Condom Burnout: Treatment Optimism or Flirting with Death?

1. Condom Burnout:Treatment Optimism or Flirting with Death? Prof. Gidi Rubinstein Netanya Academic College Israel

2. AIDS:From Terminality to Chronicity • Calming Signals by AIDS Specialists in Israeli Media: • One Can Live Healthy Life with AIDS Thanks to Highly Active Anti Retroviral Therapy (HAART) • The Basis for HIV Treatment Optimism • So Why Using A Condom in the HAART Era?

4. Post-HAART Increase of New HIV Carriers • The number of MSM being diagnosed with HIV had reached an all-time high in 2011 to 3,010 in the UK(British Health Protection Agency, 2012) • 8% increase of new HIV carriers in Israel, MSM being the largest group of new carriers; 10% of the new carriers were infected by a HAART resistant virus (Central Virus Laboratory, Shiba Medical Center, Israel) • 50,000 new HIV infections per year in the USA, MSM continue to bear the greatest burden of HIV infection (Centers for Disease Control and Prevention)

5. Freud: Eros and Thanatos • Opposition between the ego or death instincts and the sexual or life instincts. • The death drive opposes Eros, the tendency toward survival, propagation, sex, and other creative, life-producing drives. • The death drive is sometimes referred to as "Thanatos" in post-Freudian thought, complementing "Eros

6. Pessimism = DepressionOptimism = Happiness

7. Depressive Realism "Optimism is the madness of insisting that all is well when we are miserable“ (Voltaire, 1759) • People with depression have a more accurate perception of reality • They are less affected by: • positive illusions of illusory superiority • locus of control • optimism bias

8. Defensive Pessimism:Harnessing Anxiety as Motivation (Norem, 1986) • A cognitive strategy consisting in anticipating a negative outcome in order to take the necessary measures to avoid it. • Setting unrealistically low expectations in a risky situation in an attempt to harness anxiety so that performance is unimpaired.

9. The Optimistic Bias (unrealistic/comparative optimism) • Believing that they are less at risk of experiencing a negative event compared to others • When asked about their own chances, people claim that they are less likely to be affected by personal risks than their peers • Optimism may arise when ambiguous risk factors are presented in a biased manner

10. Optimistic Biases of MSM who had Unprotected Anal Sex(Shidlo, Yi, & Dalit, 2008) • He seemed too young to be HIV-positive. • He seemed too healthy to be infected. • My sexual partner was an adult and knew what he was doing. • We were in love and assumed we were both HIV- positive. • I felt that AIDS isn’t such a big deal disease anymore. • The guy was really hot. • I was too happy to deal with condoms and AIDS. • I didn’t think it would be risky if we didn’t come inside each other.

11. The “Bright” Side:HIV Treatment Optimism • In the worst case, HIV carrying means living with a chronic disease like high blood pressure or juvenile diabetes • One can live peaceful and healthy life thanks to the new medications • Having sex with a HIV carrier who regularly takes his medication is quite safe • One can forgo condom use even in casual anal intercourse • The new medications make periodical HIV tests unnecessary • The new medications may be considered a “Breakfast of Champions”, which makes unprotected anal sex possible

12. The Dark Side:What Doctors Really Think? • Life with HIV is not easy at all and requires medical follow-up and many vaccinations • HIV medications have side effects • HIV may cause other medical problems HIV may cause earlier and faster aging • HIV might involve entering a "new closet" • The problems HIV carriers face may result in depression • The problems HIV carriers face decrease their social functioning • Being a HIV carrier may cause problems in having children • HIV carrying may hinder immigration and force the carrier to stay in Israel

13. Hypotheses • HIV Treatment Optimism would be positively related to: • Acceptance of Sexual Orientation • Openness to Experience • Extraversion • ImpSS • Frequency of Unprotected Anal Sex • And negatively related to: • Conscientiousness • Neuroticism • Agreeableness

14. Participants Gay and Bisexual Jewish Israeli Men (N = 301) • Age: M = 33.97 (SD = 10.86) (range: 16-72) • Education: 32% - secondary school; 40% - undergraduate students and holders of BA/BSc degrees 22% - graduate and PhD students and holders of MA/PhD degrees • Relationship: 81.0% singles, 4.0% married to women, 10.6% married to or living with men • Closet: Out – 60.1%; Completely In – 16.9%; Partially In – 16.6% • HIV carrying: Yes – 9.0 %; No - 88.0%

15. Measures • Demographic Questionnaire • NEO-FFI (Coasta & McCrae, 1992): • Openness to Experience - a = 0.62 • Conscientiousness - a = 0.82 • Extraversion- a = 0.77 • Agreeableness- a = 0.70 • Neuroticism - a = 0.78 • ImpSS (Zuckerman, 2008) - a = 0.94 • Condom Use Assertiveness (Grimleyet al., 1993) - a = 0.73 • Reasons for Not Using A Condom (Shidlo et al., 2008)- a = 0.70 New HIV Treatment Optimism Scale - a = 0.81

16. Procedure • Online questionnaire (computer & smartphone versions) • 24/7 time sampling during 3 months as to allow similar chances for married men (day hours), relationship seekers (evenings), and clubbers (after-parties) • Standard personal messages (special version for HIV carriers)

17. ResultsThe Medical Factor (a = 0.78)(explained variance – 15.03%) • Life with HIV is not easy at all and requires medical follow-up and many vaccinations (R) • HIV medications have side effects (R) • HIV may cause other medical problems (R) • HIV carrying may cause earlier and faster aging (R)

18. Results(The Psychosocial Factor (a = 0.68(explained variance – 12.85%) • HIV carrying might involve entering a “new closet” (R) • The problems HIV carriers face may result in depression (R) • The problems HIV carriers face negatively affect their social functioning (R) • HIV carrying may cause problems in having children (R) • HIV carrying may hinder immigration and force the carrier which to stay in Israel (R)

19. Results(The Chronicity Factor (a = 0.57(explained variance – 10.82%) • In the worst case, HIV carrying means living with a chronic disease like high blood pressure or juvenile diabetes • One can live peaceful and healthy life thanks to the new medications • Having sex with a HIV carrier who regularly takes his medication is quite safe

20. Results The Risk Taking Factor(a = 0.57)(explained variance – 10.82%) • One can forgo condom use even in casual anal intercourse • The new medications make periodical HIV test unnecessary • The new medications may be considered a “Breakfast of Champions” which makes unprotected anal sex possible

21. ResultsMultiple Regression Analysis for Variables Predicting The Medical Factor Medical

22. Multiple Regression Analysis for Variables Predicting The Psychosocial Factor Psychosocial

23. ResultsMultiple Regression Analysis for Variables Predicting The Chronicity Factor Chronicity

24. ResultsMultiple Regression Analysis for Variables Predicting Risk Taking Risk Taking

25. ResultsMultiple Regression Analysis for Variables Predicting HIV Treatment Optimism (Total) Treatment Optimism

26. Discussion • HIV Treatment Optimism might be theoretically conceptualized as a specific case of optimistic/unrealistic which goes hand in hand with erroneous perception of risk • HIV Treatment Optimism may be partially explained by the calming messages sent by AIDS specialists in the Israeli media, emphasizing that AIDS is no more a terminal disease • In this study lower education levels constitute a consistent predictor of HIV Treatment Optimism • A more complete and realistic presentation of medical and psychosocial complications by AIDS specialists in the media leaves room for optimism about reducing treatment optimism and increasing prevention