Better AIDS Treatment but More Risky Sex

HIV Seen as Less Threatening with New Drug Advances, Leading More to Unsafe Sex

From the WebMD Archives

Sept. 16, 2003 -- Advances in the treatment of AIDS have lulled many people -- HIV infected or not -- into a false sense of security, but there's a very real risk of danger.

Two new studies published this month suggest that more people are engaging in unsafe sex and other behaviors, under the mistaken belief that newer medications make HIV infection less lethal.

In one report, a review of six previous studies assessing how newer HIV drug treatments have impacted behavior, researcher Craig Demmer, EdD, CHES, finds that more people now believe having unprotected sex is less risky. As a result, they're less likely to practice safe sex.

"And we see very little difference in this attitude, whether they are HIV-infected or uninfected," he tells WebMD of his analysis, published in the September issue of Health Promotion Practice.

"People believe that HIV is less fatal and not as easily transmissible because of the new treatments. But what they don't realize is that these new treatments have failure rates of anywhere between 15% and 60%."

Risky Sex Becoming More Common

After reviewing six previous studies -- including two of his own -- Demmer finds that overall, about one in three people surveyed admit to no longer practicing safe sex because they believe newer drugs will protect them from the devastation of AIDS.

"In researching other studies, I'm finding an even higher occurrence of unsafe sex and `condom fatigue' among infected gay men. Some estimates are that up to half of those infected with HIV have not used condoms in the last six months," says Demmer, associate professor of health education at Lehman College of the City University of New York.

In the other study, published in the Sept. 5 issue of the journal AIDS, a survey of 930 intravenous drug users produced remarkably similar findings: One in three admit to Johns Hopkins researchers that they are "tired" of having to always practice safe sex or make sure they don't share needles to shoot up. In fact, this "fatigue" was slightly higher among HIV-positive addicts than those without the AIDS-causing infection.

"We did our study because we heard on the street that people were relaxing their AIDS prevention strategies because they think they are safer because of the improved treatments," says researcher David D. Celentano, PhD, director of infectious disease epidemiology at Hopkins' Bloomberg School of Public Health.

"Frankly, I'm a little surprised that the HIV-infected folks were as likely, or even a little more likely, to demonstrate these shifts in attitudes. But the general opinion is that people think that HIV is becoming something of a chronic disease that can easily be managed with medication. In reality, these drugs make you sick as a dog."

While there's no denying that newer treatment drugs developed since the mid-1990s have slowed the skyrocketing AIDS-related death rate, these two studies suggest they're getting more credit that they have shown, resulting in a need for revamping the current mindset that serves as the cornerstone of most HIV and AIDS prevention programs.

"The emphasis in the last 20 years has been to prevent HIV with safe sex and needle use, but everybody knows they should wear a condom and not share needles," says Demmer. "Yet knowledge and behavior are two different things. What these people really need is to get accurate facts about treatments.

AIDS Deaths on the Rise

"These newer drugs have slowed the mortality rate, but it's starting to increase again. They are not a cure-all, and we know they never were. But the general population doesn't know that."

AIDS has already killed close to 500,000 Americans in the past two decades, and over 800,000 have been infected with the AIDS virus. Even with these newer drugs, about 20,000 people die from AIDS in the U.S. each year.

"There definitely have been changes in terms of risk behaviors -- groups that have been practicing safer sex are lapsing into unsafe patterns of behavior. And there definitely needs to be changes in AIDS prevention messages," says Seth Kalichman, PhD, social psychologist and longtime AIDS researcher at the University of Connecticut.

"There is a misbelief that people aren't likely to get infected and if they are, it's not as big a deal. And there are other misconceptions and false beliefs about being protected, like that they're OK because their partner looks healthy or that they've known this person for six months, so there's no way they'd have HIV. I think the problem is that HIV and AIDS has moved from the front burner. We have to revamp the message and get AIDS prevention back on the front burner again."

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SOURCES: Demmer, C. Health Promotion Practice, September 2003. Waimar, T. AIDS, Sept. 5, 2003; vol 17: pp 1953-1962. Craig Demmer, EdD, CHES, associate professor, health education, Lehman College of the City University of New York, New York City. David D. Celentano, PhD, professor, director, infectious disease epidemiology, Johns Hopkins' Bloomberg School of Public Health, Baltimore, Md. Seth Kalichman, PhD, professor of psychology, University of Connecticut, Storrs-Mansfield, Conn.
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