Association between 'safer sex fatigue' and rectal gonorrhea is mediated by unsafe sex with casual partners among HIV-positive homosexual men

OBJECTIVE: The objective of this study was to investigate whether and what sexual risk behavior is a mediator of associations between rectal gonorrhea (RG) and highly active antiretroviral therapy-related beliefs, safer sex fatigue, or sexual sensation-seeking among homosexual men. STUDY DESIGN: This study consisted of a cross-sectional survey between March 2002 and December 2003 among homosexual visitors of the Amsterdam sexually transmitted disease clinic. METHODS: In total, 1568 men answered a written questionnaire. Associations were determined using logistic regression corrected for repeated measurements. RESULTS: The RG infection rate was high among homosexual men who were HIV-positive (16%) compared with those with negative or unknown HIV status. Mediation could be confirmed among HIV-positive men only. Those who experienced higher levels of safer sex fatigue were more likely to be positive for RG. This association was mediated by unprotected anal intercourse (UAI) with casual partners. CONCLUSION: Addressing safer sex fatigue might help prevent UAI with casual partners and possibly also RG among HIV-positive homosexual men.