Godfried J. P. van Griensven

AVOIDANCE AS A PREDICTOR OF THE BIOLOGICAL COURSE OF HIV INFECTION OVER A 7-YEAR PERIOD IN GAY MEN

The present study prospectively investigated the relation between avoidance coping and active cognitive and behavioral coping and the progression of HIV infection over 7 years in 181 gay men. Findings revealed that for a number of medical and behavioral factors, (a) avoidance coping predicted a lower rate of decline in CD4 cells, (b) the proportional hazard (PH) attributable to avoidance of developing a syncytium-inducing HIV variant was 0.72 (95% confidence interval [CI]: 0.53 - 0.99, p < .05), and (c) the PH attributable to avoidance of dropping below 200 CD4 cells/microl was 0.66 (95% CI: 0.50 - 0.89, p < .01). Avoidance coping was not related to the development of AIDS-defining clinical symptoms. Active cognitive and behavioral coping was not related to the outcome measures.

Sexual Behavior and Depression Among HIV-Positive Gay Men

As a result of medical advances seropositive men may expect to have a longer and healthier life span than in the past. It is therefore increasingly important to determine which factors are related to the mental health of seropositive gay men, as well as those associated with a satisfying, yet safe sexual lifestyle. This study examined sexual behavior, indicators of mental health, and determinants of AIDS-preventive behavior among a group of seropositive gay men and a control group of seronegative gay men in the Netherlands. Most seropositive men consistently practiced AIDS-preventive behavior. Nevertheless, if the definition of potentially unsafe sexual behavior is broadened to include oral sex to ejaculation, a sizable proportion of seropositive men had to be categorized as having had unsafe sex. Depression scores were higher among seropositive men than among the general population, but not significantly higher than among seronegative controls. Depression was not related to unprotected anal sex. The attitudes and the intention toward condom use were positive. Seropositive men used recreational (noninjection) drugs relatively often, but this was generally not associated with unprotected anal sex. Seropositive men attached more value to anal sex than seronegative controls, but again, this preference was not related to practicing unprotected anal sex. In the relatively few cases that unprotected anal sex among seropositive men did occur, it appeared to be related to lower behavioral control and to a weaker safe-sex intention. Perceived barriers to condom use and low perceived risk were also associated with unprotected anal sex among seropositive men. Although depression was not directly related to unprotected anal sex, seropositive men with higher depression levels were less motivated to use condoms and perceived more barriers to condom use.

Incidence and Prognostic Significance of Symptomatic Primary Human Immunodeficiency Virus Type 1 Infection in Homosexual Men

To investigate the incidence of symptomatic primary human immunodeficiency virus type 1 (HIV-1) infection and its prognostic significance for HIV-1 disease progression, data for 328 homosexual men from four cohort studies were evaluated. Rates of diarrhea, fever, night sweats, cough, and fatigue prior to, during, and after seroconversion were compared by use of Poisson regression, and the prognostic significance of these symptoms was evaluated with survival methods. The incidence of all symptoms was elevated during seroconversion; however, only fever was associated with faster disease progression. Seven or more days of fever was reported by 13.8% of subjects; half of them developed AIDS within 6 years, whereas only one-fourth of the men without fever developed AIDS within 6 years. In addition, fever was the only symptom associated with shortened survival and increased CD4 cell loss. Persons experiencing prolonged periods of fever during seroconversion should therefore be considered for early treatment, including prophylaxis against opportunistic infections and combinations of antiretroviral drugs.

Understanding AIDS preventive behavior with casual and primary partners in homosexual men: The theory of planned behavior and the information-motivation-behavioral-skills model

Abstract This study examined whether components from the Information-Motivation-Behavioral-Skills Model, in particular information, added explanatory power to factors derived from the Theory of Planned Behavior with respect to predicting AIDS-preventive behaviors among gay men. Participants were recruited from a longstanding cohort study in Amsterdam. Multivariate regression analyses showed that concepts from the Theory of Planned Behavior could account adequately for intentions to use condoms with casual as well as with steady partners. Actual behavior was best predicted by past behavior. In addition, structural equation modeling demonstrated that the causal paths as posited by Theory of Planned Behavior had a good fit to the data. From the presented findings implications for preventive interventions can be drawn. Specifically, interventions to increase condom use with casual partners need to focus at improving perceived behavioral control regarding this behavior, for instance through skills training. Interventions aimed at safer sex within steady relationships should take into account that the HIV-status of the individual and his partner plays an important role in the occurrence of unprotected anal sex in a romantic dyad.

