In Amsterdam, Gay Men Have More Risky Sex

In the past 15 years, an increasing number of gay and bisexual men in Amsterdam are having unprotected sex — possibly explaining why their HIV rate has stopped falling and might even be inching up, a new study finds.

Researchers suspect that the trend — a reversal of the decline in risky sex seen in the 1980s — is related to the powerful anti-HIV drug “cocktails” that came into wide use in 1996.

The drugs, which can keep HIV from becoming full-blown AIDS and make an infected person less likely to pass the virus on, have altered many people’s view of HIV. Instead of a death sentence, it seems more like a manageable chronic disease.

But research suggests the drugs’ success may have had the unintended consequence of encouraging complacency about safer sex.

Several studies — in San Francisco, Sydney and the Netherlands, for example — have found that gay and bisexual men reported increasing rates of unprotected anal sex from the mid-1990s on.

This latest findings, reported in the journal AIDS, included 1,642 gay and bisexual men in Amsterdam who were followed for up to 25 years.

Researchers found that from 1984 to 1988, the percentage of men who said they’d had unprotected anal sex in the past six months dropped from 78 percent to 33 percent. The rate then crept upward, reaching 38 percent in 1995, before jumping to 55 percent by 2009.

When it came to yearly rates of new HIV infections, there was a sharp drop early on — from 8.6 percent of men in 1985, to 1.3 percent in 1992.

But since 1996, there has been a small increase — from 1.4 percent to 2 percent in 2009. And while it’s unclear if the new, upward trend is real or just a matter of chance, the researchers say it’s concerning considering the increases in risky sex.

Together with past studies, the current one “provides evidence for ongoing substantial (HIV) transmission” among gay and bisexual men, write the researchers, led by Dr. Iralice A.V. Jansen of the Public Health Service of Amsterdam.

They add that “targeted prevention messages” are called for.

The biggest risk factor for HIV was unprotected sex with a casual partner, according to the study. Men who said they’d had unprotected receptive sex with a casual partner in the past six months were six times more likely than other men to become HIV-positive during the study.

“There is no doubt that prevention should continue to focus on their sexual behavior with casual partners,” Jansen’s team writes.

But they add that men need to be cautious with steady partners as well. Of all HIV infections during the study period, about one-quarter were likely contracted from a steady partner. And over time, a growing proportion of infections among men in their 40s and 50s were linked to a steady partner.

It’s not clear why that is, according to Jansen’s team. It could simply be that older men were more likely to be in long-term relationships and had fewer casual partners than their younger counterparts.

Whatever the reason, the researcher say, the findings show that men in steady relationships also need to practice safer sex.

NEW YORK (Reuters Health)