Skip to main content


Log in

Prospective Study of Attitudinal and Relationship Predictors of Sexual Risk in the Multicenter AIDS Cohort Study

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript


We examined the influence of attitudes concerning HIV transmission, safe sex, and sexual sensation seeking, as well as negotiated risk reduction with primary partners, on the proportion of unprotected sexual partners (%UASP) among men who have sex with men (MSM). Participants were 263 HIV-seropositive and 238 HIV-seronegative MSM in the Multicenter AIDS Cohort Study between 1999 and 2003 who completed a 20-item attitude survey twice. Behavioral data were collected concurrently and 6–12 months after each survey. Among seropositives, decreased HIV concern and increased safer sex fatigue were associated with higher %UASP at 6 and 12 months. Among seronegatives, increased %UASP at 12 months was associated with safer sex fatigue. At 6 months and 12 months, risk reduction agreements were associated with increased %UASP among seronegatives in seroconcordant monogamous relationships, reflecting their abandonment of condoms in such partnerships. We conclude that HIV prevention efforts should target modifiable attitudes (reduced concern about HIV and safer sex fatigue) and increases in sexual risk-taking of MSM, particularly among HIV+ men having sex with serodiscordant partners.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  • Boily, M. C., Bastos, F. I., Desai, K., & Masse, B. (2004). 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. Sexually Transmitted Diseases, 31, 100–113.

    Article  PubMed  Google Scholar 

  • Cairns, G. (2006). New directions in HIV prevention: Serosorting and universal testing. IAPAC Monthly, 12, 42–45.

    PubMed  Google Scholar 

  • Centers for Disease Control & Prevention. Special focus profiles: men who have sex with men. (Accessed: 2003a).

  • Centers for Disease Control & Prevention (2003b). Trends in primary and secondary syphilis and HIV infections in men who have sex with men-San Francisco and Los Angeles, CA, 1998–2002. Morbidity and Mortality Weekly Report, 53, 575–578.

    Google Scholar 

  • Centers for Disease Control & Prevention (2005). HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men–five U.S. cities, June 2004–April 2005. Morbidity and Mortality Weekly Report, 54, 597–601.

    Google Scholar 

  • Crawford, J. M., Rodden, P., Kippax, S., & Van de Ven, P. (2001). Negotiated safety and other agreements between men in relationships: risk practice redefined. International Journal of STD & AIDS, 12(3), 164–170.

    Article  CAS  Google Scholar 

  • Crawford, I., Hammack, P. L., McKirnan, D. J., Ostrow, D., Zamboni, B. D., Robinson, B., & Hope, B. (2003). Sexual sensation seeking, reduced concern about HIV and sexual risk behaviour among gay men in primary relationships. AIDS Care, 15, 513–524.

    Article  CAS  PubMed  Google Scholar 

  • Crepaz, N., Hart, T. A., & Marks, G. (2004). Highly active antiretroviral therapy and sexual risk behavior: a meta-analytic review. Journal of the American Medical Association, 292, 224–236.

    Article  CAS  PubMed  Google Scholar 

  • Davidovich, U., de Wit, J. B., & Stroebe, W. (2000). Assessing sexual risk behaviour of young gay men in primary relationships: the incorporation of negotiated safety and negotiated safety compliance. AIDS, 14, 701–706.

    Article  CAS  PubMed  Google Scholar 

  • Diggle, P. J., K. Y. Liang, & S. L. Zeger (1995). Analysis of longitudinal data. New York, NY: Oxford University Press.

    Google Scholar 

  • Elford, J., Bolding, G., & Sherr, L. (2002). High-risk sexual behaviour increases among London gay men between 1998 and 2001: what is the role of HIV optimism? AIDS, 16, 1537–1544.

    Article  PubMed  Google Scholar 

  • Francis, D. (1985). Presentation at National HIV Prevention for Gay Men Pre-Conference to the Third International AIDS Conference. Atlanta, GA.

  • Guzman, R., Colfax, G. N., Wheeler, S., Mansergh, G., Marks, G., Rader, M., & Buchbinder, S. (2005). Negotiated safety relationships and sexual behavior among a diverse sample of HIV-negative men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 38, 82–86.

