Attitudes Toward HIV Treatments Influence Unsafe Sexual and Injection Practices Among Injecting Drug Users

The current study assesses attitudes of injection drug users toward HIV infection, HIV treatments and HIV-related risk behaviors and their association with risky sexual and injection practices, and whether HAART has altered HIV risk perceptions.

The researchers administered a questionnaire to IDUs participating in a cohort study (AIDS Link to Intravenous Experiences -- ALIVE) between December 2000 and July 2001 in Baltimore. The questionnaire accessed attitudes toward HIV treatment and risk behaviors including perceived HIV transmissibility through unprotected sex and needle sharing, safer sex and injection fatigue. Participants whose data were analyzed comprised 593 HIV-negative subjects and 338 HIV-positive subjects. The authors used logistic regression to examine the role of attitudinal factors on needle sharing and unsafe sex.

The investigators found that almost two-thirds of sexually active study participants had unprotected sex, and almost half of those injecting drugs shared needles. In HIV-positive IDUs, perception of reduced HIV transmissibility through unprotected sex was significantly associated with unprotected sex.

"One of the most striking findings of this study was the differential finding among HIV-seropositive and -seronegative participants in the association between beliefs about HIV transmissibility and unprotected sex," the authors noted. "The belief in reduced HIV transmissibility through unprotected sex was strongly associated with unprotected sex among HIV-seropositive individuals, but no association was observed among HIV-seronegative IDU[s]. This suggests that HAART may have critically influenced sexual behaviors among those living with HIV."

Safer injection fatigue was independently associated with needle sharing among HIV-positive IDUs. Among HIV-negative IDUs, only safer sex fatigue and safer injection fatigue were independently associated with unprotected sex and needle sharing.

"Among HIV-seropositive IDU[s], perceiving that HIV treatments reduce HIV transmission was significantly associated with unprotected sex. Risk reduction fatigue was strongly associated with unsafe sexual and injection behaviors among HIV-seronegative individuals," the authors wrote. "Given that HIV-infected individuals are living healthier and longer lives due to HIV treatments, interventions need to focus on educating high-risk populations of the need for continued safer sexual and injection practices regardless of effective HIV treatments. Additionally, issues of risk-reduction fatigue need to be initiated by clinicians who provide care to HIV-infected individuals."

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