with HIV/AIDS? AIDS Care-Psychol Socio-Med Aspect AIDS/HIV. 2012;24:1013–9.CrossRefGoogle Scholar
  21. 21.
    Clarke A, et al. Adherence and risk behavior in patients with HIV infection receiving antiretroviral therapy in Bangkok. Open Virol J. 2012;6:23–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Joseph HA, et al. Beliefs about transmission risk and vulnerability, treatment adherence, and sexual risk behavior among a sample of HIV-positive men who have sex with men. Aids Care-Psychol Socio-Med Aspect AIDS/HIV. 2010;22:29–39.CrossRefGoogle Scholar
  23. 23.
    Yi HS, Sandfort TGM, Shidlo A. Effects of disengagement coping with HIV risk on unprotected sex among HIV-negative gay men in New York City. Health Psychol. 2010;29:205–14.PubMedCrossRefGoogle Scholar
  24. 24.
    • MacKellar DA, 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;15:788–804. The theory-based approach of this study sets a good example to follow for future studies on treatment-related optimistic beliefs.PubMedCrossRefGoogle Scholar
  25. 25.
    Smith RM, et al. Attitudes and beliefs about anti-retroviral therapy are associated with high risk sexual behaviors among the general population of Kisumu, Kenya. AIDS Care-Psychol Socio-Med Aspect AIDS/HIV. 2011;23:1668–75.CrossRefGoogle Scholar
  26. 26.
    McDonald K. ‘The old-fashioned way’: conception and sex in serodiscordant relationships after ART. Culture Health Sex. 2011;13:1119–33.CrossRefGoogle Scholar
  27. 27.
    • Persson A. Reflections on the Swiss Consensus Statement in the context of qualitative interviews with heterosexuals living with HIV. Aids Care-Psychol Socio-Med Aspect AIDS/HIV. 2010;22:1487–92. This study is valuable in a way that it is a longitudinal qualitative which allowed for a pre and post-Swiss Statement comparison of peoples attitudes and decision-making in sexual relationships.CrossRefGoogle Scholar
  28. 28.
    Vanable PA, et al. What HIV-Positive MSM want from sexual risk reduction interventions: findings from a qualitative study. AIDS Behav. 2012;16:554–63.PubMedCrossRefGoogle Scholar
  29. 29.
    • Prestage G, et al. Is Optimism Enough? Gay men’s beliefs about HIV and their perspectives on risk and pleasure. Sex Transmit Dise. 2012;39:167–72. This is the only mixed-method study found recent years, which offered rich insights into the role of treatment-related optimistic beliefs that cannot be fully understood using only a quantitative or a qualitative method.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of ConnecticutStorrsUSA

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