HIV Optimism and High-Risk Sexual Behavior in Two Cohorts of Men Who Have Sex With Men

Abstract

en who have sex with men (MSM) account for76.3% of the HIV cases in Canada since HIV-reporting began in 1985 (Public Health Agency ofCanada, 2007). There has been a recent increase inunprotected anal intercourse (UAI) among MSMboth in the United States and Canada, which seemsto have occurred soon after the advances in antiretro-viral therapy (ART; George et al., 2006; Katz et al.,2002; Stolte, Dukers, Geskus, Coutinho, & de Wit,2004). HIV optimismdthe term given for a set ofbeliefs that ART has made HIV less of a healththreatdhas been found to be associated with HIVsexual risk behavior among MSM in a recent meta-analysis (Crepaz, Hart, & Marks, 2004), as well asin other studies on MSM (e.g., Cox, Beauchemin, A Peterson & Bakeman, 2006).However, several problems exist regarding thesupport for HIVoptimism as a current risk factor forUAI among MSM. Advances in ART, which havetransformed HIVinto a chronic and treatable disease(Sepkowitz, 2001), have been available in NorthAmerica since 1996 (Wynn, Zapor, & Smith, 2004).In the meantime, concerns that HIV optimism maynot be an important risk factor have emerged becauseofphenomenasuchasstrategicpositioning,wheretheuninfectedpartneristheinsertivepartnerandtheHIV-infected partner is the receptive partner during UAI(Prestage et al., 2005). Second, although evidencesuggests the need to examine the type of sexualpartners in studies on HIV optimism (Cox et al.,2004; Kalichman et al., 2006; Sepkowitz, 2001), fewstudies on HIVoptimism have examined the type ofsexual position, whether the participant’s partnersare HIV seroconcordant or serodiscordant with theparticipant, or controlled for HIV status of theparticipant. Finally, it is unclear whether HIVoptimism would be associated with sexual riskbehavior among MSM in Canada, as Canadianstudies have produced divergent findings regardingHIV optimism and sexual risk behavior (Cox et al.,2004; International Collaboration on HIV Optimism,2003).The primary aim of this study was to examinewhether HIV optimism was associated with UAIamong nonconcordant partners (NC partners: part-ners who are believed to be either of serodiscordant