Sexual risk behaviour and viral suppression among HIV-infected adults receiving medical care in the United States

Abstract

Objective:To describe the prevalence and association of sexual risk behaviours and viral suppression among HIV-infected adults in the United States.Design:Cross-sectional analysis of weighted data from a probability sample of HIV-infected adults receiving outpatient medical care. The facility and patient response rates were 76 and 51%, respectively.Methods:We analysed 2009 interview and medical record data. Sexual behaviours were self-reported in the past 12 months. Viral suppression was defined as all viral load measurements in the medical record during the past 12 months less than 200 copies/ml.Results:An estimated 98 022 (24%) HIV-infected adults engaged in unprotected vaginal or anal sex; 50 953 (12%) engaged in unprotected vaginal or anal sex with at least one partner of negative or unknown HIV status; 23 933 (6%) did so while not virally suppressed. Persons who were virally suppressed were less likely than persons who were not suppressed to engage in vaginal or anal sex [prevalence ratio, 0.88; 95% confidence interval (CI), 0.82–0.93]; unprotected vaginal or anal sex (prevalence ratio, 0.85; 95% CI, 0.73–0.98); and unprotected vaginal or anal sex with a partner of negative or unknown HIV status (prevalence ratio, 0.79; 95% CI, 0.64–0.99).Conclusion:The majority of HIV-infected adults receiving medical care in the U.S. did not engage in sexual risk behaviours that have the potential to transmit HIV, and of the 12% who did, approximately half were not virally suppressed. Persons who were virally suppressed were less likely than persons who were not suppressed to engage in sexual risk behaviours.

Perspectives of Linkage to Care Among People Diagnosed With HIV

“…Due to treatment advances, people living with HIV (PLWH) who receive health care immediately upon diagnosis are likely to experience decreased mortality, reduced viral loads, and fewer opportunistic infections (Anglemyer et al, 2013). People in care are also more likely to refrain from risky sexual behavior than those who do not engage in care (Mattson et al, 2014). In addition, the reduced viral load that results from therapeutic antiretroviral therapy (ART) decreases the likelihood of transmitting the virus and improves the overall health of the population.…”

HIV Community Viral Load and Factors Associated With Elevated Viremia Among a Community-Based Sample of Men Who Have Sex With Men in Vancouver, Canada

“…Men with unsuppressed VL are also more likely to have low incomes and be of non-Caucasian ethnicity, which indicate the importance of continued work to address health inequity using a social determinants of health framework[27]. A recent report of a large (over 4000 patients) sample of HIV-infected adults receiving HIV care in the United States, of whom approximately 45% were MSM, did not find an association with lack of virologic suppression (also defined as ≥200 copies/mL) and risky sex[28]. However, such a study design will systematically miss HIV-infected individuals who are not diagnosed and/or not linked to care and therefore cannot be seen as representative of HIV-infected individuals at risk of HIV transmission.…”

Clinical roundup

“…The results of the Medical Monitoring Project, a survey of over 4000 patients in the USA, were weighted to model the behaviours of over 400 000 HIV-positive people across the whole country 3. An estimated 12% of HIV-positive people engaged in ‘sexual risk behaviour’: unprotected anal or vaginal sex with a partner of negative or unknown HIV status.…”