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Epidemiology
Original article
Condomless sex in HIV-diagnosed men who have sex with men in the UK: prevalence, correlates, and implications for HIV transmission
  1. Marina Daskalopoulou1,
  2. Alison J Rodger1,
  3. Andrew N Phillips1,
  4. Lorraine Sherr1,
  5. Jonathan Elford2,
  6. Jeffrey McDonnell1,
  7. Simon Edwards3,
  8. Nicky Perry4,
  9. Ed Wilkins5,
  10. Simon Collins6,
  11. Anne M Johnson1,
  12. William J Burman7,
  13. Andrew Speakman1,
  14. Fiona C Lampe1
  15. for the ASTRA Study Group
  1. 1 Research Department of Infection and Population Health, University College London, London, UK
  2. 2 City University London, London, UK
  3. 3 Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
  4. 4 Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  5. 5 Pennine Acute Hospitals NHS Trust, Manchester, UK
  6. 6 HIV i-Base, London, UK
  7. 7 Denver Public Health, Denver, Colorado, USA
  1. Correspondence to Marina Daskalopoulou, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK; m.daskalopoulou{at}ucl.ac.uk

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%–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.

  • GAY MEN
  • HIV
  • SEXUAL BEHAVIOUR
  • EPIDEMIOLOGY (GENERAL)
  • DRUG MISUSE

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/sextrans-2016-053029

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    Footnotes

    • Contributors FCL, ANP, AJR, AS, EW, SC, NP, LS, AMJ and WJB conceived and designed the study. AS, AJR, EW, JM, SE and NP collected the data. FCL, AS and MD managed the data. MD performed the analysis and drafted the paper. All authors contributed to data interpretation, writing and revision of the paper and approved the final manuscript.

    • Funding This work was supported by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-0608-10142).

    • Competing interests AMJ is Governor of the Wellcome Trust. ANP received speaker fees for talks at conferences sponsored by Gilead. MD, AJR, LS, JE, JM, SE, NP, EW, SC, WJB, AS, FCL declare no conflicts of interest.

    • Patient consent Obtained.

    • Ethics approval North West London REC 2 research ethics committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.