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Where Does Treatment Optimism Fit in? Examining Factors Associated with Consistent Condom Use Among People Receiving Antiretroviral Treatment in Rio de Janeiro, Brazil

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Abstract

In the era of highly active antiretrovirals, people living with HIV (PLWH) have resumed sexual activity in the context of longer and healthier lives, and thus the chances of transmitting the HIV virus, as well as the potential to be re-infected also increase. HIV treatment optimism has been found to be associated with sexual risk behaviors among PLWH in different settings. A cross sectional survey was conducted to examine the relationship between treatment optimism, safer sex burnout and consistent condom use as well as variables associated with treatment optimism in a sample of PLWH on antiretrovirals (ARVs) in Rio de Janeiro, Brazil (n = 604). Seventy-two percent of participants always used a condom in the last 6 months. Homosexual, bisexual, transexual persons were less likely to use condoms consistently than heterosexuals (AOR .58 CI .42–.78). Those who were treatment optimistic (AOR .46 CI .25–.88) were more likely not use a condom consistently in the past 6 months, as were participants who reported safer sex burnout (AOR .58 CI .36–.90). Sexual orientation, safer sex burnout, and lower education levels were significantly associated with higher treatment optimism in multivariate analysis. Study findings highlight the need to address psychosocial factors such as treatment optimism and safer sex burnout associated with lower consistent condom use among PLWH in Rio de Janeiro, Brazil.

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References

  1. Weidle PJ, Holmberg SD, DeCock KM. Changes in HIV and AIDS epidemiology from new generation antiretroviral therapy. AIDS. 1999;13(Suppl A):S61–8.

    PubMed  CAS  Google Scholar 

  2. Lee TS, Liang JN, Michaels L, Wright A. The epidermoid formation and its affinity to congenital cholesteatoma. Clin Otolaryngol Allied Sci. 1998;23(5):449–54.

    Article  PubMed  CAS  Google Scholar 

  3. Hogg RS, Heath KV, Yip B, Craib KJ, O’Shaughnessy MV, Schechter MT, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279(6):450–4.

    Article  PubMed  CAS  Google Scholar 

  4. Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV outpatient study investigators. N Engl J Med. 1998;338(13):853–60.

    Article  PubMed  Google Scholar 

  5. May MT, Ingle SM. Life expectancy of HIV-positive adults: a review. Sex Health. 2011;8(4):526–33.

    Article  PubMed  Google Scholar 

  6. van Kesteren NM, Hospers HJ, Kok G. Sexual risk behavior among HIV-positive men who have sex with men: a literature review. Patient Educ Couns. 2007;65(1):5–20.

    Article  PubMed  Google Scholar 

  7. Elford J, Bolding G, Davis M, Sherr L, Hart G. Trends in sexual behaviour among London homosexual men 1998–2003: implications for HIV prevention and sexual health promotion. Sex Transm Infect. 2004;80(6):451–4.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. Chen SY, Gibson S, Katz MH, Klausner JD, Dilley JW, Schwarcz SK, et al. Continuing increases in sexual risk behavior and sexually transmitted diseases among men who have sex with men: San Francisco, CA, USA 1999–2001. Am J Public Health. 2002;92(9):1387–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Katz MH, Schwarcz SK, Kellogg TA, Klausner JD, Dilley JW, Gibson S, et al. Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men: San Francisco. Am J Public Health. 2002;92(3):388–94.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Stolte IG, Dukers NH, de Wit JB, Fennema JS, Coutinho RA. Increase in sexually transmitted infections among homosexual men in Amsterdam in relation to HAART. Sex Transm Infect. 2001;77(3):184–6.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  11. Taylor S, Davies S. Antiretroviral drug concentrations in the male and female genital tract: implications for the sexual transmission of HIV. Curr Opin HIV AIDS. 2010;5(4):335–43.

    Article  PubMed  Google Scholar 

  12. Cohen MS, Hosseinipour M, Kashuba A, Butera S. Use of antiretroviral drugs to prevent sexual transmission of HIV. Curr Clin Top Infect Dis. 2002;22:214–51.

