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McMahon JM, Simmons J, Braksmajer A, LeBlanc N. HIV-serodifferent couples' perspectives and practices regarding HIV prevention strategies: A mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000620. [PMID: 36962775 PMCID: PMC10022221 DOI: 10.1371/journal.pgph.0000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022]
Abstract
A substantial proportion of heterosexually acquired HIV infections in the U.S. occur between partners in primary relationships characterized by mixed HIV status. The U.S. Centers for Disease Control and Prevention have issued guidelines prioritizing HIV-serodifferent couples for primary HIV prevention, including treatment-as-prevention and pre-exposure prophylaxis (PrEP). Yet, very little research has been conducted to understand the perspectives and practices of HIV-serodifferent couples regarding HIV prevention strategies in the U.S. To help fill this gap, we conducted a mixed methods study with 27 mostly Black/African American and Latinx HIV-serodifferent heterosexual couples residing in New York City to explore their knowledge, attitudes, practices, and perspectives regarding combination HIV prevention, including condoms, PrEP and viral control. All couples expressed the desire to maintain viral suppression in the HIV-positive partner, which was not always achieved. There was considerable heterogeneity in the use of HIV prevention methods by couples; and several patterns emerged that were largely driven by gender and relationship dynamics. Female partners, in particular, expressed high levels of anxiety around transmission of HIV and thus desired multiple methods of protection. Healthcare providers should consider couples' psychosocial well-being, relationship quality, and other motivational factors when helping to tailor HIV preventative care for mixed-status couples.
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Affiliation(s)
- James M. McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Janie Simmons
- School of Global Public Health, New York University, New York, New York, United States of America
| | - Amy Braksmajer
- Department of Sociology, State University of New York at Geneseo, Geneseo, New York, United States of America
| | - Natalie LeBlanc
- School of Nursing, University of Rochester Medical Center, Rochester, New York, United States of America
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Is There Risk Compensation among HIV Infected Youth and Adults 15 Years and Older on Antiretroviral Treatment in South Africa? Findings from the 2017 National HIV Prevalence, Incidence, Behaviour and Communication Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106156. [PMID: 35627693 PMCID: PMC9141949 DOI: 10.3390/ijerph19106156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
Abstract
In this paper, risk compensation among individuals on antiretroviral therapy (ART), using the 2017 South African national survey on HIV, is explored. A multi-stage stratified cluster random sampling approach was used to realize 11,130 participants 15 years and older. Logistic regression analysis assessed the association between multiple sexual partners, condom use at last sexual encounter, consistency of condom usage and potential explanatory variables using HIV status and ART exposure as a mediator variable. HIV positive participants who were aware and on ART were less likely to have multiple sexual partners, and less likely not to use a condom at last sex compared to HIV positive participants who were aware but not on ART. The odds of reporting multiple sexual partners were significantly lower among older age groups, females, non-Black Africans, and rural settings, and higher among those with tertiary level education, and risky alcohol users. The odds of no condom use at last sexual encounter were more likely among older age groups, females, other race groups, and less likely among those with secondary level education. The odds of inconsistent condom use were more likely among older age groups, females, and other race groups, and less likely among those with tertiary level education, high risk and hazardous alcohol users. Risk compensation is not apparent among HIV infected adults who are on ART. Risk groups that should receive tailored interventions to reduced risky sexual behaviours were identified.
