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)