Daskalopoulou, Marina; (2017) Sexual behaviour of HIV-diagnosed men who have sex with men in England in the era of effective antiretroviral therapy: results from the ASTRA study. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Transmission of HIV among men who have sex with men (MSM) in the UK is ongoing. Among HIV-diagnosed MSM, condomless sex (CLS) with HIV-serodifferent partners (CLS-D) was considered the main HIV transmission risk before evidence of the favourable impact of antiretroviral treatment (ART). Using data on HIV-diagnosed MSM from the ASTRA study (2011-2012), this thesis assessed: (i) prevalence of different types of CLS, including CLS-D with appreciable risk of HIV transmission (accounting for ART/viral load); (ii) associated co-factors (socio-demographic, lifestyle, psychological, HIV-related); (iii) prevalence and factors associated with other sexually transmitted infections (STIs), and subsequent risk of hepatitis C virus (HCV) co-infection. Among 2189 HIV-diagnosed MSM, 38% had recent CLS; 16% had CLS-D; only 4% had CLS-D with appreciable HIV transmission risk. These CLS measures tended to be associated with younger age, more recent HIV diagnosis, and not being on ART, and were strongly associated with recreational drug and polydrug use (which were prevalent). When classifying MSM into mutually exclusive categories, 36% did not have sex in the past three months; 25% had condom-protected sex only; 22% had CLS with HIV-seroconcordant partners only (‘CLS-C without CLS-D’, which may indicate HIV-serosorting); 16% had CLS-D. Chemsex-associated drug use and disclosure of HIV-status to new sex partners were more common among MSM who had ‘CLS-C without CLS-D’ compared to CLS-D. Over 10% of MSM had recent STI co-infections. Recreational and injection drug use, CLS, and multiple partners were associated with pre-existing STIs, with initial evidence of association with incident HCV. Consideration of different types of CLS among HIV-diagnosed MSM demonstrated differing implications for prevention of HIV versus other STI transmission. Expansion of ART use should further impact favourably on HIV transmission risk. There is a need for focus on harm reduction in recreational drug use and prevention of STI co-infections among HIV-diagnosed MSM.

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