Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries

Benjamin R. Bavinton, Garrett P. Prestage, Fengyi Jin, Nittaya Phanuphak, Beatriz Grinsztejn, Christopher K. Fairley, David Baker, Jennifer Hoy, David J. Templeton, Ban K. Tee, Anthony Kelleher, Andrew E. Grulich, For the Opposites Attract study group

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Abstract

INTRODUCTION: There are few data about the range of strategies used to prevent sexual HIV transmission within gay male serodiscordant couples. We examined HIV prevention strategies used by such couples and compared differences between countries. METHODS: Opposites Attract was a cohort study of male serodiscordant couples in Australia, Brazil and Thailand, from May 2014 (Australia) or May 2016 (Brazil/Thailand) to December 2016. At visits, HIV-positive partners had viral load (VL) tested; HIV-negative partners reported sexual behaviour and perceptions of their HIV-positive partner's VL results. Within-couple acts of condomless anal intercourse (CLAI) were categorized by strategy: condom-protected, biomedically protected (undetectable VL and/or pre-exposure prophylaxis [PrEP]), or not protected by either (HIV-negative partners engaging in insertive CLAI, receptive CLAI with withdrawal, or receptive CLAI with ejaculation). RESULTS: A total of 343 couples were included in this analysis (153 in Australia, 93 in Brazil and 97 in Thailand). Three-quarters of HIV-positive partners were consistently virally suppressed (<200 copies/mL) during follow-up, and HIV-negative partners had correct perceptions of their partner's VL result for 76.5% of tests. One-third of HIV-negative partners used daily PrEP during follow-up. Over follow-up, 73.8% of couples had CLAI. HIV-negative partners reported 31,532 acts of anal intercourse with their HIV-positive partner. Of these, 46.7% were protected by condoms, 48.6% by a biomedical strategy and 4.7% of acts were not protected by these strategies. Australian couples had fewer condom-protected acts and a higher proportion of biomedically protected acts than Brazilian and Thai couples. Of the 1473 CLAI acts where the perceived VL was detectable/unknown and were not protected by PrEP (4.7% of all acts), two-thirds (n = 983) were when the HIV-negative partner was insertive (strategic positioning). Of the 490 acts when the HIV-negative partner was receptive, 261 involved withdrawal and 280 involved ejaculation. Thus, <1% of acts were in the highest risk category of receptive CLAI with ejaculation. CONCLUSIONS: Couples used condoms, PrEP or perceived undetectable VL for prevention in the majority of anal intercourse acts. Only a very small proportion of events were not protected by these strategies. Variation between countries may reflect differences in access to HIV treatment, education, knowledge and attitudes.

Original languageEnglish
Article numbere25277
Number of pages9
JournalJournal of the International AIDS Society
Volume22
Issue number4
DOIs
Publication statusPublished - 1 Apr 2019

Keywords

  • gay men
  • HIV prevention
  • homosexual
  • men who have sex with men
  • risk reduction strategies
  • serodiscordant couples
  • sexual behaviour