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Mthembu J, Hamilton AB, Milburn NG, Sinclair D, Mkabile S, Mashego M, Manengela T, Wyatt GE. "It Had a Lot of Cultural Stuff in It": HIV-Serodiscordant African American Couples' Experiences of a Culturally Congruent Sexual Health Intervention. Ethn Dis 2020; 30:269-276. [PMID: 32346272 DOI: 10.18865/ed.30.2.269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective The increased life expectancy of people living with HIV has brought about an increase in serodiscordant couples, in which there is risk of HIV transmission. Therefore, interventions that promote sexual health and reduce risk are critical to develop for these couples. Given the disproportionate burden of HIV among populations of color, it is also critical that these interventions are culturally congruent. The EBAN intervention for African American serodiscordant couples recognizes the centrality of culture in shaping sexual behaviors and helps couples develop intimacy and positive prevention behaviors. The analytic objective of our study was to examine the knowledge and awareness gained by participants in the intervention. Participants Participants (n=17) who completed at least half of the eight intervention sessions. Methods Brief post-implementation semi-structured interviews were conducted between January 1, 2016 and December 31, 2016. Team-based, targeted content analysis focused on knowledge and awareness gains. Results Participants described learning about sexual health, expanded sexual options, and sexual communication. The "EBAN café," a component that gives couples a menu of options for safer sex behaviors, was particularly popular. Participants also noted the value of learning how to communicate with one another about their sexual health-related concerns and preferences. They appreciated the "cultural stuff" that was infused throughout the sessions, including the emphasis on learning from one another as couples. Conclusions Couples at risk for HIV transmission benefit from strengthening skills and knowledge related to healthy sexuality. A behavioral intervention that aligns with cultural values and imparts culturally congruent sexual health information appeals to couples who seek ways to enhance their intimacy and sexual options while also reducing risk.
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Affiliation(s)
- Jacqueline Mthembu
- Social Aspects of Public Health Research Programme, Human Sciences Research Council, South Africa
| | - Alison B Hamilton
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Norweeta G Milburn
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - Deborah Sinclair
- Child and Family Studies, University of the Western Cape, South Africa.,Department of Special Needs Education, Ghent University, Belgium
| | - Siyabulela Mkabile
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa.,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mmathabo Mashego
- University of Venda, Limpopo, South Africa.,Department of Community Strengthening Systems, HIV South Africa, South Africa
| | | | - Gail E Wyatt
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
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Protiere C, Arnold M, Fiorentino M, Fressard L, Lelièvre JD, Mimi M, Raffi F, Mora M, Meyer L, Sagaon‐Teyssier L, Zucman D, Préau M, Lambotte O, Spire B, Suzan‐Monti M. Differences in HIV cure clinical trial preferences of French people living with HIV and physicians in the ANRS-APSEC study: a discrete choice experiment. J Int AIDS Soc 2020; 23:e25443. [PMID: 32077248 PMCID: PMC7048214 DOI: 10.1002/jia2.25443] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the advent of HIV cure-related clinical trials (HCRCT) for people living with HIV (PLWH), the risks and uncertainty involved raise ethical issues. Although research has provided insights into the levers and barriers to PLWH and physicians' participation in these trials, no information exists about stakeholders' preferences for HCRCT attributes, about the different ways PLWH and physicians value future HCRCT, or about how personal characteristics affect these preferences. The results from the present study will inform researchers' decisions about the most suitable HCRCT strategies to implement, and help them ensure ethical recruitment and well-designed informed consent. METHODS Between October 2016 and March 2017, a discrete choice experiment was conducted among 195 virally controlled PLWH and 160 physicians from 24 French HIV centres. Profiles within each group, based on individual characteristics, were obtained using hierarchical clustering. Trade-offs between five HCRCT attributes (trial duration, consultation frequency, moderate (digestive disorders, flu-type syndrome, fatigue) and severe (allergy, infections, risk of cancer) side effects (SE), outcomes) and utilities associated with four HCRCT candidates (latency reactivation, immunotherapy, gene therapy and a combination of latency reactivation and immunotherapy), were estimated using a mixed logit model. RESULTS Apart from severe SE - the most decisive attribute in both groups - PLWH and physicians made different trade-offs between HCRCT attributes, the latter being more concerned about outcomes, the former about the burden of participation (consultation frequency and moderate SE). These different trades-offs resulted in differences in preferences regarding the four candidate HCRCT. PLWH significantly preferred immunotherapy, whereas physicians preferred immunotherapy and combined therapy. Despite the heterogeneity of characteristics within the PLWH and physician profiles, results show some homogeneity in trade-offs and utilities regarding HCRCT. CONCLUSIONS Severe SE, not outcomes, was the most decisive attribute determining future HCRCT participation. Particular attention should be paid to providing clear information, in particular on severe SE, to potential participants. Immunotherapy would appear to be the best HCRCT candidate for both PLWH and physicians. However, if the risk of cancer could be avoided, gene therapy would become the preferred strategy for the latter and the second choice for the former.
