213   Confidence in HAART and Recent Unprotected Anal Sex among Men Who Have Sex with Men (MSM).

T. Bingham*, D. Johnson, and N. Harawa.
HIV Epidemiology Program, Los Angeles, CA.

Background:With the introduction of highly active anti-retroviral treatment (HAART) in 1996, public health officials began speculating about a deterioration of safer sexual practices among MSM. In Los Angeles County, a recent syphilis outbreak among MSM may indeed substantiate claims that safer sex practices are declining. In the absence of longitudinal data to monitor changes in sexual practices among MSM, we examined the association between confidence in HAART and recent risky sexual behaviors using Young Men's Survey (YMS) data.

Methods:YMS is a multi-site, cross-sectional study of HIV-related risk behaviors, attitudes, and HIV infection in men, ages 23 to 29, sampled from public venues where MSM congregate. We assessed the awareness of and confidence in HAART among 368 sexually active participants enrolled in Los Angeles from 1999 to present. We performed multiple logistic regression to estimate the association between confidence in HAART and unprotected anal sex within the past 6 months.

Results:Of the 350 MSM reporting negative (or unknown) HIV status during the interview, 63% were aware of HAART compared to 100% of the 18 self-disclosed HIV-positive men. Awareness of HAART was associated with Hollywood/West Hollywood residence [prevalence odds ratio (OR) = 1.9, 95% confidence limits (CL) = 1.2, 3.0], having a regular source of health care (OR = 1.9, 95% CL = 1.2, 2.9), white race (OR = 2.4, 95% CL = 1.5, 3.7), and higher educational attainment (OR = 2.6, 95% CL = 1.6, 4.0). Of the MSM aware of HAART, 18% of negatives and 22% of positives were confident in its ability to reduce HIV transmission. Among MSM of negative or unknown HIV status, those men reporting confidence in HAART were 3.8 times more likely than men without confidence in HAART to report unprotected anal sex in the past 6 months (OR = 3.8, 95% CL = 1.8, 7.9). After controlling for potential confounders, these MSM were still 3 times more likely to report recent unprotected anal sex (OR = 3.3, 95% CL = 1.5, 7.3).

Conclusions:Although 65% of the total sample were aware of HAART, only 18% of these actually viewed HAART as capable of reducing HIV risk. Within this small sample, however, such confidence in HAART does appear to contribute to unprotected anal sex among susceptible MSM. Risk-reduction counseling should address continuing risks in the HAART era.