Cite this

Bavinton, Benjamin R. ; Prestage, Garrett P. ; Jin, Fengyi ; Phanuphak, Nittaya ; Grinsztejn, Beatriz ; Fairley, Christopher K. ; Baker, David ; Hoy, Jennifer ; Templeton, David J. ; Tee, Ban K. ; Kelleher, Anthony ; Grulich, Andrew E. ; For the Opposites Attract study group. / Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries. In: Journal of the International AIDS Society. 2019 ; Vol. 22, No. 4.
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abstract = "INTRODUCTION: There are few data about the range of strategies used to prevent sexual HIV transmission within gay male serodiscordant couples. We examined HIV prevention strategies used by such couples and compared differences between countries. METHODS: Opposites Attract was a cohort study of male serodiscordant couples in Australia, Brazil and Thailand, from May 2014 (Australia) or May 2016 (Brazil/Thailand) to December 2016. At visits, HIV-positive partners had viral load (VL) tested; HIV-negative partners reported sexual behaviour and perceptions of their HIV-positive partner's VL results. Within-couple acts of condomless anal intercourse (CLAI) were categorized by strategy: condom-protected, biomedically protected (undetectable VL and/or pre-exposure prophylaxis [PrEP]), or not protected by either (HIV-negative partners engaging in insertive CLAI, receptive CLAI with withdrawal, or receptive CLAI with ejaculation). RESULTS: A total of 343 couples were included in this analysis (153 in Australia, 93 in Brazil and 97 in Thailand). Three-quarters of HIV-positive partners were consistently virally suppressed (<200 copies/mL) during follow-up, and HIV-negative partners had correct perceptions of their partner's VL result for 76.5{\%} of tests. One-third of HIV-negative partners used daily PrEP during follow-up. Over follow-up, 73.8{\%} of couples had CLAI. HIV-negative partners reported 31,532 acts of anal intercourse with their HIV-positive partner. Of these, 46.7{\%} were protected by condoms, 48.6{\%} by a biomedical strategy and 4.7{\%} of acts were not protected by these strategies. Australian couples had fewer condom-protected acts and a higher proportion of biomedically protected acts than Brazilian and Thai couples. Of the 1473 CLAI acts where the perceived VL was detectable/unknown and were not protected by PrEP (4.7{\%} of all acts), two-thirds (n = 983) were when the HIV-negative partner was insertive (strategic positioning). Of the 490 acts when the HIV-negative partner was receptive, 261 involved withdrawal and 280 involved ejaculation. Thus, <1{\%} of acts were in the highest risk category of receptive CLAI with ejaculation. CONCLUSIONS: Couples used condoms, PrEP or perceived undetectable VL for prevention in the majority of anal intercourse acts. Only a very small proportion of events were not protected by these strategies. Variation between countries may reflect differences in access to HIV treatment, education, knowledge and attitudes.",
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author = "Bavinton, {Benjamin R.} and Prestage, {Garrett P.} and Fengyi Jin and Nittaya Phanuphak and Beatriz Grinsztejn and Fairley, {Christopher K.} and David Baker and Jennifer Hoy and Templeton, {David J.} and Tee, {Ban K.} and Anthony Kelleher and Grulich, {Andrew E.} and {For the Opposites Attract study group}",
year = "2019",
month = "4",
day = "1",
doi = "10.1002/jia2.25277",
language = "English",
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issn = "1758-2652",
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Bavinton, BR, Prestage, GP, Jin, F, Phanuphak, N, Grinsztejn, B, Fairley, CK, Baker, D, Hoy, J, Templeton, DJ, Tee, BK, Kelleher, A, Grulich, AE & For the Opposites Attract study group 2019, 'Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries', Journal of the International AIDS Society, vol. 22, no. 4, e25277. https://doi.org/10.1002/jia2.25277

Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries. / Bavinton, Benjamin R.; Prestage, Garrett P.; Jin, Fengyi; Phanuphak, Nittaya; Grinsztejn, Beatriz; Fairley, Christopher K.; Baker, David; Hoy, Jennifer; Templeton, David J.; Tee, Ban K.; Kelleher, Anthony; Grulich, Andrew E.; For the Opposites Attract study group.

In: Journal of the International AIDS Society, Vol. 22, No. 4, e25277, 01.04.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries

AU - Bavinton, Benjamin R.

AU - Prestage, Garrett P.

AU - Jin, Fengyi

AU - Phanuphak, Nittaya

AU - Grinsztejn, Beatriz

AU - Fairley, Christopher K.

AU - Baker, David

AU - Hoy, Jennifer

AU - Templeton, David J.

AU - Tee, Ban K.

AU - Kelleher, Anthony

AU - Grulich, Andrew E.

