@article {Daskalopoulousextrans-2016-053029, author = {Marina Daskalopoulou and Alison J Rodger and Andrew N Phillips and Lorraine Sherr and Jonathan Elford and Jeffrey McDonnell and Simon Edwards and Nicky Perry and Ed Wilkins and Simon Collins and Anne M Johnson and William J Burman and Andrew Speakman and Fiona C Lampe}, editor = {,}, title = {Condomless sex in HIV-diagnosed men who have sex with men in the UK: prevalence, correlates, and implications for HIV transmission}, elocation-id = {sextrans-2016-053029}, year = {2017}, doi = {10.1136/sextrans-2016-053029}, publisher = {The Medical Society for the Study of Venereal Disease}, abstract = {Objective HIV transmission is ongoing among men who have sex with men (MSM) in the UK. Sex without a condom (condomless sex, CLS) is the main risk factor. We investigated the prevalence of and factors associated with types of CLS.Methods Cross-sectional questionnaire study in UK HIV clinics in 2011/2012 (ASTRA). MSM diagnosed with HIV for >=3 months reported on anal and vaginal sex, CLS with HIV-serodifferent partners (CLS-D) and CLS with HIV-seroconcordant (CLS-C) partners in the previous 3 months. Mutually exclusive sexual behaviours were as follows: (1) Higher HIV risk CLS-D (not on antiretroviral therapy (ART) or clinic-recorded viral load(VL) \>50 c/mL), (2) Other CLS-D, (3) CLS-C without CLS-D, (4) Condom-protected sex only and (5) No anal or vaginal sex. Associations were examined of sociodemographic, HIV-related, lifestyle, and other sexual measures with the five categories of sexual behaviour. We examined the prevalence of higher HIV risk CLS-D incorporating (in addition to ART and VL) time on ART, ART non-adherence, and recent sexually transmitted infections (STIs).Results Among 2189 HIV-diagnosed MSM (87\% on ART), prevalence of any CLS in the past 3 months was 38.2\% (95\% CI 36.2\% to 40.4\%) and that of any CLS-D was 16.3\% (14.8\%{\textendash}17.9\%). The five-category classification was as follows: (1) Higher HIV risk CLS-D: 4.2\% (3.5\% to 5.2\%), (2) Other CLS-D: 12.1\% (10.8\% to 13.5\%), (3) CLS-C without CLS-D: 21.9\% (20.2\% to 23.7\%), (4) Condom-protected sex only: 25.4\% (23.6\% to 27.3\%) and (5) No anal or vaginal sex: 36.4\% (34.3\% to 38.4\%). Compared with men who reported condom-protected sex only, MSM who reported any CLS in the past 3 months had higher prevalence of STIs, chemsex-associated drug use, group sex, higher partner numbers, and lifetime hepatitis C. Prevalence of higher HIV risk CLS-D ranged from 4.2\% to 7.5\% according to criteria included.Conclusion CLS was prevalent among HIV-diagnosed MSM, but CLS-D with higher HIV transmission risk was overall low. CLS-D is no longer the most appropriate measure of HIV transmission risk behaviour among people with diagnosed HIV; accounting for VL is important.}, issn = {1368-4973}, URL = {https://sti.bmj.com/content/early/2017/07/11/sextrans-2016-053029}, eprint = {https://sti.bmj.com/content/early/2017/07/11/sextrans-2016-053029.full.pdf}, journal = {Sexually Transmitted Infections} }