    PubMed  Google Scholar 

  13. Cohen. HIV and sexually transmitted diseases: lethal synergy. Top HIV Med. 2004;12(4):104–7.

    PubMed  Google Scholar 

  14. Kalichman SC, Pellowski J, Turner C. Prevalence of sexually transmitted co-infections in people living with HIV/AIDS: systematic review with implications for using HIV treatments for prevention. Sex Transm Infect. 2011;87(3):183–90.

    Article  PubMed  Google Scholar 

  15. Kalichman SC, Di Berto G, Eaton L. Human immunodeficiency virus viral load in blood plasma and semen: review and implications of empirical findings. Sex Transm Dis. 2008;35(1):55–60.

    Article  PubMed  Google Scholar 

  16. Bezemer D, de Wolf F, Boerlijst MC, van Sighem A, Hollingsworth TD, Prins M, et al. A resurgent HIV-1 epidemic among men who have sex with men in the era of potent antiretroviral therapy. AIDS. 2008;22(9):1071–7.

    Article  PubMed  CAS  Google Scholar 

  17. Law MG, Prestage G, Grulich A, Van de Ven P, Kippax S. Modelling the effect of combination antiretroviral treatments on HIV incidence. AIDS. 2001;15(10):1287–94.

    Article  PubMed  CAS  Google Scholar 

  18. Blower SM, Gershengorn HB, Grant RM. A tale of two futures: HIV and antiretroviral therapy in San Francisco. Science. 2000;287(5453):650–4.

    Article  PubMed  CAS  Google Scholar 

  19. Gray RH, Li X, Wawer MJ, Gange SJ, Serwadda D, Sewankambo NK, et al. Stochastic simulation of the impact of antiretroviral therapy and HIV vaccines on HIV transmission; Rakai, Uganda. AIDS. 2003;17(13):1941–51.

    Article  PubMed  Google Scholar 

  20. Rowniak S. Safe sex fatigue, treatment optimism, and serosorting: new challenges to HIV prevention among men who have sex with men. J Assoc Nurses AIDS Care. 2009;20(1):31–8.

    Article  PubMed  Google Scholar 

  21. Stolte IG, de Wit JB, Kolader M, Fennema H, Coutinho RA, Dukers NH. Association between ‘safer sex fatigue’ and rectal gonorrhea is mediated by unsafe sex with casual partners among HIV-positive homosexual men. Sex Transm Dis. 2006;33(4):201–8.

    PubMed  Google Scholar 

  22. International Collaboration on HIV Optimism. HIV treatments optimism among gay men: an international perspective. J Acquir Immune Defic Syndr. 2003;32(5):545–50.

    Article  Google Scholar 

  23. DE Ostrow, Fox KJ, Chmiel JS, Silvestre A, Visscher BR, Vanable PA, et al. Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men. AIDS. 2002;16(5):775–80.

    Article  PubMed  Google Scholar 

  24. Van de Ven P, Prestage G, Crawford J, Grulich A, Kippax S. Sexual risk behaviour increases and is associted with HIV optimism among HIV-negative and HIV-positive gay men in Sydney over the 4 year period to February 2000. AIDS. 2000;14(18):2951–3.

    Article  PubMed  Google Scholar 

  25. Kalichman SC, Eaton L, Cain D, Cherry C, Fuhrel A, Kaufman M, et al. Changes in HIV treatment beliefs and sexual risk behaviors among gay and bisexual men, 1997–2005. Health Psychol. 2007;26(5):650–6.

    Article  PubMed  Google Scholar 

  26. Kalichman SC, Nachimson D, Cherry C, Williams E. AIDS treatment advances and behavioral prevention setbacks: preliminary assessment of reduced perceived threat of HIV-AIDS. Health Psychol. 1998;17(6):546–50.

