AIDS and Behavior

, 13:645 | Cite as

Use of Viral Load to Negotiate Condom Use Among Gay Men in Sydney, Australia

  • Garrett Prestage
  • Limin Mao
  • Susan Kippax
  • Fengyi Jin
  • Michael Hurley
  • Andrew Grulich
  • John Imrie
  • John Kaldor
  • Iryna Zablotska
Original Research

Abstract

Using two cohort studies (Health in men—HIM and positive health—PH) and repeated large cross-sectional surveys (Gay Community Periodic Survey—GCPS) of gay men in Sydney, Australia, we examined the association between viral load and unprotected anal intercourse (UAI) between HIV sero-discordant regular partners. Between 2001 and 2007, we conducted 243 interviews with 102 HIV-negative gay men in HIM and 148 interviews with 99 HIV-positive gay men in PH who were in regular relationships with HIV sero-discordant partners. During the same time period, 437 HIV positive men with HIV sero-discordant regular partners completed questionnaires for the GCPS. All completed interviews or questionnaires during that time period were used for these analyses. Amongst the HIV-negative respondents, sero-discordant UAI was more likely to be reported when the men believed their HIV-positive regular partner had an undetectable rather than a detectable viral load (P = 0.002). Amongst the HIV-positive respondents, sero-discordant UAI was as likely to be reported when they themselves reported having an undetectable or a detectable viral load. Use of viral load in negotiating condom use between sero-discordant gay couples may be understood very differently by the HIV-negative and HIV-positive men within those partnerships.

Keywords

Gay men HIV Sexual behaviour Viral load Condoms 

Notes

Acknowledgments

The authors thank the AIDS Council of New South Wales, Positive Life (NSW), the Australian Federation of AIDS Organisations and the National Association of People Living with HIV/AIDS for collaboration with these studies, and the men who have participated in them over the years. The National Centre in HIV Epidemiology and Clinical Research, the National Centre in HIV Social Research, and the Australian Research Centre in Sex Health and Society receive funding from the Commonwealth Department of Health and Ageing. Sponsorship: The SGCPS and PH study was supported by the New South Wales Health Department. Funding for HIM was provided by the New South Wales Health Department (Sydney), the Commonwealth Department of Health and Ageing (Canberra), the (Australian) National Health and Medical Research Council, and the US National Institutes of Health (NIH/NIAID/DAIDS: HVDDT Award N01-AI-05395). None of these funding agencies had any further role: in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Conflict of Interest

All authors declare that they have no conflicts of interest.

