Patterns and Correlates of Deliberate Abstinence Among Men and Women With HIV/AIDS

The authors analyzed the HIV Cost and Services Utilization Study data set to assess patterns and correlates of deliberate sexual abstinence among HIV-positive gay/bisexual men, heterosexual men, and women. HCUS examined a representative sample of the adult U.S. population in care for HIV/AIDS.

The researchers hypothesized that gay/bisexual men would be less likely to deliberately abstain than women and heterosexual men, and that attitudinal factors about responsibility for transmission and substance use would be important predictors of abstinence for them. The investigators also hypothesized that physical and mental health functioning and disease progression influence the decision to abstain, regardless of gender or sexual orientation. They controlled for what they considered a likely strong negative association between having a primary relationship partner and deliberate abstinence.

Of the 1,339 HCUS respondents whose data were analyzed, 415 participants reported being sexually inactive in the previous six months. Of those, 201 were deliberately abstinent. More women (18 percent) and heterosexual men (18 percent) were deliberately abstinent than gay/bisexual men (11 percent).

In multivariate analysis, the investigators found that the likelihood of deliberate abstinence was higher among women and heterosexual men, older participants, and those with a stronger sense of responsibility. It was lower among those with a primary relationship partner/spouse, those on antiretroviral therapy, subjects with CD4 counts of 50 or higher, and drinkers.

The researchers found that higher perceived responsibility for limiting disease transmission and non-drinking status were related to deliberate abstinence only among gay men. Worse health was associated with deliberate abstinence only among heterosexual men.

"Perhaps because HIV is more common in gay communities, abstinence choice may be more closely linked to a higher sense of responsibility for reducing transmission among gay/bisexual men, and their illness may be less of an impediment to sexual activity," the authors wrote.

"In a national probability sample, nearly one-fifth of women and heterosexual men, and slightly more than one-tenth of gay/bisexual men, chose to abstain from sexual intercourse, and their reasons varied by gender and sexual orientation," the authors concluded. "Our findings can inform the design of secondary prevention interventions by suggesting one potential strategy to reduce transmission risk that is acceptable to and currently practiced by a substantial proportion of people with HIV."

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