    Article  PubMed  CAS  Google Scholar 

  27. Brennan DJ, Welles SL, Miner MH, Ross MW, Rosser BR. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kerrigan D, Bastos FI, Malta M, Carneiro-da-Cunha C, Pilotto JH, Strathdee SA. The search for social validation and the sexual behavior of people living with HIV in Rio de Janeiro, Brazil: understanding the role of treatment optimism in context. Soc Sci Med. 2006;62(10):2386–96.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  30. Malta M, Magnanini MM, Mello MB, Pascom AR, Linhares Y, Bastos FI. HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: a systematic review and meta-analysis. BMC Public Health. 2010;10:317.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Guimaraes MD, Grinsztejn B, Chin-Hong PV, Campos LN, Gomes VR, Melo VH, et al. Behavior surveillance: prevalence and factors associated with high-risk sexual behavior among HIV-infected men in Brazil in the post-HAART era. AIDS Behav. 2008;12(5):741–7.

    Article  PubMed  Google Scholar 

  32. Guimaraes MD, Boschi-Pinto C, Castilho EA. Safe sexual behaviour among female partners of HIV-infected men in Rio de Janeiro, Brazil. Int J STD AIDS. 2001;12(5):334–41.

    Article  PubMed  CAS  Google Scholar 

  33. Yeganeh N, Varella I, Santos BR, Goncalves de Melo M, Simon M, Melo T, et al. Risk-taking behavior for HIV acquisition during pregnancy in Porto Alegre, Brazil. Infect Dis Obstet Gynecol. 2012;2012:490686.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Remien RH, Bastos FI, Jnr VT, Raxach JC, Pinto RM, Parker RG, et al. Adherence to antiretroviral therapy in a context of universal access, Rio de Janeiro, Brazil. AIDS Care. 2007;19(6):740–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  35. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.

    Article  PubMed  CAS  Google Scholar 

  36. Campos LN, Guimaraes MD, Remien RH. Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil. AIDS Behav. 2010;14(2):289–99.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Dagnan D, Chadwick P, Trower P. Psychometric properties of the hospital anxiety and depression scale with a population of members of a depression self-help group. Br J Med Psychol. 2000;73(Pt 1):129–37.

    Article  PubMed  Google Scholar 

  38. Van de Ven P, Crawford J, Kippax S, Knox S, Prestage G. A scale of optimism-scepticism in the context of HIV treatments. AIDS Care. 2000;12(2):171–6.

    Article  PubMed  Google Scholar 

  39. Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwick DBB. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. AIDS Care. 2000;12(3):255–66.

    Article  PubMed  CAS  Google Scholar 

  40. StataCorp. Stata Statistical Software: Release 11. College Station: StataCorp LP; 2009.

  41. Rogers W. sg17: regression standard errors in clustered samples. Stata Tech Bull. 1993;13:19–23.

    Google Scholar 

  42. Williams RL. A note on robust variance estimation for cluster-correlated data. Biometrics. 2000;56:645–6.

    Article  PubMed  CAS  Google Scholar 

  43. Van de Ven P, Kippax S, Knox S, Prestage G, Crawford J. HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne. AIDS. 1999;13(16):2289–94.

    Article  PubMed  Google Scholar 

  44. Remien RH, Halkitis PN, O’Leary A, Wolitski RJ, Gomez CA. Risk Perception and sexual risk behaviors among HIV-positive men on antiretroviral therapy. AIDS Behav. 2005;9(2):167–76.

    Article  PubMed  Google Scholar 

  45. Dukers NH, Goudsmit J, de Wit JB, Prins M, Weverling GJ, Coutinho RA. Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS. 2001;15(3):369–78.

    Article  PubMed  CAS  Google Scholar 

  46. Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior: a meta-analytic review. JAMA. 2004;292(2):224–36.

    Article  PubMed  CAS  Google Scholar 

  47. Huebner DM, Rebchook GM, Kegeles SM. A longitudinal study of the association between treatment optimism and sexual risk behavior in young adult gay and bisexual men. J Acquir Immune Defic Syndr. 2004;37(4):1514–9.

