Brief Report

Holt, Martin; Lea, Toby; Mao, Limin; Zablotska, Iryna; Prestage, Garrett; Wit, John de

doi:10.1097/qai.0000000000000787

Cited by 25 publications

(12 citation statements)

References 22 publications

(38 reference statements)

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“…First, this tool can be employed for sentinel behavioral surveillance. Data from the U.S., Australia and Canada suggest that partner viral load and PrEP use may impact sexual decision-making among MSM 12–14 , but the trends in these behaviors have not been routinely monitored. Use of a brief behavioral assessment in the same population over time will help to understand what behaviors these newer ones (i.e., behaviors while on PrEP) are replacing and may also help explain changes in population-level HIV and STI rates.…”

Section: Discussionmentioning

confidence: 99%

A Single Question to Examine the Prevalence and Protective Effect of Seroadaptive Strategies Among Men Who Have Sex With Men

Khosropour

Dombrowski

Katz³

et al. 2017

Sexual Trans Dis

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Background Seroadaptive behaviors among men who have sex with men (MSM) are common but ascertaining behavioral information is challenging in clinical settings. To address this, we developed a single seroadaptive behaviors question. Methods MSM aged ≥18 attending an STD clinic in Seattle, Washington, 2013–2015 were eligible for this cross-sectional study. Respondents completed a comprehensive seroadaptive behaviors questionnaire which included a single question that asked HIV-negative MSM to indicate which of 12 strategies they used in the past year to reduce their HIV risk. HIV testing was performed per routine clinical care. We used the kappa statistic to examine agreement between the comprehensive questionnaire and the single question. Results We enrolled HIV-negative MSM at 3,341 (55%) of 6,105 eligible visits. The agreement between the full questionnaire and single question for five behaviors was fair to moderate (kappa values of 0.34 to 0.59). From the single question, the most commonly reported behaviors were: avoiding sex with HIV-positive (66%) or unknown-status (52%) men and using condoms with unknown-status partners (53%); 8% of men reported no seroadaptive behavior. Men tested newly HIV positive at 38 (1.4%) of 2,741 visits. HIV test positivity for the most commonly reported behaviors ranged from 0.8%–1.3%. Men reporting no seroadaptive strategy had a significantly higher HIV test positivity (3.5%) compared to men who reported at least one strategy (1.3%; P=0.02). Conclusions The single question performed relatively well against a comprehensive seroadaptive behaviors assessment and may be useful in clinical settings to identify men at greatest risk of HIV.

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Section: Discussionmentioning

confidence: 99%

A Single Question to Examine the Prevalence and Protective Effect of Seroadaptive Strategies Among Men Who Have Sex With Men

Khosropour

Dombrowski

Katz³

et al. 2017

Sexual Trans Dis

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“…11,13 This is despite the increase in HIV treatment and undetectable viral load, the decline in partner numbers, the relatively high level of ongoing condom use and the increase in use of risk-reduction strategies such as serosorting during condomless anal sex. 12,23 Serosorting has become much more commonly practised by GBM in the last decade, 12,40 but it is does not protect HIVnegative men if HIV status is incorrectly assumed or a partner has undiagnosed HIV. 24,41,42 In fact, the greater reliance on serosorting may have increased the exposure of HIV-negative men to undiagnosed HIV, which may explain why other positive changes (such as the increase in HIV treatment and undetectable viral load) have had limited effect.…”

Section: Discussionmentioning

confidence: 99%

“…24,41,42 In fact, the greater reliance on serosorting may have increased the exposure of HIV-negative men to undiagnosed HIV, which may explain why other positive changes (such as the increase in HIV treatment and undetectable viral load) have had limited effect. 12,37 Based on current trends, we expect CAI between casual partners to become more common over time and for HIV notifications to continue to rise if additional protective strategies are not deployed. Therefore, other than trying to sustain current levels of condom use, there is considerable focus in Australia on the introduction of PrEP.…”

Section: Discussionmentioning

confidence: 99%

“…Up until recently, we have classified participants' responses to a set of questions about insertive and receptive anal intercourse with casual partners into three categories: no anal intercourse, consistent condom use and any CAI, sometimes distinguishing between men who reported any receptive CAI from those who only engaged in insertive CAI. 6,12,23 To take into account the protection offered by PrEP or sustaining an undetectable viral load through HIV treatment (TasP), we developed the following mutually exclusive classification:…”

Section: Methodsmentioning

confidence: 99%

“…10 Gay and bisexual men (GBM) remain the primary population affected by HIV in Australia, with male-to-male sex accounting for 70% of all HIV infections throughout the epidemic, and 9% of GBM in capital cities reporting that they are HIV positive. 11,12 Condomless anal intercourse between casual male partners, particularly receptive intercourse, remains the main risk factor for HIV transmission in Australia, as found in behavioural studies and research with recently diagnosed GBM. 13,14 This differs from other jurisdictions (such as the United States) in which sex between regular or steady male partners has been reported as the main source of infections.…”

Section: Introductionmentioning

confidence: 99%

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Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys

et al. 2017

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Abstract. Background:In Australia, the preventative use of antiretroviral drugs [pre-exposure prophylaxis (PrEP) and treatment as prevention] is being embraced to protect individuals at high risk of HIV and reduce onward transmission. Methods: The adaptation of a behavioural surveillance system, the Gay Community Periodic Surveys, was reviewed to monitor the uptake and effect of new prevention strategies in Australia's primary HIV-affected population (gay and bisexual men, GBM). The national trends in key indicators during 2000-15 were reviewed and a new measure to take account of antiretroviral-based prevention was developed. Results: Between 2000 and 2015, there were significant increases (P < 0.001) in annual HIV testing (56.1-64.8%), condomless sex with casual partners (26.8-38.8%) and the proportion of HIV-positive men on HIV treatment (72.5-88.4%) and with an undetectable viral load (73.7-94.7%). The proportion of casual partners who were HIV negative, not on PrEP and who engaged in receptive condomless sex also increased between 2000 and 2015 from 12.8 to 19.3%. Two scenarios anticipating the effect of PrEP highlighted the need to target GBM who engage in receptive condomless sex while also sustaining condom use at a population level. Conclusions: Behavioural surveillance can be successfully adapted to follow the effect of antiretroviral-based prevention. It is anticipated that HIV testing and HIV treatment will continue to increase among Australian GBM, but to prevent new infections, intervention in the growing proportion of GBM who have condomless sex with casual partners is needed. For PrEP to have its desired effect, condom use needs to be sustained.

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Viremia Trajectories of HIV in HIV-Positive Women in the United States, 1994-2017

et al. 2019

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Key Points Question How do longitudinal viral trajectories vary among women with HIV? Findings In a cohort study of 1989 women, 3 trajectories were identified with low (28.6%), intermediate (39.4%), and high (32.0%) probability of viremia. Although younger age, African American or Hispanic race/ethnicity, depression symptoms, drug use, and unstable housing were associated with a high probability of viremia, between 2015 and 2017, 71.2% of women achieved sustained viral suppression, including 35.2% of those in the group with a high probability of viremia. Meaning Despite substantial demonstrated success in decreasing HIV viremia substantially over time for most of the women, continued efforts appear to be needed to address mental health, social, behavioral, and structural factors that continue to be associated with the high probability of sustained viremia.

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Brief Report

Cited by 25 publications

References 22 publications

A Single Question to Examine the Prevalence and Protective Effect of Seroadaptive Strategies Among Men Who Have Sex With Men

A Single Question to Examine the Prevalence and Protective Effect of Seroadaptive Strategies Among Men Who Have Sex With Men

Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys

Viremia Trajectories of HIV in HIV-Positive Women in the United States, 1994-2017

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