HIV prevention fatigue: Men who have sex with men (MSM) are tuning out HIV prevention messages

Background/Objectives: HIV prevention fatigue (weariness of monitoring/maintaining safer behaviors to prevent transmission) has been proposed but rarely studied as an explanation for the recent resurgence in MSM's high-risk sexual behavior. This study describes prevention fatigue among MSM, its association with high-risk behavior and the consequent challenges for HIV prevention.

Methods: A venue-based sample of MSM in Upstate New York was studied (n=635). Fatigue was measured by the mean score (1-4=no-high fatigue) and agreement with four statements: “you take risks because you are tired of being careful;” “you often tune out HIV messages” “you are burned out about HIV;” and “people are less careful because they are tired of being safe.” The relationships between fatigue, sociodemographics, and high-risk behaviors were assessed using linear and poisson regression.

Results: The mean fatigue score was 2.2 (SD=0.8). Black MSM had lower fatigue than whites (p=0.0003) after adjusting for enrollment venue, age, education, HIV status and sexual orientation. MSM with high fatigue were more likely to have higher overall risk (adjusted prevalence risk ratio (aPRR)=1.1, 95% CI: 1.0-1.3), UAI (aPRR =1.2, CI: 1.0-1.4), and 6+ partners (aPRR=1.2, CI: 1.0-1.5). In the multivariable analysis, tuning out HIV messages and risk taking because “you are tired of being careful” were more strongly associated with HIV risk than the other statements.

Conclusions: Prevention fatigue presents a relatively new challenge for safer sex promotion among MSM. Innovative interventions are needed for MSM who tune out HIV prevention messages and to reinforce the importance of lifelong adoption of safer behaviors.