HIV Treatment Optimism Among Gay Men: An International Perspective
May 22, 2003
The 1996 11th International Conference on AIDS in Vancouver, British Columbia, Canada, represented a turning point in the treatment of HIV infection with the reporting of new drugs, when given in combination, that can substantially reduce viral load. This in turn has reduced the death rate associated with HIV infection and AIDS by a factor of less than or equal to five.
No sooner had the scientists announced their breakthrough than had the discussion turned towards the implications for HIV prevention in gay men. Prior to Vancouver, HIV/AIDS treatment achieved only moderate success and considered for all intents and purposes incurable, disabling, and in most cases fatal. Faced with this reality, fear of AIDS may have acted as a check on gay men's sexual behavior. When effective treatments became available (HAART), there was concern that fear of AIDS may dissipate to be replaced by "HIV optimism" and that optimism could create complacency around safer sexual practices among gay men.
Considering that HAART has been available in industrialized countries for five years, the authors pose three fundamental questions. First, to what extent are gay men optimistic in the light of the new HIV drug therapies? Second, does the level of optimism among gay men vary between communities? Third, what is the association between HIV optimism and sexual risk behavior? The objective of this investigation was to examine HIV optimism among gay men in four industrialized countries using a standard scale.
Between January and December 2000, gay men were surveyed in Australia (Sydney and Melbourne, n=3,120), Canada (Vancouver, n=357), England (London, n=690), and France (Paris, n=1,715) by means of self-administered questionnaires. In London, Paris, and Sydney/Melbourne, men were surveyed as part of a behavioral surveillance program, while men in Vancouver were enrolled in a cohort study. Information was collected on HIV status, sexual behavior, and responses to a four-item HIV optimism scale. Possible responses to each item were as follows: strongly disagree,1; disagree,2; agree,3; and strongly agree,4. Agreement indicated optimism in the light of new HIV drug therapies. Total scores could range from a minimum of 4 (strongly disagree on all four items [i.e., not at all optimistic] to a maximum of 16 (strongly agree on all four items [i.e., extremely optimistic]).
Overall mean optimism scores were low (range across cities, 5.1-6.8), indicating that most men disagreed or disagreed strongly with all four statements. In categorical analysis, no more than 20 percent of men in any city agreed with the HIV optimism statements. Mean scores were lowest in Paris (p Of nearly 6,000 gay men surveyed in five major cities in Australia, Canada, England, and France in the year 2000, very few were optimistic in the light of new drug therapies for HIV infection. Far from being optimistic, most gay men appeared to be realistic about the benefits of HAART. Across the four countries, no consistent association emerged between HIV optimism and HIV status, highlighting the heterogeneous nature of gay men's response to new therapies. The authors conclude, "the often-made assumption that gay men's responses to HIV infection and its treatment are universal needs to be reconsidered in the light of the diversity of their responses seen here."
Journal of Acquired Immune Deficiency Syndromes
04.15.03; Vol. 32; No. 5: P. 545-550; City University and Royal Free & University College Medical School, London, England; National Centre in HIV Social Research and National Centre in HIV Epidemiology & Clinical Research, University of New South Wales, Sydney, Australia; British Colombia Centre for Excellence in HIV/AIDS, University of British Colombia, Vancouver, Canada
This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update. Visit the CDC's website to find out more about their activities, publications and services.