Young men with detectable HIV more likely to have unprotected sex

A new US study explores the risky behaviour among young men with detectable levels of the human immunodeficiency virus (HIV).

Researchers at the Columbia University Mailman School of Public Health in New York have found that young men who have sex with men (YMSM) and have detectable levels of HIV were more likely to report sex without using condom.

YMSM, who are referred to those aged between 13 and 29 years old, are particularly vulnerable to HIV infection, the study says. More than one-quarter of new infections in the US occur in YMSM. To reduce the number of new HIV infections among YMSM, the medical community relies on HIV testing, antiretroviral treatment, adherence and viral suppression among YMSM with HIV.

However, in addition to these interventions, behavioural approaches may also need to be implemented to reduce risky sexual behaviours including condomless anal intercourse (CAI).

In the new study, which appeared in JAMA Pediatrics, the authors analysed differences in demographic and psychosocial factors between virologically suppressed YMSM and those with detectable HIV. They also sought to identify psychosocial factors associated with CAI and serodiscordant, or between partners of differing HIV status, CAI among YMSM with detectable HIV viral load.

The team studied close to 1,000 YMSM with HIV at 20 adolescent HIV clinics in the US from December 2009 through June 2012. Among the participants, almost 70 per cent had a detectable HIV viral load.

They found that over 50 per cent of YMSM with detectable HIV reported CAI, which is higher than virologically suppressed YMSM, at 44 per cent.

Based on their findings, the researchers observed that among YMSM with detectable HIV, those who reported problematic substance use were more likely to report CAI or serodiscordant CAI. YMSM with detectable HIV who disclosed their HIV status to sex partners were more likely to report CAI compared with non-disclosing YMSM.

“Combination HIV prevention and treatment interventions, which include behavioral, biomedical and structural strategies to increase viral suppression and reduce HIV transmission risk behaviors, that target HIV-infected YMSM are needed,” the study concludes. “To truly curb HIV incidence among YMSM, we cannot solely rely on one strategy to prevent and treat HIV,” they add.

In Australia, HIV continues to be transmitted primarily through sexual contact between men, according to AIDS 2014 fact sheet. Of the more than 21,000 people living with diagnosed HIV infection in Australia, 80 per cent of them attribute their infection to male-to-male sexual contact. The prevalence of HIV among all MSM in Australia is reported at approximately 11.2 per cent.

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