Correspondence

Are Advances in Treatment Changing Views about High-Risk Sex?

N Engl J Med 1997; 337:501-502August 14, 1997

Article

To the Editor:

Recent advances in the treatment of human immunodeficiency virus (HIV) disease 1 have raised considerable hope for people living with HIV, as well as for those at risk of infection.2 These advances also pose potential new public health problems, because they may influence risky sexual behavior.

We recruited 54 men who have sex with men (average age, 32 years; 72 percent were white, 7 percent Asian, 6 percent biracial, 4 percent black, 4 percent Latino, and 7 percent from other races or ethnic groups) to participate in an intervention counseling study. Basing our study on earlier work that identified rationalizations used for engaging in risky sexual behavior,3 we attempted to help these men modify their thinking and change their high-risk behavior. The participants were recruited when they called to schedule an appointment for HIV testing, if they reported having engaged in unprotected anal intercourse within the past 12 months and if they had previously tested negative for HIV antibodies at least once.

The interviews confirmed that for most participants, information about the “new treatments” did not reduce their level of concern about infection or their perception of the risk of infection (Table 1Table 1Perceptions by 54 Gay Men of How the New Treatments Affect Their Risk of HIV Infection through High-Risk Sexual Behavior.). Nevertheless, 26 percent suggested that they were “less concerned about becoming HIV-positive” because of the new treatments. Also, 13 percent “somewhat” or “strongly” agreed with the statement “I am more willing to take a chance of getting infected when having sex,” and 15 percent stated that they had already taken such a chance. In addition, 4 of 22 men responding to a separate questionnaire (18 percent) reported that at the time of their high-risk sexual encounter, to a moderate degree they had had the thought, “If I am exposed to HIV, I can take the new drugs [protease inhibitors, sometimes known as the “cocktail”] that will prevent me from becoming infected.” These data were collected before the program of postexposure treatment planned by the San Francisco Department of Public Health became publicly available.2

Our findings suggest that recent advances in treatment are affecting the sexual decision making of some high-risk, HIV-negative gay men. The degree to which changes in thinking will become more widespread with greater advances in treatment is unknown, but efforts at prevention must address the altered perceptions of risk that result from the improved treatments for HIV disease.

James W. Dilley, M.D.
William J. Woods, Ph.D.
William McFarland, M.D., Ph.D., M.P.H.
University of California, San Francisco, San Francisco, CA 94143-0884

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