Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men

Abstract

Objective-A range of risk reduction behaviours in which homosexual men practise unprotected anal intercourse (UAI) has been described. We aimed to assess the extent of any reduction in HIV risk associated with these behaviours.Design-A prospective cohort study of HIV-negative homosexual men in Sydney, Australia. Methods-Men were followed up with 6-monthly detailed behavioural interviews and annual testing for HIV. The four risk reduction behaviours (behaviourally defined) examined were serosorting, negotiated safety, strategic positioning, and withdrawal during receptive UAI (UAI-R).Results-In 88% of follow-up periods in which UAI was reported, it occurred in the context of consistent risk reduction behaviours. Compared with those who reported no UAI, the risk of HIV infection was not raised in negotiated safety [hazard ratio = 1.67, 95% confidence interval (CI) 0.59-4.76] and strategic positioning (hazard ratio = 1.54, 95% CI 0.45-5.26). Serosorting outside negotiated safety was associated with an intermediate rate of HIV infection (hazard ratio = 3.11, 95% CI 1.09-8.88). Withdrawal was associated with a higher risk than no UAI (hazard ratio = 5.00, 95% CI 1.94-12.92). Patterns of UAI differed greatly according to partner's serostatus. Men who reported serosorting were less likely to report either strategic positioning or withdrawal.Conclusion-Each behaviour examined was associated with an intermediate HIV incidence between the lowest and highest risk sexual behaviours. The inverse association between individual behaviours suggests that men who practise serosorting rely on this protection. The high prevalence of these behaviours demands that researchers address the contexts and risks associated with specific types of UAI.

Substance Use and HIV Risk Behavior among Men Who Have Sex with Men: The Role of Sexual Compulsivity

“…20 Although recent ground breaking randomized clinical trials have demonstrated that antiretroviral therapy (ART) decreases rates of HIV seroconversion and onward transmission, substance users were excluded from these well-controlled efficacy trials. 21,22 Further clinical research is needed to examine whether behavioral interventions targeting substance use and sexual risk behavior optimize the effectiveness of ART for HIV prevention with substance-using MSM.…”

“…Compared to a reference group that reported no UAI (n=415), separate multivariate logistic regression analyses examined correlates of SDUAI (n=105) and serosorting among HIV-negative MSM (n=185). 20 The multivariate models included interaction terms for sexual compulsivity with stimulant, poppers, EDM, and alcohol use. Stratified AORs adjusted for variables that were significant in the full multivariate model (e.g., poppers, EDM use), were calculated to probe significant interaction terms.…”

Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys

“…12,23 Serosorting has become much more commonly practised by GBM in the last decade, 12,40 but it is does not protect HIVnegative men if HIV status is incorrectly assumed or a partner has undiagnosed HIV. 24,41,42 In fact, the greater reliance on serosorting may have increased the exposure of HIV-negative men to undiagnosed HIV, which may explain why other positive changes (such as the increase in HIV treatment and undetectable viral load) have had limited effect. 12,37 Based on current trends, we expect CAI between casual partners to become more common over time and for HIV notifications to continue to rise if additional protective strategies are not deployed.…”

“…24 This classification system can be stratified by HIV status, reporting categories 1-2, 4 and 6-7 for HIV-negative and untested men and categories 1-3 and 5 for HIV-positive men only.…”

How partnership type and HIV seroconcordance affect HIV transmission risk in regular sexual partnerships: a cross-sectional survey of Australian gay and bisexual men

“…where both partners are HIV-negative), negotiated safety agreements, where the couple agrees not to have CLAI with outside partners, are associated with a low HIV incidence. 24 Use of negotiated safety has been common in Australia since the mid-1990s, 25 and HIV testing rates are comparatively high. 26 This may explain, in part, the lower proportion of infections ascribed to romantic, committed relationships compared with elsewhere.…”