References

  1. Chan, D. J., McNally, L., Batterham, M., & Smith, D. E. (2008a). Relationship between HIV-RNA load in blood and semen in antiretroviral-naïve and experienced men and effect of asymptomatic sexually transmissible infections. Current HIV Research, 6, 138–142. doi: 10.2174/157016208783885074.PubMedCrossRefGoogle Scholar
  2. Chan, D. J., Ray, J. E., McNally, L., Batterham, M., & Smith, D. E. (2008b). Correlation between HIV-RNA load in blood and seminal plasma depending on antiretroviral treatment status, regimen and penetration of semen by antiretrovial drugs. Current HIV Research, 6, 477–484. doi: 10.2174/157016208785861177.PubMedCrossRefGoogle Scholar
  3. Crepaz, N., Hart, T., & Marks, G. (2004). Highly active antiretroviral therapy and sexual risk behavior. Journal of the American Medical Association, 292(2), 224–236. doi: 10.1001/jama.292.2.224.PubMedCrossRefGoogle Scholar
  4. Diamond, C., Richardson, J., Milam, J., Stoyanoff, S., McCutchan, J. A., Kemper, C., et al. (2005). Use of and adherence to antiretroviral therapy is associated with decreased sexual risk behavior in HIV clinic patients. Journal of Acquired Immune Deficiency Syndromes, 39(2), 211–218.PubMedGoogle Scholar
  5. Falster, K., Gelgor, L., Shaik, A., Zablotska, I., Prestage, G., Grierson, J., et al. (2008). Trends in antiretroviral treatment use and treatment response in three Australian states in the first decade of combination antiretroviral treatment. Sexual Health, 5, 125–130. doi: 10.1071/SH07082.CrossRefGoogle Scholar
  6. Gray, R. H., Wawer, M. J., Brookmeyer, R., Sewankambo, N. K., Serwadda, D., Wabwire-Mangen, F., et al. (2001). Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda. Lancet, 357, 1149–1153. doi: 10.1016/S0140-6736(00)04331-2.PubMedCrossRefGoogle Scholar
  7. Halkitis, P. N., Zade, D. D., Shrem, M., & Marmor, M. (2004). Beliefs about HIV noninfection and risky sexual behavior among MSM. AIDS Education and Prevention, 16, 448–458. doi: 10.1521/aeap.16.5.448.48739.PubMedCrossRefGoogle Scholar
  8. Kalichman, S. C., Di Berto, G., & Eaton, L. (2008). Human immunodeficiency virus viral load in blood plasma and semen: Review and implications of empirical findings. Sexually Transmitted Diseases, 35(1), 55–60.PubMedCrossRefGoogle Scholar
  9. Kippax, S., Crawford, J., Davis, M., Rodden, P., & Dowsett, G. (1993). Sustaining safe sex: A longitudinal study of a sample of homosexual men. AIDS (London, England), 7, 257–263. doi: 10.1097/00002030-199302000-00015.Google Scholar
  10. Kippax, S., Noble, J., Prestage, G., Crawford, J., Campbell, D., Baxter, D., et al. (1997). Sexual negotiation in the AIDS era: Negotiated safety revisited. AIDS (London, England), 11, 191–197. doi: 10.1097/00002030-199702000-00009.Google Scholar
  11. Mao, L., Crawford, J. M., Hospers, H. J., Prestage, G. P., Grulich, A. E., Kaldor, J. M., et al. (2006). “Serosorting” in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia. AIDS (London, England), 20, 1204–1206. doi: 10.1097/01.aids.0000226964.17966.75.Google Scholar
  12. Muñoz-Laboy, M., Castellanos, D., & Westacott, R. (2005). Sexual risk behaviour, viral load, and perceptions of HIV transmission among homosexually active Latino men. AIDS Care, 17(1), 33–45. doi: 10.1080/09540120412331305115.PubMedCrossRefGoogle Scholar
  13. Parsons, J. T., Schrimshaw, E. W., Wolitski, R. J., Halkitis, P. N., Purcell, D. W., Hoff, C. C., et al. (2005). Sexual harm reduction practices of HIV-seropositive gay and bisexual men: Serosorting, strategic positioning, and withdrawal before ejaculation. AIDS (London, England), 19, S13–S25.Google Scholar
  14. Prestage, G. P., Fogarty, A., Mao, L., Van de Ven, P., Kippax, S., Kaldor, J. M., et al. (2005). How has the sexual behaviour of gay men changed since the onset of AIDS: 1986–2003. Australian and New Zealand Journal of Public Health, 29, 530–535. doi: 10.1111/j.1467-842X.2005.tb00245.x.PubMedCrossRefGoogle Scholar
  15. Prestage, G. P., Jin, F. F., Zablotska, I., Imrie, J. J., Grulich, A. E., & Pitts, M. (2008). Trends in HIV testing among homosexual and bisexual men in eastern Australian states. Sexual Health, 5(2), 119–123. doi: 10.1071/SH07081.PubMedCrossRefGoogle Scholar
  16. Prestage, G., Mao, L., McGuigan, D., Crawford, J., Kippax, S., Kaldor, J., et al. (2006). HIV risk and communication between regular partners in a cohort of HIV-negative gay men. AIDS Care, 18, 166–172. doi: 10.1080/09540120500358951.PubMedCrossRefGoogle Scholar