Is the human immunodeficiency virus-related Kaposi's sarcoma epidemic coming to an end? Insights from the Tricontinental Seroconverter Study.

A decline in the proportion of Kaposis sarcoma among AIDS cases since the 1980s has been attributed to changes in sexual behavior among homosexual men and a decreasing exposure to a hypothesized Kaposis sarcoma cofactor. Recent studies have shown that the incidence rate of Kaposis sarcoma has remained relatively stable, which seems to argue against the hypothesis of a declining exposure to the putative cofactor. To examine this paradox, we evaluated the incidence of Kaposis sarcoma, using Cox proportional hazard analyses, and performed a simulation to compare incidences of different AIDS outcomes among 407 homosexual men with documented dates of seroconversion. Our data show that men who seroconverted early in the epidemic did not progress faster to Kaposis sarcoma than men who seroconverted more recently. A lower incidence rate of Kaposis sarcoma would be expected among the latter group if exposure to the hypothesized cofactor is decreasing over time. The percentage of Kaposis sarcoma among incident AIDS cases decreased over the years following seroconversion, but not over calendar time. This study demonstrates that the decline in the proportion of Kaposis sarcoma among AIDS cases should not be interpreted as a decline in the incidence of Kaposis sarcoma and that there is no evidence that a hypothesized Kaposis sarcoma cofactor is declining over calendar time.

Associations of age, immunosuppression, and AIDS among homosexual men in the Tricontinental Seroconverter Study

To characterize the associations of age, immunosuppression, and AIDS outcomes, we evaluated serial measures of CD4+ lymphocytes from 376 homosexual men with documented dates of HIV-1 seroconversion registered in the Tricontinental Seroconverter Study. Using regression models and adjusting for variation within individuals, we found no association between age and the number of CD4+ lymphocytes at seroconversion or with CD4+ lymphocyte decline after seroconversion. Men who developed opportunistic infections had fewer CD4+ lymphocytes at the time of diagnosis compared with men who developed AIDS-defining Kaposis sarcoma. Older age was significantly associated with higher numbers of CD4+ lymphocytes in individuals diagnosed with AIDS-defining Kaposis sarcoma but was not significant for individuals with opportunistic infections. Because older age shortens the latency period of Kaposis sarcoma and does not affect the CD4+ lymphocyte loss, it results in higher CD4+ lymphocytes at the time of diagnosis. These findings suggest distinct biologic mechanisms for various AIDS manifestations, which is important for clinical decision making and health care planning.

Do Today's Young Homosexual Men Practice Safer Sex Than Today's Older Homosexual Men Did When They Were Young? An Analysis of Sexual Behavior Change Across Cohorts in Amsterdam

Comparisions of the level of sexual risk taking of todays younger and older homosexual men have not provided unequivocal conclusions regarding whether younger homosexual men are at higher risk than their older counterparts. To appraise more fully the level of risk taking among young homosexual men, this study also emphasizes a comparison of young homosexual men today with their older counterparts when they were young. Information from the Amsterdam Cohort Study and the Amsterdam Young Gay Mens Study was used to provide data on HIV and STD prevalence as well as sexual behavior among younger (≤30 years) and older (>30 years) homosexual men in 1984/85 and 1995/96. Overall prevalence of HIV and STDs has dropped considerably among young gay men since 1984/85. Levels of unprotected receptive anal intercourse have also declined across time (from 98% to less than 48%), with 37% now restricting this practice to one partner. Direct behavioral comparisons between younger and older homosexual men might provide a ‘high-risk’ image for young gay men. However, when young homosexual men today are compared with their older counterparts when they were younger, a substantial reduction in high-risk sexual behavior across time is observed.