HIV testing behaviour and use of risk reduction strategies by HIV risk category among MSM in Vancouver

Abstract

We carried out an analysis of a serobehavioural study of men who have sex with men >19 years of age in Vancouver, Canada to examine HIV testing behaviour and use of risk reduction strategies by HIV risk category, as defined by routinely gathered clinical data. We restricted our analysis to those who self-identified as HIV-negative, completed a questionnaire, and provided a dried blood spot sample. Of 842 participants, 365 (43.3%) were categorised as lower-risk, 245 (29.1%) as medium-risk and 232 (27.6%) as higher-risk. The prevalence of undiagnosed HIV infection was low (lower 0.8%, medium 3.3%, higher 3.9%; p = 0.032). Participants differed by risk category in terms of having had an HIV test in the previous year (lower 46.5%, medium 54.6%, higher 67.0%; p < 0.001) and in their use of serosorting (lower 23.3%, medium 48.3%, higher 43.1%; p < 0.001) and only having sex with HIV-positive men if those men had low viral loads or were taking HIV medication (lower 5.1%, medium 4.8%, higher 10.9%; p = 0.021) as risk reduction strategies. These findings speak to the need to consider segmented health promotion services for men who have sex with men with differing risk profiles. Risk stratification could be used to determine who might benefit from tailored multiple health promotion interventions, including HIV pre-exposure prophylaxis.

Brief Report

“…Echoing recent Dutch research, 5 we cannot tell whether viral load is being discussed with HIV-negative casual partners before sex without condoms or whether it is being "unilaterally" used by HIVpositive men. However, similar to Canadian research, 15 we found that 1 in ten HIV-negative and untested men frequently made sure that their HIV-positive partners had an undetectable viral load before sex without condoms. This suggests a growing awareness of "treatment as prevention" among Australian men who have sex without condoms, despite community skepticism about the concept.…”

“…6,7 If consistently applied or sustained, condom use, an undetectable viral load and PrEP can be highly effective in preventing HIV infection, whereas the other strategies are generally less effective. 6,[8][9][10][11][12] The relative frequency of use of different strategies has been described among Australian, Swiss, and North American gay and bisexual men, 1,[13][14][15] suggesting that over three-quarters use some form of risk reduction during anal intercourse. In many countries, the most common RRS between casual partners remains condom use, with minorities reporting serosorting, strategic positioning, and withdrawal.…”

“…In Australian and Dutch studies, an undetectable viral load has been found to be associated with a greater likelihood of anal sex without condoms between regular but not casual male partners, 1,4,5 and in Canada, 11% of "higher risk" gay and bisexual men used undetectable viral load as a strategy. 15 The informal use of antiretroviral drugs as PrEP has been reported among small proportions (,3%) of gay and bisexual men in Australia and the USA. 17,18 In many countries, the HIV epidemic has resurged among gay and bisexual men.…”

A Single Question to Examine the Prevalence and Protective Effect of Seroadaptive Strategies Among Men Who Have Sex With Men

“…First, this tool can be employed for sentinel behavioral surveillance. Data from the U.S., Australia and Canada suggest that partner viral load and PrEP use may impact sexual decision-making among MSM 12–14 , but the trends in these behaviors have not been routinely monitored. Use of a brief behavioral assessment in the same population over time will help to understand what behaviors these newer ones (i.e., behaviors while on PrEP) are replacing and may also help explain changes in population-level HIV and STI rates.…”

Dried Blood Spot Tests for the Diagnosis and Therapeutic Monitoring of HIV and Viral Hepatitis B and C

“…A program of this type has been implemented by the Montpellier teaching hospital since 2013 in all addiction treatment centers located in the Languedoc Roussillon Region (Accueillir, 2014). Sex workers (Shokoohi et al, 2016), homeless people (Foroughi et al, 2017), migrants and some men who have sex with men (MSM) (Bogowicz et al, 2016), as well as populations living in hard to reach areas such as French Guiana (Schaub, 2017) are also key populations that can have difficult access to laboratory infectious diseases testing for which the use of DBS should be considered.…”