    Article  PubMed  Google Scholar 

  • Hirshfield, S., Remien, R. H., Humberstone, M., Walavalkar, I., & Chiasson, M. A. (2004). Substance use and high-risk sex among men who have sex with men: a national online study in the USA. AIDS Care, 16, 1036–1047.

    Article  CAS  PubMed  Google Scholar 

  • International Collaboration on HIV Optimism (2003). HIV treatments optimism among gay men: an international perspective. Journal of Acquired Immune Deficiency Syndromes, 32, 545–550.

    Article  Google Scholar 

  • Jacobson, L. P., Ostrow, D. G., Hylton, J., Gore, M. E., Weisberg, M., & Silvestre, A. (2004). Unsafe sexual behavior among homosexual men increases in the era of highly active antiretroviral therapy. 15th International AIDS Conference, Bangkok, Thailand.

  • Kalichman, S. C., Ramachandran, B., & Ostrow, D. (1998). Protease inhibitors and the new AIDS combination therapies: Implications for psychological services. Professional Psychology: Research & Practice, 29, 349–356.

    Article  Google Scholar 

  • Kaslow, R. A., Ostrow, D. G., Detels, R., Phair, J. P., Polk, B. F., & Rinaldo, C. R. Jr. (1987). The Multicenter AIDS Cohort Study: rationale, organization, and selected characteristics of the participants. American Journal of Epidemiology, 126, 310–318.

    CAS  PubMed  Google Scholar 

  • Kelly, J. A., Otto-Salaj, L. L., Sikkema, K. J., Pinkerton, S. D., & Bloom, F. R. (1998). Implications of HIV treatment advances for behavioral research on AIDS: protease inhibitors and new challenges in HIV secondary prevention. Health Psychology, 17, 310–319.

    Article  CAS  PubMed  Google Scholar 

  • Kippax, S., Noble, J., Prestage, G., Crawford, J. M., Campbell, D., Baxter, D., & Cooper, D. (1997). Sexual negotiation in the AIDS era: negotiated safety revisited. AIDS, 11, 191–197.

    Article  CAS  PubMed  Google Scholar 

  • Mao, L., Crawford, J. M., Hospers, H. J., Prestage, G. P., Grulich, A. E., Kaldor, J. M., & Kippax, S. C. (2006). “Serosorting” in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia. AIDS, 20, 1204–1206.

    Article  PubMed  Google Scholar 

  • Morin, S. F., Vernon, K., Harcourt, J. J., Steward, W. T., Volk, J., Riess, T. H., Neilands, T. B., McLaughlin, M., & Coates, T. J. (2003). Why HIV infections have increased among men who have sex with men and what to do about it: findings from California focus groups. AIDS and Behavior, 7, 353–362.

    Article  PubMed  Google Scholar 

  • Odets, W. (1995). In the shadow of the epidemic: Being HIV-negative in the age of AIDS. Durham, NC: Duke University Press.

    Google Scholar 

  • Ostrow, D., Fox, K., Kleeberger, C., Jacobson, L. P., Chmiel, J. S., Silvestre, A., Visscher, B. R., & Strathdee, S. A. (2001). Psychosocial correlates of incomplete adherence to HIV antiretroviral therapy (HAART): Mental health matters. 8th Conference on Retroviruses and Opportunistic Infections, Chicago, IL.

  • Ostrow, D. G., Cook, R. L., Sundaram, V., Cox, C., Qiao, W., Visscher, V., & Hylton, J. (2006). The setting of new or anonymous sexual encounters predicts risky sexual behavior and new sexually transmitted infections among MSM in the Multicenter AIDS Cohort Study (MACS). 16th International AIDS Conference, Toronto, Canada.

  • Ostrow, D. G., DiFranceisco, W., & Kalichman, S. C. (1997). Sexual adventurism, substance use, and high-risk sexual behavior: A structural modeling analysis of the Chicago MACS/coping and change cohort. AIDS and Behavior, 1, 191–202.