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Affiliation(s)
- Christel Protiere
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | | | - Marion Fiorentino
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Lisa Fressard
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Jean D Lelièvre
- INSERMCréteilFrance
- Faculté de médecineUniversité Paris EstCréteilFrance
- Vaccine Research InstituteCréteilFrance
| | - Mohamed Mimi
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - François Raffi
- Department of Infectious DiseasesHotel‐Dieu Hospital ‐ INSERM CIC 1413Nantes University HospitalNantesFrance
| | - Marion Mora
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Laurence Meyer
- Département d'épidémiologie, INSERM, U1018Université Paris‐Sud 11AP‐HPHôpital de BicêtreLe Kremlin‐BicêtreFrance
| | - Luis Sagaon‐Teyssier
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - David Zucman
- Hôpital Foch, service de médecine interneSuresnesFrance
| | | | - Olivier Lambotte
- Assistance Publique ‐ Hôpitaux de ParisHôpital BicêtreService de Médecine Interne et Immunologie cliniqueLe Kremlin‐BicêtreFrance
- Immunology of Viral Infections and Autoimmune DiseasesINSERM, U1184Le Kremlin‐BicêtreFrance
- UMR 1184Université Paris SudLe Kremlin‐BicêtreFrance
- CEADSV/iMETIIDMITFontenay‐aux‐RosesFrance
| | - Bruno Spire
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Marie Suzan‐Monti
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
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Mendez‐Lopez A, McKee M, Stuckler D, Granich R, Gupta S, Noori T, Semenza JC. Population uptake and effectiveness of test-and-treat antiretroviral therapy guidelines for preventing the global spread of HIV: an ecological cross-national analysis. HIV Med 2019; 20:501-512. [PMID: 31140715 PMCID: PMC6772052 DOI: 10.1111/hiv.12750] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Although the benefits of adopting test-and-treat antiretroviral therapy (ART) guidelines that recommend initiation of ART regardless of CD4 cell counts have been demonstrated at the individual level, there is uncertainty about how this translates to the population level. Here, we explored whether adopting ART guidelines recommending earlier treatment initiation improves population ART access and viral suppression and reduces overall disease transmission. METHODS Data on ART initiation guidelines and treatment coverage, viral suppression, and HIV incidence from 37 European and Central Asian countries were collected from the European Centre for Disease Prevention and Control and the Global HIV Policy Watch and HIV 90-90-90 Watch databases. We used multivariate linear regression models to quantify the association of ART initiation guidelines with population ART access, viral suppression, and HIV incidence, adjusting for potential confounding factors. RESULTS Test-and-treat policies were associated with 15.2 percentage points (pp) [95% confidence interval (CI) 0.8-29.6 pp; P = 0.039] greater treatment coverage (proportion of HIV-positive people on ART) compared with countries with ART initiation at CD4 cell counts ≤ 350 cells/μL. The presence of test-and-treat policies was associated with 15.8 pp (95% CI 2.4-29.1 pp; P = 0.023) higher viral suppression rates (people on ART virally suppressed) compared with countries with treatment initiation at CD4 counts ≤ 350 cells/μL. ART initiation at CD4 counts ≤ 500 cells/μL did not significantly improve ART coverage compared to initiation at CD4 counts ≤ 350 cells/μL but achieved similar degrees of viral suppression as test-and-treat. CONCLUSIONS Test-and-treat was found to be associated with substantial improvements in population-level access to ART and viral suppression, further strengthening evidence that rapid initiation of treatment will help curb the spread of HIV.
