AIDS VELTER 2_90x120.qxp:Low BCG

High prevalence and incidence of HIV infection among men
who have sex with men recruited in commercial gay venues
in Paris (France): Prevagay 2009 survey
TUPE0373
A. Velter1, F. Barin2, A. Bouyssou1, J. Guinard2, S. Le Vu1, J. Pillonel1, A. Alexandre3, C. Semaille1
1/ French Institute for Public Health Surveillance, Saint-Maurice, France – 2/ National HIV Reference Laboratory, Tours, France – 3/ Syndicat national des entreprises gaies, Paris, France
Background
TABLE
• In France, men who have sex with men (MSM) represent 1/3 of new HIV diagnoses (2008).
• MSM are the only population for whom new HIV diagnoses have not decreased since 2003.
1
Comparison of HIV biological data and questionnaire data,
Prevagay, France, 2009
N=886
Biological data
HIV positive
N
%
157
729
17.7%
[15% - 20%]
82.3%
126
31
7
16
8
729
14.2%
3.5%
22%
52%
26%
82.3%
• Behavioural MSM surveys provide self reported HIV prevalence ranging from 12% to 17%.
Objective
• To estimate HIV prevalence and incidence in this population, based on biological results.
Methods
HIV negative
Biological and questionnaire data
Already known as HIV positive
Biological and undiagnosed HIV positive
No HIV screening during life-time
Reported being HIV negative
Not confident of their HIV negative status
Biological HIV negative
• Prevalence was not significantly different for place of residence; country of birth.
• Cross-sectional survey during 6 weeks –
May-June 2009.
• Prevalence was higher for older MSM (figure 3), MSM with no university degree, backrooms attendees
(last 12 months), having over 10 sexual partners (last 12 months), at least one UAI with casual partners (last
12 months), at least one STI during the last 12 months.
• 14 Paris gay commercial venues (bars, saunas,
backrooms).
• Each participant was invited to self-collect a
fingerprick blood sample on blotting paper and
to self-complete a behavioural questionnaire.
FIGURE
3
HIV prevalence and confidence interval, by age class,
Prevagay, France, 2009
• The number of participants expected for an
estimated prevalence of 15%, was 784.
• Blood samples were screened using the
Genscren-ultra-HIV-Ag-Ab (Biorad) assay and
confirmed by Western Blot (figure1).
22.0%
19.7%
17.6%
• The enzyme immunoassay for recent HIV-1
infections (EIA-RI) was used to estimate cross-sectional incidence (180 days window-period, false recent rate
of 1.6%).
8.9%
• Individual biological results were not returned to participants, but they were given a VIP card inviting them
to visit one of the 3 Parisian VCT partners, for HIV or hepatitis screening.
FIGURE
1
Blotting paper with blood sample spots and HIV biological analysis
< 3 0 y e a rs
HIV screening (150 µl ->75 µl)
Genscreen ultra Ag-Ab (spot 1)
3 0 -3 9 y e a r s
4 0 -4 9 y e a r s
HIV cross sectional incidence
• From the HIV recent infection test, the annual HIV incidence estimate was 7.5 % person-years [95% CI : 4.5 -10.5].
InVS - SNEG - ANRS
PREVAGAY
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If HIV positive:
• That is: among 100 HIV negative MSM, 7.5 will be infected by HIV during the year.
• Recent Infection Test and serotyping (spot 2)
- RIT old and serotyping positive = HIV POS.
- RIT recent and/or serotyping negative:
. WB confirmation (spot 3):
Positive: HIV POS;
Negative or doubtful and low screening
(ratio DO/CO <5): ARN (CV et RT-PCR) (spots 4/5).
• The incidence estimate was higher in the age class of 40-49 (table 2).
Results
TABLE
2
HIV incidence estimate by age class, Prevagay, France, 2009
Age class
<30
30 - 39
40 - 49
≥50
Incidence estimate
2.5%
7.8%
9.4%
6.2%
• VIP card for VCT: 28% did not accept the card; main reasons were recent screening, HIV positive status.
• 4% did present the VIP card in one of the 3 VCT partners and had screening: all were HIV negative.
• Of the 1578 men approached, 886 (56%) provided both blood specimen and behavioural questionnaire.
• Other results on sexual risk behaviours and knowledge of HIV status, available: poster THPE0342.
• Among the men who did not participate, the main reasons were :
- commercial gay venues were not the right location for blood sampling;
- they did not like injection, or were afraid by the sight of blood.
• Participants were similar to the population of other Paris commercial gay venues surveys:
- median age of 38 years, graduate, gay self-identification;
- 50% reporting over 10 sexual partners during the last 12 months;
- 35% reporting at least one unprotected intercourse (UAI) with casual partners, during the last 12 months.
Except for HIV screening as Prevagay participants had more HIV screening during the last 12 months (63%).
HIV Prevalence
2
HIV biological data, Prevagay, France, 2009
Blood specimen
+ behavioural
questionnaires
n=886
• Biological prevalence was high, similar to Barcelona (Spain) survey, but more important than the prevalence
results of London and British cities surveys.
• The proportion of undiagnosed HIV positive status was important (20%), although this population had a
high rate of HIV screening.
• No biological results were returned to participants, and few went for screening in spite of the VIP card.
Prevagay results will be presented in leaflets available in all French commercial gay venues.
• Prevention programs must continue in all commercial gay venues (sex-on-site or not).
Undiagnosed HIV positive
n=31
20%
Diagnosed HIV positive
n=126
80%
Undiagnosed HIV positive
No HIV screening (life time)
n=7
• The population of Parisian commercial gay venues patrons described by this survey is rather specific by their
way of life and high sexual activity; results cannot be considered representative of French MSM.
• The HIV incidence estimate is very high, it could be explained by high risk sexual behaviours (UAI, number
of partners).
Biological HIV positive
n=157
18% [15% - 20 %]
Biological HIV negative
n=729
• Prevagay was the first prevalence survey in French commercial gay venues; this was made possible by the
collaboration between the national public health institution (InVS), the HIV prevention team of the Syndicat
national des entreprises gaies (Sneg) and the commercial gay venues owners and staff.
Undiagnosed HIV positive
Reported being HIV negative
n=16
Undiagnosed HIV positive
Not confident of HIV negative status
n=8
Contact : Annie Velter ([email protected]) - Institut de veille sanitaire - 12, rue du Val d’Osne 94415 Saint-Maurice Cedex France - Tél. : +33 (0)1 41 79 68 06 - Fax : +33 (0)1 41 79 67 66
July 2010
FIGURE
Conclusions