    Article  PubMed  Google Scholar 

  48. Ostrow DG, Silverberg MJ, Cook RL, Chmiel JS, Johnson L, Li X, et al. Prospective study of attitudinal and relationship predictors of sexual risk in the multicenter AIDS cohort study. AIDS Behav. 2008;12(1):127–38.

    Article  PubMed  Google Scholar 

  49. Murray LR, Garcia J, Munoz-Laboy M, Parker RG. Strange bedfellows: the Catholic Church and Brazilian National AIDS Program in the response to HIV/AIDS in Brazil. Soc Sci Med. 2011;72(6):945–52.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Hart GJ, Elford J. Sexual risk behaviour of men who have sex with men: emerging patterns and new challenges. Curr Opin Infect Dis. 2010;23(1):39–44.

    Article  PubMed  Google Scholar 

  51. Snowden JM, Raymond HF, McFarland W. Prevalence of seroadaptive behaviours of men who have sex with men, San Francisco, 2004. Sex Transm Infect. 2009;85(6):469–76.

    Article  PubMed  CAS  Google Scholar 

  52. Kalichman SC, Cherry C, Amaral CM, Swetzes C, Eaton L, Macy R, et al. Adherence to antiretroviral therapy and HIV transmission risks: implications for test-and-treat approaches to HIV prevention. AIDS Patient Care STDS. 2010;24(5):271–7.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Joseph HA, Flores SA, Parsons JT, Purcell DW. 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(1):29–39.

    Article  PubMed  Google Scholar 

  54. Flaks RC, Burman WJ, Gourley PJ, Rietmeijer CA, Cohn DL. HIV transmission risk behavior and its relation to antiretroviral treatment adherence. Sex Transm Dis. 2003;30(5):399–404.

    Article  PubMed  Google Scholar 

  55. Siegel K, Lekas HM. AIDS as a chronic illness: psychosocial implications. AIDS. 2002;16(Suppl 4):S69–76.

    PubMed  Google Scholar 

  56. Ramrakha S, Caspi A, Dickson N, Moffitt TE, Paul C. Psychiatric disorders and risky sexual behaviour in young adulthood: cross sectional study in birth cohort. BMJ. 2000;321(7256):263–6.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  57. Parsons JT, Halkitis PN, Wolitski RJ, Gomez CA. Correlates of sexual risk behaviors among HIV-positive men who have sex with men. AIDS Educ Prev. 2003;15(5):383–400.

    Article  PubMed  Google Scholar 

  58. Guimaraes MD, McKinnon K, Campos LN, Melo AP, Wainberg M. HIV risk behavior of psychiatric patients with mental illness: a sample of Brazilian patients. Rev Bras Psiquiatr. 2010;32(4):351–60.

    Article  PubMed  Google Scholar 

  59. Nduna M, Jewkes RK, Dunkle KL, Shai NP, Colman I. Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape, South Africa. J Int AIDS Soc. 2010;13:44.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank the patients in Rio de Janeiro for their participation in this study and acknowledge The Rio Collaborative Group: Betina Durovni & Rosa Domingues (Municipal Secretariat of Health); Louise Schilkowsky, Lia Adler Cherman, Rosane Messias da Silva, Paulo Roberto N. dos Santos, Naja da Silva Reis, Maria Isabel F. Lima (on behalf of the network of health units); Thais Garcia & Diego Pacheco (field coordinators) and participating clinicians and staff at the study clinics. The study was funded by the Ford Foundation, Brazil office.

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Authors and Affiliations

  1. Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Homaira Hanif & Peter J. Winch

  2. Department of Health Information, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

    Francisco I. Bastos & Neilane Bertoni

  3. Department of DCS/ENSP, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

    Monica Malta

  4. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Deanna Kerrigan

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  1. Homaira Hanif
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  2. Francisco I. Bastos
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Correspondence to Homaira Hanif.

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Hanif, H., Bastos, F.I., Malta, M. et al. 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 18, 1945–1954 (2014). https://doi.org/10.1007/s10461-014-0711-5

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