  17. Rawstorne, P., Fogarty, A., Crawford, J., Prestage, G. P., Grierson, J., Grulich, A. E., et al. (2007). Differences between HIV-positive gay men who ‘frequently’, ‘sometimes’ or ‘never’ engage in unprotected anal intercourse with serononconcordant casual partners, positive health cohort, Australia. AIDS Care, 19, 514–522. doi: 10.1080/09540120701214961.PubMedCrossRefGoogle Scholar
  18. Remien, R., Halkitis, P., O’Leary, A., Wolitski, R., & Gómez, C. (2005). Risk perception and sexual risk behaviors among HIV-positive men on antiretroviral therapy. AIDS and Behavior, 9(2), 167–176. doi: 10.1007/s10461-005-3898-7.PubMedCrossRefGoogle Scholar
  19. Rosengarten, M., Race, K., & Kippax, S. (2000). Touch Wood, everything will be OK”: Gay men’s understandings of clinical markers in sexual practice Monograph 7/2000. Sydney: National Centre in HIV Social Research.Google Scholar
  20. Stolte, I. G., Dukers, N. H. T. M., Geskus, R. B., Coutinho, R. A., & DeWit, J. B. F. (2004). Homosexual men change to risky sex when perceiving less threat of HIV/AIDS since availability of highly active antiretroviral therapy: A longitudinal study. AIDS (London, England), 18, 303–309. doi: 10.1097/00002030-200401230-00021.Google Scholar
  21. UNAIDS/WHO. (2008). Joint statement: Antiretroviral therapy and sexual transmission of HIV. Retrieved 1 February 2008, from http://data.unaids.org/pub/PressStatement/2008/080201_hivtransmission_en.pdf.
  22. Van de Ven, P., Campbell, D., Kippax, S., Knox, S., Prestage, G., Crawford, J., et al. (1998). Gay men who engage repeatedly in unprotected anal intercourse with casual partners: The Sydney men and sexual health study. International Journal of STD and AIDS, 9, 336–340. doi: 10.1258/0956462981922368.PubMedCrossRefGoogle Scholar
  23. Van de Ven, P., Kippax, S., Crawford, J., Rawstorne, P., Prestage, G., Grulich, A., et al. (2002). In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care, 14, 471–480. doi: 10.1080/09540120208629666.PubMedCrossRefGoogle Scholar
  24. Van de Ven, P. G., Mao, L., Fogarty, A., Rawstorne, P., Crawford, J., Prestage, G. P., et al. (2005). Undetectable viral load is associated with sexual risk taking in HIV serodiscordant gay couples in Sydney. AIDS (London, England), 19, 179–184.Google Scholar
  25. Van der Snoek, E. M., De Wit, J. B. F., Mulder, P. G. H., & Van der Meijden, W. I. (2005). Incidence of sexually transmitted diseases and HIV infection related to perceived HIV/AIDS threat since highly active antiretroviral therapy availability in men who have sex with men. Sexually Transmitted Diseases, 32, 170–175. doi: 10.1097/01.olq.0000149786.09706.66.PubMedCrossRefGoogle Scholar
  26. Vernazza, P., Hirschel, B., Bernasconi, E., & Flepp, M. (2008). Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitement antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bulletin des Médecins Suisses, 9, 5.Google Scholar
  27. Vittinghoff, E., Douglas, J., Judson, F., McKirnan, D., MacQueen, K., & Buchbinder, S. (1999). Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology, 150(3), 306–311.PubMedGoogle Scholar
  28. Wilson, D., Law, M., Grulich, A., Cooper, D., & Kaldor, J. (2008). Relation between HIV viral load and infectiousness: A model-based analysis. Lancet, 372(9635), 314–320.PubMedCrossRefGoogle Scholar
  29. Xia, Q., Molitor, F., Osmond, D. H., Tholandi, M., Pollack, L. M., Ruiz, J. D., et al. (2006). Knowledge of sexual partner’s HIV serostatus and serosorting practices in a California population-based sample of men who have sex with men. AIDS (London, England), 20, 2081–2089. doi: 10.1097/01.aids.0000247566.57762.b2.Google Scholar
  30. Zablotska, I., Crawford, J., Imrie, J., Prestage, G.P., Jin, F., Grulich, A.E., Kippax, S. (2009). Increases in unprotected anal intercourse with serodiscordant casual partners among HIV negative gay men in Sydney. AIDS and Behaviour. doi: 10.1007/s10461-008-9506-x.
  31. Zablotska, I., Prestage, G., Grulich, A. E., & Imrie, J. (2008). Differing trends in sexual risk behaviours in three Australian states: New South Wales, Victoria and Queensland, 1998–2006. Sexual Health, 5, 125–130. doi: 10.1071/SH07076.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Garrett Prestage
    • 1
  • Limin Mao
    • 2
  • Susan Kippax
    • 2
  • Fengyi Jin
    • 1
  • Michael Hurley
    • 3
  • Andrew Grulich
    • 1
  • John Imrie
    • 2
  • John Kaldor
    • 1
  • Iryna Zablotska
    • 2
  1. 1.National Centre in HIV Epidemiology and Clinical ResearchUniversity of New South WalesDarlinghurst, SydneyAustralia
  2. 2.National Centre in HIV Social ResearchUniversity of New South WalesSydneyAustralia
  3. 3.Australian Research Centre in Sex Health and SocietyLa Trobe UniversityMelbourneAustralia

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