{"id":1257,"date":"2017-02-28T14:23:24","date_gmt":"2017-02-28T14:23:24","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1257"},"modified":"2017-02-28T14:23:24","modified_gmt":"2017-02-28T14:23:24","slug":"hiv-prevention-through-haart-a-victim-of-its-own-success","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2017\/02\/28\/hiv-prevention-through-haart-a-victim-of-its-own-success\/","title":{"rendered":"HIV prevention through HAART: a victim of its own success?"},"content":{"rendered":"<p>A recent study (<a href=\"https:\/\/www.researchgate.net\/publication\/313422029_Diminishing_Perceived_Threat_of_AIDS_and_Increasing_Sexual_Risks_of_HIV_Among_Men_Who_Have_Sex_with_Men_1997-2015\">Kalichman &amp; Allen<\/a> (K&amp;A)) involving a series of four cross-sectional surveys (1996-2016) at a Gay Pride event in US Atlanta Georgia adds to the mounting body of evidence that substantial changes have occurred in community-held beliefs about the safety of certain sexual behaviours in the era of HIV treatment as prevention.<\/p>\n<p>It might seem surprising, in view of the known effectiveness of ART as a preventative tool, that its deployment has generally failed to deliver the preventative benefits that might have been anticipated.\u00a0 It is essential to achieve progress right along the \u2018treatment cascade\u2019, including, not only access to testing, but integration into treatment and viral suppression, for those benefits to be realized.\u00a0 The fact remains that levels of infection amongst MSM, even in countries that have scaled up testing and treatment, have remained stable or are actually rising.<\/p>\n<p>The obvious hypotheses, tested by K&amp;A in this study, are that, 1., the perception of safety on the part of MSM has led to an increase in condomless anal sex, and that, 2., the growing incidence of STIs resulting from these sexual practices has itself had a direct impact in reducing the protective effects of ART. \u00a0(Of course, this is not to deny that sizeable proportion of the MSM community in the US \u2013 as in Australia (<a href=\"http:\/\/sti.bmj.com\/content\/87\/6\/489\">Mao &amp; de Wit)<\/a> \u2013 be successfully engaged in deliberate HIV risk-reduction strategies.)\u00a0 The four surveys adopted identical measures and procedures, and involved ascertaining proportion of condom use during anal intercourse and number partners over the previous six months as well as assessment of beliefs regarding the preventive effectivess of ART (nine items of the questionnaire).<\/p>\n<p>Results were as follows.\u00a0 For HIV negative men: condomless anal sex (CAS) increased from <strong>43%<\/strong> (1997) to <strong>61%<\/strong> (2015); reporting two or more condomless sex partners from <strong>9%<\/strong> to <strong>33%<\/strong>.\u00a0 For HIV positive men:\u00a0 CAS from <strong>25%<\/strong> to <strong>67%<\/strong>; reporting two or more condomless sex partners from <strong>9%<\/strong> to <strong>57%<\/strong>.\u00a0 As regards beliefs that ART was protective, comparisons across survey times indicate a main effect for year of survey, <strong>F(3, 1829) = 6.3,p&lt;0.01<\/strong>, with an effect across survey year for men who engaged in CAS, <strong>F(1,1829) = 9.3,p&lt;0.01<\/strong>.\u00a0 Most evident from figures is a precipitous drop in perception of risk amongst both groups between the third and fourth survey (2006 and 2016).<\/p>\n<p>K&amp;A\u2019s hypotheses (one or both) would seem to be corroborated from another quarter by the observed association with the introduction of HAART of an increased infection rate of gonorrhoea and syphilis (<a href=\"http:\/\/sti.bmj.com\/content\/77\/3\/184\">Stolte &amp; Coutinho (STIs)<\/a>) and of viral STIs (<a href=\"http:\/\/sti.bmj.com\/content\/early\/2016\/10\/27\/sextrans-2016-052677\">de Laar &amp; Richel (STIs)<\/a>).\u00a0 Indeed rates of MSM syphilis increase coinciding with HAART introduction have been so dramatic in some places (e.g. Buenos Aires (<a href=\"http:\/\/sti.bmj.com\/content\/early\/2016\/11\/17\/sextrans-2016-052893\">Bissio &amp; Cassetti (STIs)<\/a>) as to lead to a hypothesis that HAART agents may actually be impairing immunity to the virus (<a href=\"http:\/\/sti.bmj.com\/content\/early\/2016\/11\/30\/sextrans-2016-052870\">Rekart &amp; Cameron (STIs)<\/a>; <a href=\"http:\/\/sti.bmj.com\/content\/early\/2017\/02\/01\/sextrans-2016-052940\">Tuddenham &amp; Ghanem (STIs)<\/a>).\u00a0 Whatever the validity of the latter hypothesis, evidence of STI epidemics is consistent with evidence of attitudinal and behavioural changes, such as those proposed by K&amp;A.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A recent study (Kalichman &amp; Allen (K&amp;A)) involving a series of four cross-sectional surveys (1996-2016) at a Gay Pride event in US Atlanta Georgia adds to the mounting body of evidence that substantial changes have occurred in community-held beliefs about the safety of certain sexual behaviours in the era of HIV treatment as prevention. It [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/02\/28\/hiv-prevention-through-haart-a-victim-of-its-own-success\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2043,2784,13992,4352],"tags":[],"class_list":["post-1257","post","type-post","status-publish","format-standard","hentry","category-behaviour","category-condoms","category-hiv-prevention","category-preventative-effect-of-art"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>HIV prevention through HAART: a victim of its own success? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/02\/28\/hiv-prevention-through-haart-a-victim-of-its-own-success\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HIV prevention through HAART: a victim of its own success? - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"A recent study (Kalichman &amp; Allen (K&amp;A)) involving a series of four cross-sectional surveys (1996-2016) at a Gay Pride event in US Atlanta Georgia adds to the mounting body of evidence that substantial changes have occurred in community-held beliefs about the safety of certain sexual behaviours in the era of HIV treatment as prevention. It [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2017\/02\/28\/hiv-prevention-through-haart-a-victim-of-its-own-success\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2017-02-28T14:23:24+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/02\\\/28\\\/hiv-prevention-through-haart-a-victim-of-its-own-success\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/02\\\/28\\\/hiv-prevention-through-haart-a-victim-of-its-own-success\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"HIV prevention through HAART: a victim of its own success?\",\"datePublished\":\"2017-02-28T14:23:24+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/02\\\/28\\\/hiv-prevention-through-haart-a-victim-of-its-own-success\\\/\"},\"wordCount\":509,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"articleSection\":[\"Behaviour\",\"Condoms\",\"HIV prevention\",\"Preventative effect of ART\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/02\\\/28\\\/hiv-prevention-through-haart-a-victim-of-its-own-success\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/02\\\/28\\\/hiv-prevention-through-haart-a-victim-of-its-own-success\\\/\",\"name\":\"HIV prevention through HAART: a victim of its own success? 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