Use of Viral Load to Negotiate Condom Use Among Gay Men in Sydney, Australia

Abstract

Using two cohort studies (Health in men-HIM and positive health-PH) and repeated large cross-sectional surveys (Gay Community Periodic Survey-GCPS) of gay men in Sydney, Australia, we examined the association between viral load and unprotected anal intercourse (UAI) between HIV sero-discordant regular partners. Between 2001 and 2007, we conducted 243 interviews with 102 HIV-negative gay men in HIM and 148 interviews with 99 HIV-positive gay men in PH who were in regular relationships with HIV sero-discordant partners. During the same time period, 437 HIV positive men with HIV sero-discordant regular partners completed questionnaires for the GCPS. All completed interviews or questionnaires during that time period were used for these analyses. Amongst the HIV-negative respondents, sero-discordant UAI was more likely to be reported when the men believed their HIV-positive regular partner had an undetectable rather than a detectable viral load (P = 0.002). Amongst the HIV-positive respondents, sero-discordant UAI was as likely to be reported when they themselves reported having an undetectable or a detectable viral load. Use of viral load in negotiating condom use between sero-discordant gay couples may be understood very differently by the HIV-negative and HIV-positive men within those partnerships.

Relationship Characteristics Associated with Sexual Risk Behavior Among MSM in Committed Relationships

“…The fact that many of the discordant couples in this study engaged in UAI may support earlier findings of condom fatigue, perception of low risk due to undetectable viral load, and the sense that condoms represent a barrier to establishing trust, intimacy, and pleasure. 4,7,13,16,18,24 Relationship dynamics associated with sexual behavior revealed differences as well as similarities by partner type (i.e., primary vs. outside partners of discordant or unknown HIV status) and couple serostatus. Attachment (for concordant positive and discordant couples) and intimacy (for concordant negative couples), two variables that convey relationship closeness, were positively associated with UAI with one's primary partner, findings that fit nicely with existing research on why many couples typically avoid condoms.…”

“…20 Finally, MSM in relationships may experience condom fatigue or mistakenly perceive themselves to be low risk due to their relationship status or access to new biomedical interventions. 1,11,[21][22][23][24][25] While the literature lays the foundation for understanding HIV risk for MSM couples, much of it fails to include both partners and few studies attempt to account for the relationship dynamics above.…”

Prevalence of seroadaptive behaviours of men who have sex with men, San Francisco, 2004

“…For HIV positive men and their partners, antiretroviral therapy (ART) can be a factor in assessment of risk and sexual decision-making 34 35. Similarly, an HIV positive person’s viral load has been demonstrated to be related to the probability of transmission35 and to inform sexual decision-making and, thus, should also be considered a seroadaptive strategy 11 34 36. Recent policies and debate emanating from Switzerland may increase awareness and adoption of a seroadaptive behaviour of engaging in UAI with HIV serodiscordant partners when adherent to ART and viral load is suppressed 37 38.…”

Gay Men are Less Likely to Use Condoms with Casual Sex Partners They Know ‘Well’

“…Many gay men have adopted strategies to minimise the risk of HIV transmission other than relying solely on consistent condom use, such as serosorting, relying on undetectable viral load and strategic positioning during unprotected anal intercourse with casual partners (UAIC) [1][2][3][4]. Such strategies usually rely on a degree of familiarity with their sex partners and some knowledge of HIV status, although such knowledge may be assumed rather than actual.…”