    Article  Google Scholar 

  • Ostrow, D. G., Fox, K. J., Chmiel, J. S., Silvestre, A., Visscher, B. R., Vanable, P. A., Jacobson, L. P., & Strathdee, S. A. (2002). Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men. AIDS, 16, 775–780.

    Article  PubMed  Google Scholar 

  • Ostrow, D. G., & Kalichman, S. C. (1999). Psychosocial and public health impacts of new HIV therapies. New York, NY: Kluwer/Plenum Academic Press.

    Google Scholar 

  • Ostrow, D. G., McKirnan, D. J., & Vanable, P. A. (2005). The impact of new combination HIV therapies on knowledge, attitude and behaviors among Chicago gay men. 12th World AIDS Conference, Geneva, Switzerland.

  • Parsons, J. T., Schrimshaw, E. W., Wolitski, R. J., Halkitis, P. N., Purcell, D. W., Hoff, C. C., & Gomez, C. A. (2005). Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation. AIDS, 19(Suppl 1), S13–S25.

    Article  PubMed  Google Scholar 

  • Scheer, S., Chu, P. L., Klausner, J. D., Katz, M. H., & Schwarcz, S. K. (2001). Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS. Lancet, 357, 432–435.

    Article  CAS  PubMed  Google Scholar 

  • Shernoff, M. (2005). Without condoms: Unprotected sex, gay men & barebacking. New York, NY: Routledge.

    Google Scholar 

  • Smith, S. M. (2005). New York City HIV superbug: fear or fear not? Retrovirology, 2, 14.

    Article  PubMed  Google Scholar 

  • Stephenson, J. M., Imrie, J., Davis, M. M., Mercer, C., Black, S., Copas, A. J., Hart, G. J., Davidson, O. R., & Williams, I. G. (2003). Is use of antiretroviral therapy among homosexual men associated with increased risk of transmission of HIV infection? Sexually Transmitted Infections, 79, 7–10.

    Article  CAS  PubMed  Google Scholar 

  • Stolte, I. G., de Wit, J. B., van Eeden, A., Coutinho, R. A., & Dukers, N. H. (2004). Perceived viral load, but not actual HIV-1-RNA load, is associated with sexual risk behaviour among HIV-infected homosexual men. AIDS, 18, 1943–1949.

    Article  PubMed  Google Scholar 

  • Tongeren, J. V., & Madison, K. (2004). Partnering HIV treatment with HIV prevention. International Antiviral Therapy Evaluation Center (IATEC) Update 7.

  • Tun, W., Celentano, D. D., Vlahov, D., & Strathdee, S. A. (2003). Attitudes toward HIV treatments influence unsafe sexual and injection practices among injecting drug users. AIDS, 17, 1953–1962.

    Article  PubMed  Google Scholar 

  • US Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Rockville, MD: HIV/AIDS Treatment Information Service (Accessed: 10/29/2004) Available at:

  • Van de Ven, P., Crawford, J., Kippax, S., Knox, S., & Prestage, G. (2000). A scale of optimism-scepticism in the context of HIV treatments. AIDS Care, 12, 171–176.

    Article  PubMed  Google Scholar 

  • Van de Ven, P., Kippax, S., Knox, S., Prestage, G., & Crawford, J. (1999). HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne. AIDS, 13, 2289–2294.

    Article  PubMed  Google Scholar 

  • Vanable, P. A., Ostrow, D. G., & McKirnan, D. J. (2003). Viral load and HIV treatment attitudes as correlates of sexual risk behavior among HIV-positive gay men. Journal of Psychosomatic Research, 54, 263–269.

    Article  PubMed  Google Scholar 

  • Vanable, P. A., Ostrow, D. G., McKirnan, D. J., Taywaditep, K. J., & Hope, B. A. (2000). Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health psychology, 19, 134–145.

    Article  CAS  PubMed  Google Scholar 

  • Wainberg, M. A., & Friedland, G. (1998). Public health implications of antiretroviral therapy and HIV drug resistance. Journal of the American Medical Association, 279, 1977–1983.

