Serosorting in choosing one`s steady partner is more
Transcription
Serosorting in choosing one`s steady partner is more
Background: Despite its limited effectiveness on HIV prevention, serosorting among MSM has been shown to be relatively frequent among those who do not consistently use condoms. The aim of the study was to identify HIV+ MSM characteristics associated with serosorting in choosing their steady partner. Methods: From a population of 1117 HIV+ MSM enrolled in the VESPA ANRS EN12 study, we selected those who were engaged in a stable relationship for more than 12 months. Individuals who seroconverted anytime during that relationship and those whose HIV diagnosis was established during the previous 12 months were excluded. These criteria enabled us to interpret seroconcordance as a proxy of patient's serosorting. Viral load was obtained from medical records. A face-to-face interview collected information about psychosocial characteristics such as anxiety (HAD) disclosure to family, and sexual behavior. Logistic regression was used to identify factors associated with serosorting in choosing their steady partner. Results: The study group consisted of 360 individuals, 275 having a serodiscordant steady partner and 85 having a seroconcordant one. Median[IQR] age was 42[37-58], and 71% of patients had an undetectable viral load, while median[IQR] years since HIV diagnosis were 10.2[5.9-17.1]. The multivariate analysis showed that after adjustment for time since HIV diagnosis, serosorting was associated with detectable viral load (OR[95%CI]:1.7[1.0-3.3]). Other factors associated with serosorting were seropositivity disclosure to family (OR[95%CI]:2.2[1.1-4.4]), and lower levels of anxiety (OR[95%CI]:0.93[0.9-1.0] per unit). Additionally, serosorting was associated with non systematic condom use with the steady partner (OR[95%CI]:3.4[1.7-6.8]), and having used classified advertisements during the previous 12 months to seek casual partners (OR[95%CI]:2.3[1.0-5.3]).? Conclusion: Among HIV+ MSM serosorting in choosing their steady partner is more frequent in viremic patients and might express the need for a better mental and sexual quality of life with steady partners. Key words: MSM, HIV, serosorting, associated factors. ABSTRACT Factors associated with serosorting among HIV-positive MSM in France : results from the French VESPA ANRS study M. Suzan-Monti1, M. Preau1,2, J. Blanche1, S. Cabut1, MP. Carrieri1, F. Lert3, Y. Obadia1,4, B. Spire1, the ANRS VESPA-12 study group AUTHORS Characteristics of participants (n=360) 1 INSERM, U912 (SE4S), Marseille, France 2 Université de Nantes, Nantes, France 3 INSERM U687, Villejuif, France 4 ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d’Azur, Marseille, France In the recent years, HIV prevention fatigue and relapse in safe sex practices have been described in the gay community. Background Serosorting is perceived by men having sex with men (MSM) as a way to reduce HIV transmission risk by engaging in unprotected sex with seroconcordant partners. VESPA French Study (ANRS EN12) : design In 2003, the French National Agency of AIDS Research (ANRS, France) supported a national cross-sectional survey conducted among a random stratified sample of 4963 HIV-infected patients, recruited in 102 French hospital departments delivering HIV care. The stratification criteria were department’s geographic location and HIV caseload. Eligible subjects were French speaking outpatients aged 18 or older, who had been diagnosed for HIV and were living in France for at least 6 months. Data collection Socio-economic and behavioral data: face-to-face standardized interviews with trained interviewers using the CAPI system Metho ds Psychosocial data :self-administered questionnaire including the Hospital Anxiety and Depression (HAD) scale Clinical data: medical questionnaire Statistical methods and patients Serosorting was defined as reporting to have a seroconcordant partner. Factors associated with serosorting were explored using logistic regression models. Stratified survey plan weighted by the inverse of patient’s annual number of visits in the clinic. Patients (N=360) Homosexual or bisexual patients who were engaged in a stable relationship for more than 12 months. Individuals who seroconverted anytime during that relationship and those whose HIV diagnosis was established during the previous 12 months were excluded. % or Median [IQR] ¹ 42 [37-47] Age (years) Year of HIV diagnosis : before 1990 1990 – 1996 after 1996 Used classified advertisements during the previous 12 months