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ASTRA: Perceived viral load status may influence behavior risk
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GLASGOW — Approximately 16% of men who have sex with men included in the Antiretrovirals, Sexual Transmission Risk and Attitudes study reported having recent unprotected sex with an HIV-discordant partner, according to findings presented here.
MSM taking ART stated that engaging in unprotected sex was associated with undetectable viral load status. “However, prevalence of unprotected sex with an HIV-discordant partner is also high among MSM not taking ART. These findings have implications for prevention strategies among MSM in the U.K.,” Fiona Lampe, MD, of the department of clinical neuroscience at the University College London, said during a presentation.
For the multicenter Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study, Lampe and colleagues assessed the associations between the use of ART and the beliefs of viral load suppression and transmission risk with sexual behavior among 2,182 MSM with HIV in the United Kingdom from 2011 to 2012.
Study participants completed a questionnaire that defined unprotected sex with an HIV-discordant partner as “anal or vaginal sex without a condom in the past 3 months with a partner of negative or unknown HIV status.”
About 85% of MSM were taking ART; 83.2% had a viral load of <50 copies/mL, 8.4% reported a viral load of >50 copies/mL; and 8.4% were unaware of their status. The overall prevalence of unprotected sex with an HIV-discordant partner was 14.8%.
Transmission risk belief scores (TRBS) of 0 to 2 were used to gauge participants’ risk belief (2: agree that when viral load is undetectable, a condom is not needed to prevent HIV transmission; 1: agree that undetectable viral load makes someone less infectious to a sexual partner; or 0: do not agree with either statement).
Forty-eight percent of MSM had a TRBS risk score of 0, 47.7% had a risk score of 1 and 4.3% had risk score of 2. As the TRBS risk score increased, the prevalence of unprotected sex increased (P<.001).
Compared with MSM not taking ART, the prevalence of unprotected sex was lower among MSM taking ART (13.8% vs. 20.1%; P=.004). After adjusting for lifestyle, demographic and HIV-associated factors, researchers continued to observe an association between taking ART and viral load status and having unprotected sex: Prevalence was highest among those reporting viral loads ≤50 copies/mL vs. viral loads >50 copies/mL and unknown viral loads (14.7% vs. 9.4%; P=.016).
The absence of an HIV-positive stable partner, having a recent HIV diagnosis and reporting recreational drug use were also independently associated with unprotected sex (P<.05 for all).
“MSM with HIV continued to believe in importance of condoms even with undetected viral load,” Lampe said. “There was no evidence that taking ART is associated with an increase in condom-less sex. In fact, ART tended to be associated with lower levels of unprotected sex.”
For more information:
Lampe F. #323. Presented at: HIV11 Congress; Nov. 11-15, 2012; Glasgow.
Disclosure: Lampe reports no relevant financial disclosures.