A study of Australian gay men examining unprotected sex and the beliefs that are associated with it has found that the concept of ‘treatments optimism’ needs to be unpacked. While some men do think that having HIV is less serious than it used to be, there is more of an association between unprotected sex and men believing that treatments have made HIV-positive people less infectious.
But writing in the journal Sexually Transmitted Diseases, the researchers warn that the relationships between information, beliefs and behaviour are not straightforward, with individuals managing risk, desire and pleasure in complex ways.
Soon after the advent of combination therapy, commentators began to explain unprotected sex in gay and bisexual men in terms of ‘treatments optimism’ – the theory that reductions in illness and death had caused men to be less concerned about HIV infection, and so more willing to have unprotected sex. While a number of studies have confirmed an association between beliefs characteristic of treatments optimism and risk behaviour, it is unlikely that such beliefs – held by a minority of men – are sufficient to explain rising infection rates in gay men.
Moreover, there has always been controversy over whether treatment optimism leads to unprotected anal sex, or whether it is a way in which men rationalise their sexual behaviour, after the event.
Garrett Prestage and colleagues note that there is an association between ‘HIV transmission optimism’ and risk behaviour in this group of Australian men. However they raise questions about how men come to hold their beliefs about HIV.
The beliefs that men hold about ‘treatments optimism’ or ‘transmission optimism’ can reflect many different things, the researchers suggest. In some cases, beliefs depend on the information men have access to. Similarly, some men’s beliefs are partially based on their own experience of sex or of life with HIV.
In other cases, beliefs are informed by desires: optimistic beliefs about HIV transmission can sit comfortably with a desire to have unprotected sex, while scepticism about reduced infectiousness can reflect an overwhelming desire to avoid transmission. Finally, beliefs are informed by different personal attitudes toward risk. Some men are risk-averse, while others are relatively adventurous and inclined to take risk in the pursuit of pleasure.
“Measures of HIV optimism should be complemented by analysis of the complexities of individuals’ assessments of both risk and pleasure in specific sexual contexts,” they conclude.
Fuente: NAM AIDSmap
Referencia: Prestage G et al. Is Optimism Enough? Gay men’s beliefs about HIV and their perspectives on risk and pleasure. Sexually Transmitted Diseases, online ahead of print, 2011.
Prestage G et al. Pleasure and Sexual Health: The PASH Study. National Centre in HIV Epidemiology and Clinical Research, Sydney, 2009.