to seek casual partner Disclosure of HIV status to family members Unsafe sex with steady partner ² Anxiety score ³ Adherence and HIV viral load 4 : adherent with undetectable viral load others Experience of discrimination from sexual partner 5 Death of a steady partner because of HIV Knowledge of a person dead because of HIV No of sexual partners in the previous 12 months - 0 or 1 - 2 to 5 - more than 5 Stable and comfortable housing 6 CLINICAL DATA CD4 cell count/mm3 HIV viral load <400 cp/ml CDC cell stage C 32.4 37.1 30.5 8.1 26.6 69.6 7 [4 - 10] 44.7 55.3 19.9 21.2 75.8 51 21.7 27.3 46.5 444 [292-643] 69.7 25 Factors associated with Serosorting : multivariate analysis Coef (95% CI) P - value Year of diagnosis: - after 1990 1 - before 1990 1.85 [1.1 ; 3.2] 0.03 Unsafe sex with steady partner2: - no 1 - yes 3.44 [1.7 ; 6.8] <10^-3 Disclosure to family members : - no 1 - yes 2.16 [1.1 ; 4.4] 0.04 Adherence and HIV viral load 4: - Adherent and undetectable HIV viral load 0.57 [0.3 ; 1.0] 0.04 - Others 1 Used classified advertisements during the previous 12 months to seek casual partners : - no 1 - yes 2.34 [1.0 ; 5.3] 0.04 Anxiety score 3(HAD) 0.93 [0.9 ; 1.0] 0.04 1 IQR = interquartile range 2 Unsafe sex was defined as reporting no systematic condom use during the previous 12 months with a steady partner who was either HIV negative or of unknown HIV status. 3 Anxiety (and depression) were assessed using the Hospital Anxiety and Depression (HAD) scale, which comprises 14 questions (seven relating to anxiety and seven to depression) concerning individual’s experience over the previous week 4 Viral load threshold : 400 cp/ml 5 Discrimination because of HIV infection 6 Owner or tenant and reporting satisfying housing conditions C O N C L U S I O N S Serosorting in choosing one’s steady partner is more frequent in viremic HIV + MSM than in non-viremic ones. Serosorting is associated with less systematic condom use with steady partner. Experience with HIV disease is likely to influence HIV serosorting among HIV + MSM. Acknowledgements List of participating groups: (ANRS EN12 VESPA) Participant hopitals (Head of Departments) : CH Pays d’Aix, Aix-en-Provence; Hôpital Nord, Amiens; CHU, Angers; Saint-Michel, Angoulême; CH Région Annecienne, Annecy; CH, Antibes Juan_les-Pins; CH Victor Dupouy, Argenteuil; Hôpital Robert Ballanger, Aulnay-sous-Bois; CH Henry Duffaut, Avignon; CHIC Côte Basque, Bayonne; CHU Saint-Jacques, Besançon; Hôpital Avicenne, Bobigny; CHU Pellegrin, Bordeaux; Hôpital Ambroise Paré, Boulogne-Billancourt; CH Fleyriat, Bourg-en-Bresse; CH Jacques Cœur, Bourges; CHU Côte de Nacre, Caen; CH, Cannes; CH Antoine Gayraud, Carcassonne; CH, Chalons-sur-Saône; Hôpital Antoine Béclère, Clamart; CHG Hôtel Dieu, Clermont-Ferrand; CH, Compiègne; CH Sud Francilien, Corbeil-Essonnes; CH, Creil; Hôpital Henri Mondor, Créteil; Hôpital Charles Romieu, Dignes-les-Bains; Hôpital du Bocage, Dijon; Hôpital Raymond Poincaré, Garches; CH, Grasse; CH, Grenoble; CHD, La Roche-sur-Yon; CH, Lagny-sur-Marne; Hôpital de Bicêtre, Le Kremlin-Bicêtre; CH, Le Mans; CH, Longjumeau; Hôpital Edouard Herriot, Lyon; Hôpital Hôtel-Dieu, Lyon; CH François Quesnay, Mantes-la-Jolie; Hôpital Conception, Marseille; Hôpital Nord, Marseille; Hôpital Sainte-Marguerite, Marseille; CH, Martigues, Hôpital Saint-Faron, Meaux; Hôpital Bon-Secours, Metz; CHU gui de Chauliac, Montpellier; CHR Hôtel-Dieu, Nantes; Hôpital L’Archet, Nice; CHU, Nîmes; CH, Niort; GIH Bichat-Claude Bernard, Paris; Hôpital Cochin, Paris; HEGP, Paris; Hôpital Lariboisière, Paris; Hôpital Necker, Paris; GH Pitié-Salpêtrière, Paris; Hôpital Saint-Antoine, Paris; Hôpital Saint-Joseph, Paris; Hôpital Saint-Louis, Paris; Hôpital Tenon, Paris; CH François Mitterrand, Pau; CH Maréchal Joffre, Perpignan; Hôpital Haut-Lévêque, Pessac; CHU La Miletrie, Poitiers; CHR Robert Debré, Reims; CHR Pontchaillou, Rennes; CHU Charles Nicolle, Rouen; CHG Casanova-Delafontaine, Saint-Denis; Hôpital Nord, Saint-Etienne; CHI, Saint-Germain-en-Laye; CH, Saint-Nazaire; CH Bassin de Thau, Sète; Hôpital Civil, Strasbourg; Hôpital Foch, Suresnes; CHIC Vic-en-Bigorre, Tarbes; HIA Sainte-Anne, Toulon Naval; CH de la Grave, Toulouse; Hôpital Purpan, Toulouse; CHU Bretonneau, Tours; CH, Troyes; CH Hôtel-Dieu, Valenciennes; CH Nancy Brabois, Vandoeuvre-les-Nancy; Hôpital Paul Brousse, Villejuif; CHI, Villeuneuve-Saint-Georges. A special thank to all people living with HIV who accepted to participate in the study Financial Support: Agence Nationale de Recherche sur le SIDA et les hépatites virales (ANRS)