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Affiliation(s)
| | - M McKee
- Department of Public Health & PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - D Stuckler
- Department of Public Health & PolicyLondon School of Hygiene & Tropical MedicineLondonUK
- Dondena Research CentreUniversity of BocconiMilanItaly
| | - R Granich
- Independent Public Health ConsultantSan FranciscoCAUSA
| | - S Gupta
- Independent Public Health ConsultantDelhiIndia
| | - T Noori
- European Centre for Disease Prevention and ControlStockholmSweden
| | - JC Semenza
- European Centre for Disease Prevention and ControlStockholmSweden
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Melo MGD, Sprinz E, Gorbach PM, Santos B, Rocha TDM, Simon M, Almeida M, Lira R, Chaves MC, Kerin T, Varella I, Nielsen-Saines K. HIV-1 heterosexual transmission and association with sexually transmitted infections in the era of treatment as prevention. Int J Infect Dis 2019; 87:128-134. [PMID: 31404674 PMCID: PMC6894479 DOI: 10.1016/j.ijid.2019.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022] Open
Abstract
Objectives: HIV-1 heterosexual transmission among individuals on antiretroviral treatment (ART) with undetectable viremia is extremely rare. The aim of this study was to evaluate the risk of sexual HIV-1 transmission and other sexually transmitted infections (STIs) in HIV-1 serodifferent couples while the index partner is on ART. Methods: HIV transmission was evaluated in 200 HIV-1 heterosexual serodifferent couples in a stable relationship (≥3 months). All HIV-positive individuals had been on ART for ≥3 months and had been followed up for a median preceding time of 4.5 years (range 0.3–16years) at the HIV couples clinic at Hospital Nossa Senhora da Conceição in Porto Alegre, Brazil. Following written informed consent, participants responded to demographic/behavioral questionnaires. Quantitative PCR for HIV RNA, T-cell subsets, and STI testing (syphilis, herpes, human papillomavirus, gonorrhea, and bacterial vaginosis) were performed. Self-collected vaginal swabs were obtained for quantitative HIV genital viral load testing. Results: Among 200 couples, 70% of index partners were female. Five seroconversions were observed; the HIV infection incidence was 2.5% (95% confidence interval 0.8% to 5.7%). Mean plasma viral load results were higher in HIV transmitters compared to non-transmitters (p = 0.02). The presence of STIs was significantly greater in couples who seroconverted (60.0% vs. 13.3%; odds ratio 9.75, 95% confidence interval 1.55–61.2; p = 0.023). The duration of undetectable HIV viremia and presence of STIs were associated with HIV transmission. Conclusions: Undetectable viremia was the main factor associated with non-transmissibility of HIV in this setting.
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Affiliation(s)
| | - Eduardo Sprinz
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pamina M Gorbach
- UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Breno Santos
- Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | | | - Mariana Simon
- Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | | | - Rita Lira
- Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | | | - Tara Kerin
- David Geffen UCLA School of Medicine Department of Pediatrics, Los Angeles, California, USA
| | - Ivana Varella
- Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Karin Nielsen-Saines
- David Geffen UCLA School of Medicine Department of Pediatrics, Los Angeles, California, USA.
