Acute hepatitis C in HIV-infected men who have sex with men (MSM) in France in 2006 and 2007: interviews with patients (HEPAIG qualitative study, ANRS 07342)
Background: Recent reports suggest that HCV may be sexually transmitted among HIV-infected MSM. A qualitative study (HEPAIG-quali) is combined with the epidemiological and behavioural HEPAIG study in order to better describe the circumstances associated with acute HCV co-infection.
Methods: A random and proportional probability sample of 100 medical wards was designed according to the number of HIV cases in MSM reported to the National HIV surveillance system. Acute HCV was defined by a positive anti-HCV antibody or HCV PCR within one year of a documented negative anti-HCV test. MSM meeting case definition were proposed after consent to undergo two successive semi-structured interviews exploring their social and sexual life, the circumstances and impact of HCV-infection and its possible treatment.
Results: Among the 79 included MSM, 31 were interviewed. Of these men, aged 33 to 58, half live in Paris. Their social context is very diverse regarding lifestyle, employment and income. Unprotected sexual practices are frequent and their descriptions range from occasional relapse to regular barebacking (in which case, seroadaptation is usual). Each describe at least two possible routes or factors associated with HCV transmission: unprotected anal intercourse, unprotected fisting, bleeding during sex, having STDs, having a HCV-infected partner, sharing straws or sex-props. As possible additional factors, many of them don’t use lubricants or take enema before sex. Most of them were aware of possible HCV transmission through blood, but they thought they were not that much at risk of infection through unsafe sex. Their reactions to diagnosis range from shock to surprise or “bad luck”. They are apprehensive of treatment, but are nevertheless confident towards the chances of being cured.
Conclusions: This qualitative approach enriches the behavioural HEPAIG study, helps to understand the perception of HCV-risk, and underlines the need for a prevention campaign on sexual HCV transmission targeted at HIV-infected MSM.
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