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Oral Presentations
O10 – GETTING REAL WITH IMPLEMENTING PREP 2
Tuesday, July 16, 2019 4:15 PM – 5:45 PM
O10.6 A longitudinal analysis of men who have sex with men’s condom use and attitudes during HIV antiretroviral prevention scale-up
  1. Nathan Lachowsky1,
  2. Lu Wang2,
  3. Nicanor Bacani2,
  4. Heather Armstrong3,
  5. Gbolahan Olarewaju2,
  6. Kiffer Card1,
  7. Richard Crosby4,
  8. Eric Roth5,
  9. Robert Hogg6,
  10. David Moore2
  1. 1University of Victoria, School of Public Health and Social Policy, Victoria, Canada
  2. 2BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
  3. 3University of British Columbia, Vancouver, Canada
  4. 4University of Kentucky, Lexington, USA
  5. 5University of Victoria, Victoria, Canada
  6. 6British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada

Abstract

Background Within British Columbia, men who have sex with men (MSM) comprise an increasing proportion of new HIV diagnoses (60% in 2016). We sought to identify temporal trends in condom-use and condom-related attitudes among MSM, especially in relation to antiretroviral-based prevention scale-up.

Methods A prospective biobehavioural cohort of sexually-active MSM in Metro Vancouver were recruited using respondent-driven sampling (RDS). Every six months, participants self-completed questionnaires. We analyzed temporal trends (6-month periods) in condomless sex (binary outcome) and condom-related attitudes (continuous outcomes) using 3-level generalized linear mixed model (visit; participant; RDS chain). Statistical interactions were tested between time and antiretroviral treatment/pre-exposure prophylaxis (PrEP) use.

Results Between 03/2015–02/2018, 520 participants (32.1% HIV-positive) completed 1861 study visits. Over time, reporting any condomless anal sex with an unknown/opposite status partner increased for HIV-negative men (OR=1.20, 95%CI:1.03–1.40) and decreased for HIV-positive men (OR=0.83, 95%CI:0.73–0.94). Correct Condom Use Self-Efficacy scale scores decreased among HIV-positive men (B=-0.296, p<0.001) but remained unchanged among HIV-negative men (p=0.167). Overall, Condom Barriers Experience subscale scores decreased, indicating more problems over time (B=-0.236, p<0.001). Other individual items indicated that fewer men reported they ‘can always get condoms’ (B=-0.023, p=0.003), ‘always have condoms when I have sex’ (B=-0.028, p=0.006), and ‘can always ask sexual partners to use condoms’ (B=-0.027, p=0.002). Over time, the ability to ‘say no’ to condomless sex increased among HIV-negative men using PrEP (B=0.172, p=0.023), but decreased among HIV-negative men not using PrEP (B=-0.049, p=0.001) (interaction, p=0.004).

Conclusion MSM reported changing condom experiences over time, including decreased condom access, availability, and norms. HIV-positive men had less condomless sex with serodiscordant partners and reported more difficulties using condoms over time. PrEP-using men reported greater agency to decline condomless sex; the opposite was true for other HIV-negative men. Innovations in individual and community-level condom promotion and interventions are needed, especially for HIV-negative men not using PrEP.

Disclosure No significant relationships.

  • HIV
  • gay
  • bisexual and other men who have sex with men

https://doi.org/10.1136/sextrans-2019-sti.163

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