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de Melo MG, Varella I, Gorbach PM, Sprinz E, Santos B, de Melo Rocha T, Simon M, Almeida M, Lira R, Chaves MC, Baker Z, Kerin T, Nielsen-Saines K. Antiretroviral adherence and virologic suppression in partnered and unpartnered HIV-positive individuals in southern Brazil. PLoS One 2019; 14:e0212744. [PMID: 30811480 PMCID: PMC6392295 DOI: 10.1371/journal.pone.0212744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 02/10/2019] [Indexed: 11/18/2022] Open
Abstract
Background An undetectable serum HIV-1 load is key to effectiveness of antiretroviral (ARV) therapy, which depends on adherence to treatment. We evaluated factors possibly associated with ARV adherence and virologic response in HIV-infected heterosexual individuals. Methods A cross-sectional study was conducted in 200 HIV-1 serodiscordant couples and 100 unpartnered individuals receiving ARV treatment at a tertiary hospital in southern Brazil. All subjects provided written informed consent, answered demographic/behavioral questionnaires through audio computer-assisted self-interviews (ACASI), and collected blood and vaginal samples for biological markers and assessment of sexually transmitted infections (STIs). HIV-negative partners were counseled and tested for HIV-1. Results The study population mean age was 39.9 years, 53.6% were female, 62.5% were Caucasian, 52.6% had incomplete or complete elementary education, 63.1% resided in Porto Alegre. Demographic, behavioral and biological marker characteristics were similar between couples and single individuals. There was an association between adherence reported on ACASI and an undetectable serum viral load (P<0.0001). Logistic regression analysis demonstrated that single-tablet ARV-regimens were independently associated with adherence (OR = 2.3; 95CI%: 1.2–4.4; P = 0.011) after controlling for age, gender, education, marital status, personal income, ARV regimen, and median time of ARV use. A positive correlation between genital secretion PCR results and serum viral load was significant in the presence of STIs (r = 0.359; P = 0.017). Although HIV PCR detection in vaginal secretions was more frequent in women with detectable viremia (9/51, 17.6%), it was also present in 7 of 157 women with undetectable serum viral loads (4.5%), p = 0.005. Conclusions ARV single tablet regimens are associated with adherence. Detectable HIV-1 may be present in the genital secretions of women with undetectable viremia which means there is potential for HIV transmission in adherent individuals with serologic suppression.
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Affiliation(s)
| | - Ivana Varella
- Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Pamina M. Gorbach
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Eduardo Sprinz
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Breno Santos
- Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | | | - Mariana Simon
- Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | | | - Rita Lira
- Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | | | - Zoe Baker
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Tara Kerin
- David Geffen UCLA School of Medicine Department of Pediatrics, Los Angeles, California, United States of America
| | - Karin Nielsen-Saines
- David Geffen UCLA School of Medicine Department of Pediatrics, Los Angeles, California, United States of America
- * E-mail:
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8
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Calendar trends in sexual behaviours in a cohort of HIV-infected MSM at the era of treatment as prevention of HIV infection. AIDS 2018; 32:1871-1879. [PMID: 29927787 DOI: 10.1097/qad.0000000000001916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND With the advent of treatment as prevention of HIV infection (TasP), we assessed trends in sexual behaviours between 2000 and 2017 among HIV-infected MSM enrolled in the French ANRS PRIMO cohort. METHODS At each cohort visit, a clinical questionnaire including laboratory values was completed and a self-administered questionnaire was used to collect sexual behaviours, that is, the number, type (steady/casual) and HIV status (positive or negative/unknown) of partners, and condom use. The possible influence of viral load (undetectable/detectable) measured at the preceding visit on the evolution over time of sexual behaviour was assessed with logistic regression models fitted by generalized estimating equations (GEE), taking into account longitudinal data. RESULTS We analyzed data from 10657 follow-up visits by 1364 MSM. Overall, whatever the considered behavioural variable: at least one sexual partner, steady and/or casual, condomless sex with steady, casual partners, serodiscordant or not, we observed a calendar increase with a particularly more marked rise from 2010 (P < 0.0001). Inconsistent condom use did not differ according to the viral load status (detectable vs. undetectable). Trends in inconsistent condom use increased across different generations of MSM, as defined by the year they were diagnosed with HIV infection. CONCLUSIONS 'Having a sexual partner' and condomless sex, both increased in frequency between 2000 and 2017. Viral load status did not influence condom use as could have been expected from the 2008 Swiss Statement.