    Article  CAS  PubMed  Google Scholar 

  • Wilson, T., Feldman, J., Vega, M., Gandhi, M., Richardson, J., Cohen, M., McKaig, R., Ostrow, D., & Gange S. (2007). Acquisition of new sexual partners among women with HIV-infection: Patterns of disclosure and sexual behavior with new partnerships. AIDS Education and Prevention, 19, 151–159.

    Google Scholar 

  • Xiridou, M., Geskus, R., De Wit, J., Coutinho, R., & Kretzschmar, M. (2003). The contribution of steady and casual partnerships to the incidence of HIV infection among homosexual men in Amsterdam. AIDS, 17, 1029–1038.

    Article  PubMed  Google Scholar 

Download references


The development of the Men’s Attitude Survey (the MAS) was made possible by a National Institutes of Mental Health supplemental grant (Drs. Willo Pequenot and Ellen Stover, Project Officers, NIMH) to the first author’s National Institute of Drug Abuse-funded “Awareness Intervention for Men” project (R01-DA-01-09944, Dr Richard Needle, Project Officer) and the thousands of gay/bisexual men who volunteered to participate in the yearly Halsted Street Market Days surveys in Chicago between 1997 and 2000. We wish to acknowledge the assistance and scientific input of Dr. Ostrow’s AIM collaborators in this effort, namely, David McKirnan, PhD, Peter Vanable, PhD, and Brent Hope, MS. The Multicenter AIDS Cohort Study (MACS) includes the following: Baltimore: The Johns Hopkins University, Bloomberg School of Public Health: Joseph B. Margolick (Principal Investigator), Haroutune Armenian, Barbara Crain, Adrian Dobs, Homayoon Farzadegan, Joel Gallant, John Hylton, Lisette Johnson, Shenghan Lai, Justin McArthur, Ned Sacktor, Ola Selnes, James Shepard, Chloe Thio. Chicago: Howard Brown Health Center, Feinberg School of Medicine, Northwestern University, and Cook County Bureau of Health Services: John P. Phair (Principal Investigator), Joan S. Chmiel (Co-Principal Investigator), Sheila Badri, Bruce Cohen, Craig Conover, Eileen Martin, Maurice O’Gorman, David Ostrow, Frank Palella, Daina Variakojis, Steven M. Wolinsky. Los Angeles: University of California, UCLA Schools of Public Health and Medicine: Roger Detels (Principal Investigator), Barbara R. Visscher (Co-Principal Investigator), Aaron Aronow, Robert Bolan, Elizabeth Breen, Anthony Butch, Thomas Coates, Rita Effros, John Fahey, Beth Jamieson, Otoniel Martínez-Maza, Eric N. Miller, John Oishi, Paul Satz, Harry Vinters, Dorothy Wiley, Mallory Witt, Otto Yang, Stephen Young, Zuo Feng Zhang. Pittsburgh: University of Pittsburgh, Graduate School of Public Health: Charles R. Rinaldo (Principal Investigator), Lawrence Kingsley (Co-Principal Investigator), James T. Becker, Robert L. Cook, Robert W. Evans, John Mellors, Sharon Riddler, Anthony Silvestre. Data Coordinating Center: The Johns Hopkins University Bloomberg School of Public Health: Lisa P. Jacobson (Principal Investigator), Alvaro Muñoz (Co-Principal Investigator), Haitao Chu, Stephen R. Cole, Christopher Cox, Stephen J. Gange, Janet Schollenberger, Eric C. Seaberg, Sol Su. Website located at NIH: National Institute of Allergy and Infectious Diseases: Robin E. Huebner; National Cancer Institute: Geraldina Dominguez; National Heart, Lung and Blood Institute: Cheryl McDonald.

Author information

Authors and Affiliations


Corresponding author

Correspondence to David G. Ostrow.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ostrow, D.G., Silverberg, M.J., Cook, R.L. et al. Prospective Study of Attitudinal and Relationship Predictors of Sexual Risk in the Multicenter AIDS Cohort Study. AIDS Behav 12, 127–138 (2008).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: