Trends in unsafe sex and influence of viral load among patients followed since primary HIV infection, 2000 to 2009.

Published: February 24, 2011

Abstract

BACKGROUND: In the current context of increasing unsafe sex, HIV incidence may have evolved, depending on HIV prevalence in sexual networks and, among HIV-infected persons who practice unsafe sex, on their infectivity and partners’ HIV serostatus. We examined calendar trends in sexual behaviours at risk of HIV transmission (SBR) among 967 adults followed since primary HIV-infection (ANRS PRIMO cohort), and relationships with current treatment and viral load (VL).

METHODS: Patients completed since 2000 self-administered questionnaires on sexual practices every 6 months. SBR with HIV-negative/unknown partners were analyzed among 155 heterosexual women, 142 heterosexual men (HM) and 670 MSM by using logistic GEE models (6656 visits).

RESULTS: During 2000-2009, the frequency of SBR did not increase significantly among women with steady partners; risk factors were a low education level and alcohol/smoking use. Among HM with steady partners, the frequency of SBR doubled since 2006; during this period the only associated factor was cART≥6months or VL<400cp/ml. Among MSM, SBR increased gradually over time; SBR with steady partners was associated with a low education level and alcohol use. SBR was more frequent among MSM with casual partners; no association with VL was found.

CONCLUSION: In France, recent trends and risk factors in unprotected sex with HIV-negative/unknown partners differ according to gender/sexual preference. The recent increase in SBR among HM with low VL may be related to increasing awareness of the "treatment-as-prevention" concept. The lack of association between SBR and VL among MSM supports use of treatment-as-prevention as part of diversified prevention strategies.

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