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9
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Condomless Sex Among Virally Suppressed Women With HIV With Regular HIV-Serodiscordant Sexual Partners in the Era of Treatment as Prevention. J Acquir Immune Defic Syndr 2018; 76:372-381. [PMID: 29077673 DOI: 10.1097/qai.0000000000001528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sexual HIV transmission does not occur with sustained undetectable viral load (VL) on antiretroviral therapy (ART). Awareness of ART prevention benefits and its influence on condom use among women with HIV (WWH) remain unexplored. We estimated prevalence and correlates of condomless sex with regular HIV-serodiscordant partners among WWH with undetectable VL on ART. METHODS We used baseline questionnaire data from the community-based longitudinal Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). We included WWH self-reporting vaginal/anal sex with ≥1 HIV-negative/unknown status regular partner within 6 months, and undetectable VL (<50 copies/mL) on ART. We excluded participants exclusively reporting female partners or missing condom-use data. Condomless sex was defined as <100% condom use within 6 months. The primary explanatory variable was awareness of ART prevention benefits. Logistic regression identified factors independently associated with condomless sex. RESULTS Of 271 participants (19% of the CHIWOS cohort), median age was 41 (interquartile range: 34-47), 51% were in a relationship, 55% reported condomless sex, and 75% were aware of ART prevention benefits. Among women aware, 63% reported condomless sex compared with 32% of women not aware (P < 0.001). Factors independently associated with condomless sex included being aware of ART prevention benefits (adjusted odds ratio: 4.08; 95% confidence interval: 2.04 to 8.16), white ethnicity, ≥high-school education, residing in British Columbia, and being in a relationship. CONCLUSIONS Virally suppressed women aware of ART prevention benefits had 4-fold greater odds of condomless sex. Advancing safer sex discussions beyond condoms is critical to support women in regular serodiscordant partnerships to realize options for safe and satisfying sexuality in the Treatment-as-Prevention era.
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10
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Ma P, Gao L, Zhang D, Yu A, Qiu C, Li L, Yu F, Wu Y, You W, Guo Y, Ning X, Lu W. Trends in the incidence of AIDS and epidemiological features in Tianjin, China from 2005 to 2016. Oncotarget 2017; 8:102540-102549. [PMID: 29254269 PMCID: PMC5731979 DOI: 10.18632/oncotarget.21016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/27/2017] [Indexed: 01/12/2023] Open
Abstract
The objective of this study was to assess the epidemiological trends among patients with AIDS in Tianjin, China. A long-term surveillance study was conducted from 2005 to 2016 in Tianjin, China. All patients with AIDS registered in Tianjin from 2005 to 2016 were recruited to this study. Demographic information and clinical features were recorded. A total of 3062 patients with AIDS who were treated with antiretroviral therapy were included in this study. Among AIDS patients, men were more likely to be younger than women (age, 37.84 years vs. 43.27 years; P < 0.001). The incidence of AIDS increased by 39.6% annually over the past 12 years overall. There was the greatest increase (by 44.7%) for homosexual route. Moreover, the proportion of patients aged < 30 years increased considerably over the 12-year study period, while there was a decrease in the proportion of patients aged ≥ 35 years. The frequency of homosexual transmission increased by 86% from before 2011 to 2016, but the frequency of heterosexual transmission decreased by 49%. The frequency of transmission through intravenous drug use decreased in men and patients aged 25–29 years. For those infected through homosexual transmission, there was a significant increase in the numbers of patients aged 20–24 years and 25–29 years. It is important for developing countries to effectively prevent and control the transmission of HIV/AIDS; in particular, it is crucial to promote disease education and sexual protection among young men.
