by Roger Pebody
The proportion of HIV-positive gay and bisexual men having ‘unsafe sex’ falls from 42% to 2% when a nuanced definition of the term is used, Dr Keith Horvath of the University of Minnesota and colleagues report in the Archives of Sexual Behaviour.
“Traditional definitions of sexual risk (condomless anal sex or condomless anal sex with a serodiscordant partner) may not suffice, given the success of biomedical prevention in the absence of condoms,” they say.
Their data come from a cohort of HIV-positive gay and bisexual men living in New York who were recruited to an online intervention to improve adherence to HIV treatment. Of the 401 participants, 281 reported anal sex in the past three months and this group are the focus of this analysis.
The participants’ average age was 38 and they had been diagnosed for an average of 12 years. Over half were black and a third were college-educated. Men had an average of nine sexual partners in the past three months and half reported stimulant drug use.
The traditional definition of ‘risky sex’ is condomless anal sex with a partner who is HIV negative or of unknown HIV status – 42% reported this in the past three months. Read more via AIDSmap
MLAHorvath, Keith J., et al. "Defining Sexual Risk in the Era of Biomedical HIV Prevention: Implications for HIV Research and Practice." Archives of sexual behavior (2019): 1-12.
excerpt
Discussion
Traditional definitions of high-risk sex have become more complicated with the introduction of TasP (Cohen et al., 2011) and PrEP (Grant et al., 2010). While CAS has been used as a primary marker of HIV risk for MSM, studies demonstrate that it no longer serves to identify specific drivers for HIV transmission in the current era of biomedical prevention (Jin et al., 2015; Kelly, 2016; Rodger et al., 2019). However, consensus on best practices for defining amplified transmission risk among HIV-positive samples has not yet been reached. We investigated correlates of four definitions of high-risk sexual behavioral among HIV-positive MSM living in New York City to further understanding and prompt discussion on the topic….
The four models presented here also reveal that potential intervention targets may be very different depending on how risk is defined. Education was the strongest predictor of the traditional definition of HIV risk (Definition 1) and the definition that also included unsuppressed VL (Definition 2). Conversely, alcohol use and lower enacted stigma emerged as the strongest predictors in the definition that considered only partner PrEP use (Definition 3), while internalized stigma and various forms of social support were associated with the most restrictive definition of high risk (Definition 4). Of note, although only six men met the requirements for Definition 4, all of them were racial and ethnic minorities, and reported illicit drug use, stimulant use, and elevated depressive symptoms. These results are encouraging in that alcohol use, stigma, social support, and drug use are modifiable factors and effective interventions that address these factors have been demonstrated to be effective (Kahler et al., 2018; Lyons et al., 2017; Safren et al., 2012). Taken together, these findings serve as a reminder that the ways in which HIV risk is defined have important implications for intervention design. Furthermore, as researchers grapple at this time with how to define HIV risk in the era of biomedical HIV prevention, suggested intervention targets may differ widely across studies until greater consensus on a definition of risk is reached.