ATLANTA, June 16 (UPI) -- U.S. researchers have found that many HIV-positive men are using the Internet to "negotiate safety" -- make attempts to find partners for unprotected sex without risking further transmission of the disease.
In a series of reports at the 2005 National HIV Prevention Conference, researchers warned that these departures from safe-sex behavior remain risky and might be related to increases in other sexually transmitted illnesses, such as syphilis and gonorrhea.
Also, Internet-arranged sex still could result in new infections of the human immunodeficiency virus, the organism that causes AIDS, doctors said.
Of the 1 million-plus Americans infected with HIV, 45 percent are men who have sex with men -- the most common mode of transmission in the United States. Heterosexual transmission is second at 27 percent, and about 20 percent of infections are caused through intravenous-drug use.
"The AIDS epidemic in the United States is not over, as many people think it is," said Dr. Ron Valdiserri, deputy director of the National Center for HIV, STD and TB Prevention, a division of the Centers for Disease Control and Prevention in Atlanta.
"These men are attempting to reduce their HIV transmission risk by engaging in sex that is less risky than unprotected anal sex," Valdiserri said. Less risky, however, he suggested, does not mean risk free.
"People who have their HIV under control with anti-retroviral therapies do have a reduced risk of transmitting the virus to others," said Dr. Kenneth Mayer, professor of medicine at Brown Medical School in Providence, R.I., "but that doesn't mean they cannot infect someone."
HIV is an organism known as a retrovirus.
Researchers examined the growing trend in which men who have sex with men seek partners by "serosorting" and then considering which forms of risk-taking are appropriate on the basis of the potential partner's "viral load."
Viral load is the level of HIV circulating in the bloodstream. Clinicians often measure that level to assess efficacy of anti-retroviral treatment. The lower the viral load, the more the patient is in control of the disease.
By "serosorting" -- often accomplished on the Internet -- an HIV-positive person will look for unprotected-sex partners who also are HIV-positive, assuming that there is little risk because both parties already are infected. Serosorting is used by HIV-negative men who have sex with men as well, on the assumption that because both are negative, there is no transmission risk.
In one study, Dr. Cornelis Rietmeijer, a researcher with the Denver Public Health Department, found about 16 percent of men who have sex with men have recruited partners over the Internet. Those men were more likely to have a higher number of sex partners, have a history of sexually transmitted disease, have unprotected anal intercourse and have a current diagnosis of gonorrhea.
Rietmeijer noted, however, his study found that these men were more likely to engage in serosorting discussions, were more likely to discuss HIV status and were more likely to perceive their partners' serostatus to be similar to their own.
His team found that online discussions were more likely to involve HIV status than among men who found their partners via other venues, such as bathhouses.
"Men who have sex with men may decide to forego condom protection when they engage in anal sex with partners they perceive to be seroconcordant (same status)," Rietmeijer said. "Such serosorting behavior may result in lower risk for HIV transmission, but equal or higher risk for transmission of other sexually transmitted disease."
Mayer noted these behaviors carry a risk of super-infection -- becoming infected with a second strain of HIV from a partner. Although rare, super-infection has been known to occur among individuals with HIV.
He said an HIV-positive man who has sex with an HIV-negative man usually will take the "bottom" position, assuming that insertive sex will protect the negative partner from infection.
"In fact," Mayer said, "insertive anal intercourse as well as oral ejaculation carries risks." He said those risks include HIV transmission, as well as other diseases such as syphilis.
Mayer noted that in 1997 -- at the height of condom use among men who have sex with men -- syphilis cases in his clinic dropped to 2, while in 2003 they had rebounded to 51, an indication that men were being less compliant in safe-sex practices and condom use.
Robert Guzman, a researcher in the AIDS Office of the San Francisco Department of Public Health, also has been examining the issue of men determining how to have sex -- unprotected or protected, oral or anal, receptive or insertive -- on the basis of "viral load." He and colleagues interviewed 119 men to obtain their opinions on having sex with other men who have low or undetectable viral loads.
"Men with casual and primary partners who did not have the same HIV status (serodiscordant) frequently discuss viral load to guide decisions about risk behavior," Guzman said at a news briefing Wednesday.
"HIV-negative men who have sex with men who discuss viral load are more concerned about becoming infected, but report greater willingness to increase risks with an HIV-positive partner whose viral load is undetectable," he said.
As with serosorting, there are several risks involved in relying on viral load:
-- Even persons with undetectable viral loads have been known to transmit HIV.
-- Unprotected anal or oral intercourse can increase the risk of other diseases.
-- A person's viral load varies from day to day, so a person who had a low viral-load report from his doctor the previous week may have developed a more transmissible condition on the day sex is initiated.
-- Viral load in the reproductive tract may differ greatly from viral load in the bloodstream.
Guzman said healthcare workers should communicate to men who have sex with men "who use information about viral load to guide risk behavior about potential risks in adopting this strategy."
Mayer noted that some HIV-positive men who have sex with men "are trying to engage in safer practices, but people still don't have the personalized information to protect themselves and others."
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Ed Susman covers medical research and public health issues for UPI Science News. E-mail: [email protected]
