Viral load and HIV treatment attitudes as correlates of sexual risk behavior among HIV-positive gay men

Objectives: People living with HIV who achieve an "undetectable" viral load may assume that they are less infectious, leading to increased sexual risk. We examined the relation between perceiving that one has an undetectable viral load and sexual risk taking among gay men. Methods: HIV-positive participants (N=60) completed measures assessing HIV serostatus, perceived HIV viral load (detectable vs. undetectable), sexual risk and treatment attitudes. Results: Contrary to hypotheses, HIV-positive men with detectable viral loads were more likely to report unprotected anal sex with a nonprimary partner than were men reporting undetectable viral loads. Although a significant minority endorsed the belief that an HIV-positive partner with an undetectable viral load is less infectious, this belief was unrelated to sexual risk. Multivariate analyses showed that the strongest predictor of sexual risk was a measure assessing participants' reduced concern over HIV stemming from the availability of improved HIV treatments. After controlling for reduced HIV concern, viral load status was no longer a significant predictor of risk. Conclusions: Results suggest that reduced concern about the consequences of HIV infection may be more important than perceived health status as a determinant of risky sex and highlight the need for continued prevention efforts among people who are HIV-positive.