Unprotected Sexual Practices Among Men Who Have Sex with Women and Men Who Have Sex with Men Living with HIV/AIDS in Rio de Janeiro

Abstract

Combined antiretroviral therapy is now acknowledged for preventing new HIV infections, besides decreasing mortality and morbidity. However, in many Latin America countries the epidemic is still driven by unprotected sexual intercourse. This study aims to describe sexual practices related to HIV/STD and to evaluate factors associated to unprotected sex among men who have sex with women (MSW) and men who have sex with men (MSM) under care at a reference center for HIV in Rio de Janeiro, Brazil. A cross-sectional study, nested in a Brazilian clinical cohort, evaluated the sexual practices of 404 sexually active HIV-positive MSW and men who have MSM. Approximately 30 % of them reported unprotected sexual practices during the 6 months prior to the interview. Most frequent risky practices reported were unprotected vaginal sex among MSW and unprotected receptive anal sex among MSM. Factors increasing the chance of unprotected sexual practices among MSW were the partner's desire of becoming pregnant (OR 2.81; CI 95 %: 1.36-5.95). To have received comments about excessive consumption of alcohol (OR 2.43; CI 95 %: 1.01-5.83), illicit drug use (OR 4.41; CI 95 %: 1.75-11.60) and lived in marital situation (OR 2.10; CI 95 %: 1.09-4.08) were significantly associated with unsafe sexual practices among MSM. The results highlight that health care of men living with HIV, as well as the prevention strategies, must consider the particularities of sexual behavior practiced by people who differ in sexual orientation.

Unsafe Sexual Behavior Among Gay/Bisexual Men in the Era of Combination Antiretroviral Therapy (cART)

“…It has been suggested that frequent alcohol and drug use are common in urban gay male culture [59]. Contrary to the several studies that have found alcohol use at least once a week [55] or excess alcohol consumption [54,60] related to unsafe sexual practices in MSM, we found no association in our study. Our results, however, are closer to those of a meta-analysis not specific to MSM that found drinking alcohol was unrelated to condom use [61] and Peruvian study of MSM finding a non-significant association between problem drinking and receptive or insertive anal intercourse in the last 6 months [62].…”

Impact of early antiretroviral treatment on sexual behaviour

“…More recently, in the TEMPRANO-ANRS12136 trial of immediate versus deferred ART initiation (2008-2012), the proportion of participants reporting CLS-D was similar when compared between randomized arms at year 1 [48]. Many observational studies have assessed the association between ART and sexual behaviour among people with diagnosed HIV , including two meta-analyses [29,32] and some studies in low/middle income countries [41,43,45]. The vast majority found no association of ART use or viral suppression with CLS-D, or found ART was in fact associated with lower levels of CLS-D. A few studies reported different findings overall, or in specific subgroups or analyses.…”

“…Findings from some observational studies have suggested that, in some contexts or subgroups, condom use may be influenced by knowledge of viral suppression [24][25][26][27][28][29]. However, in most studies, overall, levels of CLS-D were similar or lower among people on ART compared with those not on ART (or among people with undetectable compared with detectable viral load) [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. Two randomized trials have provded data on this issue [47,48]; neither supports the hypothesis that ART use leads to increased CLS-D.…”

“…However, it is important to reeavualate this association as patterns of sexual behaviour may have changed with increasing awareness of the protective effect of suppressed viral load, paritcularly since the publication of HPTN 052 in 2011 [13]. Furthermore, now that the protective effect of viral suppression on HIV transmission is assured, it is necessary to consider measures additional to CLS-D, that capture sex with risk of HIVtransmission by accounting for viral suppression [45,[47][48][49]. When considering risk of other STIs, CLS overall is the most relevant measure.…”

Práticas sexuais de homens que fazem sexo com homens: adaptação de questionário

“…Sabe-se que um importante fator de risco para Infecções Sexualmente Transmissíveis (IST) e que aparece associado ao aumento de casos de HIV em HSH na América Latina é o sexo anal, insertivo ou receptivo, sem o uso do preservativo (Julio et al, 2015;Pinheiro, Calazans, & Ayres, 2013;Wade, Harper, & Bauermeister, 2017). Estudos desenvolvidos no Brasil destacam que mais de 30% dos HSH entrevistados referiram um uso inconsistente de preservativo nos últimos 6 meses (Rocha, Gomes, Camelo, Ceccato, & Guimarães, 2013) e 12 meses (Brignol & Dourado, 2011).…”