Enhanced Treatments, Access to Care Reduce High-Risk Behaviors Among Men With HIV

People newly infected and diagnosed with HIV know the consequences they face and the risks ahead for themselves and others, a new study published on October 15 in the journal AIDS suggests.

Investigators from the department of Health Care Policy at Harvard Medical School and the Boston University School of Public Health—who are actively engaged in a number of projects designed to assess changes in certain at-risk behaviors among those undergoing treatment for the virus—analyzed changes in health and HIV risk behaviors among 4000-plus men who have sex with men following their seroconversion, and both before and after they started receiving treatment. The cases included in the analysis were gathered from participants in the Multicenter AIDS Cohort Study, and included subjects from 4 US cities diagnosed between 1984 and 2008.

“In the early days of the AIDS epidemic, there was clearly a lot of fear surrounding the virus, and the fact that effective treatments were lacking certainly contributed to that fear,” explained study co-author Angela R Bazzi, PhD, MPH, assistant professor, Community Health Sciences, Boston University School of Public Health in an interview with Contagion®. “Men in this highly affected population played a critical role in advocacy for improved treatment research and access. But even once effective therapies became available, it was another couple of decades before the research on treatment as prevention made it clear that taking treatment consistently can stop onward HIV transmission.”

Indeed, the work of Dr. Bazzi and colleagues spans the key years of evolution in HIV management, and their findings arguably reflect that. They performed longitudinal regression analyses with “individual fixed effects accounted for time-invariant, unobservable determinants of risk behaviors,” while they also assessed the “sensitivity” of their findings to “control for indicators of physical and mental health such as CD4 count and depression,” study authors wrote.

Notably, the investigators found that the 558 men with HIV who experienced seroconversion during the study’s observation period were less likely to engage in sex with 2 or more partners (adjusted odds ratio [aOR]: 0.371), participate in insertive anal sex with 2 or more partners (aOR: 0.360), and/or drink heavily (aOR: 0.704). Of course, at least historically, alcohol and/or recreational drug use has been associated with a greater tendency to engage in other risk behaviors.

“Our historical data precede this evidence and recent ‘U=U’ messaging—meaning: that achieving an undetectable viral load enables a patient to be untransmissible,” Dr. Bazzi noted. “So, it is possible that some of the attitudes around treatment are different—and even more positive—today, at least for those who have access to this new information. While it is also possible that condomless sex could increase following this messaging, other factors (like hope, linkage to care, and counseling) could offset those changes. We need rigorous research with newer data to answer these questions more accurately.”

Still, the findings of Dr. Bazzi et al suggest that enhanced treatment options for HIV have had a positive impact as well. Overall, the authors found that men who experienced seroconversion following the advent of antiviral therapy (circa 1996) and received treatment were even more likely to reduce risk behaviors. For example, their analysis showed that seroconversion after 1996 was associated with further reduced odds of insertive anal sex with 2 or more partners (aOR: 0.219 vs 0.411 before 1996). Interestingly, though, study subjects’ CD4 count and/or the presence of depression did not yield significant changes.

“In addition to saving lives, having access to effective HIV treatments improves a range of health behaviors among patients living with HIV,” Dr. Bazzi said. “We can’t show definitely why these health behaviors improved, but… treatment access (and actual use) may have provided men with a ‘new lease on life’ and sense of hope about surviving into the future. Second, getting on treatment also involves being linked to clinical care, which provides opportunities for education and counseling on HIV and general health. Whether either or both of these explanations are true, our findings clearly show that access to effective, life-saving HIV treatment positively impacted health behaviors.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.