How partnership type and HIV seroconcordance affect HIV transmission risk in regular sexual partnerships: a cross-sectional survey of Australian gay and bisexual men

Abstract

Abstract. Background: Regular sexual partnerships among gay and bisexual men (GBM) who practice condomless anal intercourse (CLAI) have not been well characterised in terms of partnership type, HIV seroconcordance and risk of HIV transmission. Primarily sexual regular partnerships, although commonly reported by gay men, have largely been ignored in research and HIV prevention. Among regular partners reporting CLAI with each other, we determined factors differentiating romantic or committed relationships from partnerships organised primarily around sex ('fuckbuddies') and estimated the proportion of CLAI presenting risk for HIV transmission. Methods: An online, cross-sectional survey of Australian GBM was conducted. Univariate and multivariate generalised estimating equations were used to determine statistical associations. Results: Men reported on 2250 regular sexual partnerships. Over half the partnerships were romantic or committed relationships. Over half the partnerships were HIV-negative seroconcordant (54.9%), 3.1% were HIV-positive seroconcordant, 5.2% were serodiscordant and 36.8% were of unknown seroconcordance. Potential risks presented by CLAI were sometimes mitigated by protective factors, such as having a clear spoken agreement about sex with outside partners, having fewer outside partners, openly discussing HIV risk and having an agreement to reduce risk from outside partners. These protective factors were more often found in romantic or committed relationships than among primarily sexual partnerships, and were less often found in partnerships of unknown seroconcordance. Conclusion: CLAI is more common among regular sexual partnerships considered to be of a romantic, committed nature. However, factors associated with such romantic or committed partnerships can also protect against HIV transmission risk. Unknown seroconcordance, particularly lack of communication about HIV status among primarily sexual partnerships, is a key risk factor that needs to be addressed by HIV education.Additional keywords: HIV prevention, men who have sex with men, relationships.

Baseline Preferences for Daily, Event-Driven, or Periodic HIV Pre-Exposure Prophylaxis among Gay and Bisexual Men in the PRELUDE Demonstration Project

“…We found no evidence that men with HIV-negative primary partners had a specific PrEP dosing preference, nor evidence of an association between PrEP preference and engaging in receptive CLAI with other regular or casual partners of HIV-positive or unknown status. While these partner types can pose a much higher risk of HIV transmission than an HIV-positive primary partner ( 35 , 36 ), they may not be associated with the same prolonged anxiety or association with HIV. Thus, other HIV prevention strategies can be negotiated with other regular and casual partners, as compared with HIV-positive main regular partners.…”

Does HIV Pre-Exposure Prophylaxis Modify the Effect of Partnership Characteristics on Condom Use? A Cross-Sectional Study of Sexual Partnerships Among Men Who Have Sex with Men in San Francisco, California

“…8,9 While the majority of research continues to focus on differences between individuals to explain sexual risk taking, 10 a growing body of research suggests that a significant proportion of the variability in condom use during anal intercourse exists within individuals across different sexual partnerships. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] Within the sexual partnerships of MSM, the strongest associations between condom use and partnership characteristics have been observed based on partnership type and agreement of serostatus between partners (seroconcordance). Mathematical models based on data from five US cities during the 2003-2005 cycle of the National HIV Behavioral Surveillance (NHBS) System suggested that 68% of HIV transmissions among MSM occurred within main partnerships, as a result of the higher number of sex acts and lower condom use during anal sex with main partners compared to casual or exchange partners (i.e., those where money and/or other gifts were exchanged for sex).…”

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

“…High-profile research evidence regarding TasP and PrEP was released throughout the course of the study, and consequently, individual and community notions of what constituted "safe(r) sex" among gay men were dynamic. Thus, CLAI was common, with three-quarters of couples engaging in at least some CLAI during follow-up, higher than estimates reported in previous studies of male serodiscordant couples [7,26,27,30,31]. Nearly half of anal intercourse Perceived detectable viral load, actually <200 copies ("not correct") 287 (16.1) 50 (4.9) 34 (7.9) c 203 (60.8) b…”

“…a Denotes significant differences between countries at the p < 0.001 level using univariable logistic regression, with Australia as the referent category; b denotes significant differences between countries at the p < 0.01 level using univariable logistic regression, with Australia as the referent category. other studies of serodiscordant couples [43], but this measure may no longer be sufficient to identify "high risk" [31,44]. Finally, previous analysis determined that risk is highest in the first year of a gay male serodiscordant relationship [7].…”

“…Time to ART initiation has also decreased markedly in Melbourne, Victoria, where 23.0% of couples were enrolled . The eligibility requirement that couples have at least some CLAI with each other has been used in other studies of serodiscordant couples , but this measure may no longer be sufficient to identify “high risk” . Finally, previous analysis determined that risk is highest in the first year of a gay male serodiscordant relationship .…”