Targeted, multilevel strategies are needed to reduce risk behaviors among young men who have sex with men living with HIV, particularly among those with a detectable viral load, according to a study published in JAMA Pediatrics.
“Numerous studies have found that many HIV-infected [young men who have sex with men (YMSM)] engage in risky sexual behaviors after their diagnosis,” Patrick A. Wilson, PhD, associate professor of sociomedical sciences at Columbia University’s Mailman School of Public Health, and colleagues wrote. “YMSM who are not virally suppressed may be at particular risk to engage in sexual risk behaviors that serve to perpetuate HIV transmission.”
The researchers conducted a cross-sectional survey of 991 YMSM with HIV. Wilson and colleagues sought to analyze the differences between virologically suppressed participants and those with a detectable viral load, and to identify correlates of condomless anal intercourse and serodiscordant condomless anal intercourse among YMSM with a detectable viral load.
The survey participants, aged 15 to 26 years, were enrolled through 20 HIV clinics across the United States and provided demographic, behavioral and psychosocial assessments. The researchers obtained participants’ viral load information through blood testing or medical records. The survey was conducted from December 2009 through June 2012, with data analysis completed on July 31.
According to the researchers, 69.4% of the participants had detectable viral load, 46.2% reported having condomless anal intercourse, and 31.3% reported serodiscordant condomless anal intercourse within the past 3 months. YMSM with a detectable viral load were more likely than virologically suppressed YMSM to report condomless anal intercourse (54.7% vs. 44.4%) as well as serodiscordant condomless anal intercourse (34.9% vs. 25%). Problematic substance use, nonblack race and disclosure of HIV status to sexual partners were associated with condomless anal intercourse among YMSM with detectable virus, the researchers said.
Results also showed that transgender participants were less likely than their cisgender counterparts to report condomless anal intercourse (adjusted OR = 0.35; 95% CI, 0.14-0.85), and unemployed YMSM with detectable viral load were less likely to report serodiscordant condomless anal intercourse than employed participants (aOR = 0.74; 95% CI, 0.55-0.99).
More than half of YMSM in the study (52.1%) reported being currently prescribed ART.
“Our findings highlight the inadequacies of treatment as prevention as the sole risk reduction method among HIV-infected YMSM in the United States, and speak to a greater need for behavioral approaches to improve ART uptake and ultimately achieve higher rates of viral suppression in this population,” Wilson and colleagues wrote. “Combination HIV prevention and treatment interventions, which include behavioral, biomedical and structural strategies to increase viral suppression and reduce HIV transmission risk behaviors, that target HIV-infected YMSM are needed.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.