Sexual behaviour of people living with HIV in London: Implications for HIV transmission

City University London, and Homerton University Hospital NHS Foundation Trust, London, UK.
AIDS (Impact Factor: 5.55). 02/2007; 21 Suppl 1(Suppl 1):S63-70. DOI: 10.1097/01.aids.0000255087.62223.ff
Source: PubMed


To examine the sexual behaviour of gay men as well as black African heterosexual men and women living with diagnosed HIV in London, and to consider the implications for HIV transmission.
People living with HIV receiving treatment and care in outpatient clinics in north east London were asked to complete a confidential, self-administered questionnaire in 2004-2005. Respondents were asked about unprotected anal or vaginal intercourse in the previous 3 months, and the type (main or casual) and HIV status of their partner(s).
A total of 1687 people with diagnosed HIV returned a completed questionnaire (response rate 73% of eligible clinic attenders) including 480 black African heterosexual women, 224 black African heterosexual men and 758 gay/bisexual men (464 white, 112 ethnic minority). One in five gay men with HIV (20.1%, 144/715) reported unprotected anal intercourse with a partner of unknown or discordant HIV status (usually a casual partner). This presents a risk of HIV transmission. By comparison, one in 20 (5.1%, 32/623) black African heterosexual men and women with HIV reported unprotected vaginal intercourse that presented a risk of HIV transmission; odds ratio (gay men versus black African men and women combined) 5.28, 95% confidence interval 3.52, 7.91, P<0.001. Neither viral load nor being on HAART were significantly associated with unprotected intercourse among gay men or black African heterosexual men and women (P>0.05).
Behavioural research among people with diagnosed HIV in London shows that gay men are more likely than black African heterosexual men and women to engage in sexual behaviour that presents a risk of HIV transmission.

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    • "Among HIV-infected individuals, a significant proportion of MSM (10-30%), and a lower proportion of heterosexual individuals, report recent condom-less sex with partners of HIV-negative status or unknown HIV status [11] [14] [15] [16] [17] [18] [19] [20], thereby posing a risk of HIV transmission to an uninfected person. An important question is whether use of ART tends to lead to increases in condom-less sex at an individual level. "
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    ABSTRACT: Life expectancy for people diagnosed with HIV has improved dramatically however the number of new infections in the UK remains high. Understanding patterns of sexual behaviour among people living with diagnosed HIV, and the factors associated with having condom-less sex, is important for informing HIV prevention strategies and clinical care. In addition, in view of the current interest in a policy of early antiretroviral treatment (ART) for all people diagnosed with HIV in the UK, it is of particular importance to assess whether ART use is associated with increased levels of condom-less sex. In this context the ASTRA study was designed to investigate current sexual activity, and attitudes to HIV transmission risk, in a large unselected sample of HIV-infected patients under care in the UK. The study also gathered background information on demographic, socio-economic, lifestyle and disease-related characteristics, and physical and psychological symptoms, in order to identify other key factors impacting on HIV patients and the behaviours which underpin transmission. In this paper we describe the study rationale, design, methods, response rate and the demographic characteristics of the participants. People diagnosed with HIV infection attending 8 UK HIV out-patient clinics in 2011-2012 were invited to participate in the study. Those who agreed to participate completed a confidential, self-administered pen-and-paper questionnaire, and their latest CD4 count and viral load test results were recorded. During the study period, 5112 eligible patients were invited to take part in the study and 3258 completed questionnaires were obtained, representing a response rate of 64% of eligible patients. The study includes 2248 men who have sex with men (MSM), 373 heterosexual men and 637 women. Future results from ASTRA will be a key resource for understanding HIV transmission within the UK, targeting prevention efforts, and informing clinical care of individuals living with HIV.
    Full-text · Article · Oct 2013 · PLoS ONE
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    • "Annual estimates state that more than 40 million people are infected with HIV/AIDS globally with an alarming death rate of 3.1 million [1]. HIV spread is mostly via vertical and horizontal transference, contaminated blood and its products, and IDUs [2,3]. Risky sexual behavior predicts that HIV spread is possibly greater in homosexual individuals than the heterosexual population and even so, more attention should be given to the matter [3-5]. "
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    ABSTRACT: Background Transgender males are at high risk for sexually transmitted diseases including AIDS caused by the notorious Human Immunodeficiency Virus (HIV), yet little consideration is given by the policy makers, researchers and non-governmental organizations (NGOs) towards this sensitive issue in Pakistan. Methods In this study, we have investigated the prevalence of HIV infection among 306 transgender males with a median age of 29 years (range 15–64 years) residing in Rawalpindi, Pakistan. Rapid HIV antibody-screening methods including the strip test and Enzyme Linked Immuno-absorbent tests were employed to detect HIV antibodies among the subjects. For further confirmation, Polymerase Chain Reaction (PCR) was carried out. Statistical analytical techniques utilized included logistic regression and chi-square. Results HIV-1 was found to be the predominant viral subtype. PCR confirmed 21.6% (Confidence Interval 0.17-0.26) of the respondents were reported being HIV positive. 15.7% of the transgender men who shave at home and 13.7% of the transgender men who were educated below 5th grade were found to have HIV. Conclusion This study shows a very high prevalence of HIV among transgender males. Unawareness among these individuals about the ramifications of this infection owes largely to lack of education. The spread rate is alarming and HIV epidemic is imminent if awareness is not widespread.
    Full-text · Article · Oct 2012 · Virology Journal
    • "In high-risk groups, unsafe sexual practices are common. One survey found that 20% of HIV-positive gay and bisexual men had recently had unprotected anal intercourse with a partner of negative or unknown HIV status (Elford et al., 2007). A study of HIV positive women reported that more than 40% had engaged in unprotected vaginal intercourse, and 10% in unprotected anal intercourse, in the previous six months (Kalichman, 1999). "

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