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Affiliation(s)
- Ping Ma
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Liying Gao
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Defa Zhang
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Aiping Yu
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Chunting Qiu
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Lei Li
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Fangfang Yu
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Yue Wu
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Wei You
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Yanyun Guo
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Xianjia Ning
- Center of Epidemiology and Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China.,Department of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China
| | - Wei Lu
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
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Koff A, Goldberg C, Ogbuagu O. Condomless sex and HIV transmission among serodifferent couples: current evidence and recommendations. Ann Med 2017; 49:534-544. [PMID: 28409656 DOI: 10.1080/07853890.2017.1320423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection remains a global pandemic. The primary driver of HIV incidence is sexual transmission between serodifferent individuals. Condoms, when used consistently and correctly, are effective at preventing sexually transmitted HIV infections and are considered an integral component of a comprehensive approach to HIV prevention. However, the demonstrated effectiveness of antiretroviral therapy (ART) to prevent HIV transmission, known as treatment as prevention and of pre-exposure prophylaxis, have raised an intriguing dilemma on the necessity and additive preventive benefit of condom use among individuals in serodifferent relationships utilizing these prevention strategies. Recent published evidence, although of limited follow-up duration, has shown no linked HIV transmissions with condomless sex among serodifferent couples where the infected partner was on ART and virologically suppressed. This paper will review the evidence surrounding HIV transmission risk among serodifferent couples with and without the use of condoms and will highlight factors that increase or attenuate this risk. It will also address the important benefits that condomless sex offers couples. This paper aims to provide a template for providers to have personalized discussions with their patients, particularly those with an HIV-positive sexual partner, around their individual risk of HIV transmission and the role of condom use.
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Affiliation(s)
- Alan Koff
- a Department of Medicine , Norwalk Hospital , Norwalk , CT , USA
| | - Carole Goldberg
- b Department of Mental Health and Counselling , Yale School of Medicine , New Haven , CT , USA
| | - Onyema Ogbuagu
- c Section of Infectious Diseases , Yale School of Medicine , New Haven , CT , USA
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Carrieri MP, Marcellin F, Fressard L, Préau M, Sagaon-Teyssier L, Suzan-Monti M, Guagliardo V, Mora M, Roux P, Dray-Spira R, Spire B. Suicide risk in a representative sample of people receiving HIV care: Time to target most-at-risk populations (ANRS VESPA2 French national survey). PLoS One 2017; 12:e0171645. [PMID: 28192455 PMCID: PMC5305195 DOI: 10.1371/journal.pone.0171645] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 01/24/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Suicide risk is high among people living with HIV (PLHIV). This study aimed to identify major correlates of suicide risk in a representative sample of PLHIV in France, in order to help target individuals who would benefit from suicide risk screening and psychiatric care. METHODS The ANRS VESPA2 cross-sectional survey (April 2011-January 2012) collected socio-demographic, medical and behavioral data from 3,022 PLHIV recruited in 73 French HIV hospital departments. The study sample comprised the 2,973 participants with available self-reported data on suicide risk (defined as having either thought about and planned to commit suicide during the previous 12 months or attempted suicide during the same period of time) and medical data on comorbidities. Weighted Poisson models adjusted for HCV co-infection and significant clinical variables were used to estimate the relationship between suicide risk and HIV transmission groups, experience with HIV disease and other psychosocial factors. RESULTS Suicide risk was reported by 6.3% of PLHIV in the study sample. After adjustment for HIV immunological status and HCV co-infection, women (IRR [95%CI]:1.93 [1.17; 3.19]) and men who have sex with men (MSM) (1.97 [1.22; 3.19]) had a higher suicide risk than the rest of the sample. Moreover, the number of discrimination-related social contexts reported (1.39 [1.19; 1.61]), homelessness (4.87 [1.82; 13.02]), and reporting a feeling of loneliness (4.62 [3.06; 6.97]) were major predictors of suicide risk. CONCLUSIONS Reducing the burden of precarious social conditions and discrimination is an important lever for preventing suicide risk among PLHIV in France. Comprehensive care models involving peer/community social interventions targeted at women and MSM need to be implemented to lower the risk of suicide in these specific subgroups of PLHIV.
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Affiliation(s)
- Maria Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Fabienne Marcellin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
- * E-mail: (FM); (LF)
| | - Lisa Fressard
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
- * E-mail: (FM); (LF)
| | - Marie Préau
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- GREPS, Psychology Institute, Lyon 2 University, 5 avenue Pierre Mendes-France, Bron, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marie Suzan-Monti
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Valérie Guagliardo
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Rosemary Dray-Spira
- INSERM, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in social epidemiology, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in social epidemiology, Paris, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - ANRS-VESPA2 Study Group
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
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