AU - For the Opposites Attract study group

PY - 2019/4/1

Y1 - 2019/4/1

N2 - INTRODUCTION: There are few data about the range of strategies used to prevent sexual HIV transmission within gay male serodiscordant couples. We examined HIV prevention strategies used by such couples and compared differences between countries. METHODS: Opposites Attract was a cohort study of male serodiscordant couples in Australia, Brazil and Thailand, from May 2014 (Australia) or May 2016 (Brazil/Thailand) to December 2016. At visits, HIV-positive partners had viral load (VL) tested; HIV-negative partners reported sexual behaviour and perceptions of their HIV-positive partner's VL results. Within-couple acts of condomless anal intercourse (CLAI) were categorized by strategy: condom-protected, biomedically protected (undetectable VL and/or pre-exposure prophylaxis [PrEP]), or not protected by either (HIV-negative partners engaging in insertive CLAI, receptive CLAI with withdrawal, or receptive CLAI with ejaculation). RESULTS: A total of 343 couples were included in this analysis (153 in Australia, 93 in Brazil and 97 in Thailand). Three-quarters of HIV-positive partners were consistently virally suppressed (<200 copies/mL) during follow-up, and HIV-negative partners had correct perceptions of their partner's VL result for 76.5% of tests. One-third of HIV-negative partners used daily PrEP during follow-up. Over follow-up, 73.8% of couples had CLAI. HIV-negative partners reported 31,532 acts of anal intercourse with their HIV-positive partner. Of these, 46.7% were protected by condoms, 48.6% by a biomedical strategy and 4.7% of acts were not protected by these strategies. Australian couples had fewer condom-protected acts and a higher proportion of biomedically protected acts than Brazilian and Thai couples. Of the 1473 CLAI acts where the perceived VL was detectable/unknown and were not protected by PrEP (4.7% of all acts), two-thirds (n = 983) were when the HIV-negative partner was insertive (strategic positioning). Of the 490 acts when the HIV-negative partner was receptive, 261 involved withdrawal and 280 involved ejaculation. Thus, <1% of acts were in the highest risk category of receptive CLAI with ejaculation. CONCLUSIONS: Couples used condoms, PrEP or perceived undetectable VL for prevention in the majority of anal intercourse acts. Only a very small proportion of events were not protected by these strategies. Variation between countries may reflect differences in access to HIV treatment, education, knowledge and attitudes.

AB - INTRODUCTION: There are few data about the range of strategies used to prevent sexual HIV transmission within gay male serodiscordant couples. We examined HIV prevention strategies used by such couples and compared differences between countries. METHODS: Opposites Attract was a cohort study of male serodiscordant couples in Australia, Brazil and Thailand, from May 2014 (Australia) or May 2016 (Brazil/Thailand) to December 2016. At visits, HIV-positive partners had viral load (VL) tested; HIV-negative partners reported sexual behaviour and perceptions of their HIV-positive partner's VL results. Within-couple acts of condomless anal intercourse (CLAI) were categorized by strategy: condom-protected, biomedically protected (undetectable VL and/or pre-exposure prophylaxis [PrEP]), or not protected by either (HIV-negative partners engaging in insertive CLAI, receptive CLAI with withdrawal, or receptive CLAI with ejaculation). RESULTS: A total of 343 couples were included in this analysis (153 in Australia, 93 in Brazil and 97 in Thailand). Three-quarters of HIV-positive partners were consistently virally suppressed (<200 copies/mL) during follow-up, and HIV-negative partners had correct perceptions of their partner's VL result for 76.5% of tests. One-third of HIV-negative partners used daily PrEP during follow-up. Over follow-up, 73.8% of couples had CLAI. HIV-negative partners reported 31,532 acts of anal intercourse with their HIV-positive partner. Of these, 46.7% were protected by condoms, 48.6% by a biomedical strategy and 4.7% of acts were not protected by these strategies. Australian couples had fewer condom-protected acts and a higher proportion of biomedically protected acts than Brazilian and Thai couples. Of the 1473 CLAI acts where the perceived VL was detectable/unknown and were not protected by PrEP (4.7% of all acts), two-thirds (n = 983) were when the HIV-negative partner was insertive (strategic positioning). Of the 490 acts when the HIV-negative partner was receptive, 261 involved withdrawal and 280 involved ejaculation. Thus, <1% of acts were in the highest risk category of receptive CLAI with ejaculation. CONCLUSIONS: Couples used condoms, PrEP or perceived undetectable VL for prevention in the majority of anal intercourse acts. Only a very small proportion of events were not protected by these strategies. Variation between countries may reflect differences in access to HIV treatment, education, knowledge and attitudes.

KW - gay men

KW - HIV prevention

KW - homosexual

KW - men who have sex with men

KW - risk reduction strategies

KW - serodiscordant couples

KW - sexual behaviour

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DO - 10.1002/jia2.25277

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JO - Journal of the International AIDS Society

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