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Changes in sexual behaviour, pre-exposure prophylaxis use and HIV incidence among gay, bisexual, and other men who have sex with men in England

Hanum, Nadia; (2022) Changes in sexual behaviour, pre-exposure prophylaxis use and HIV incidence among gay, bisexual, and other men who have sex with men in England. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

The identification of longitudinal changes in sexual behaviour over time, pre-exposure prophylaxis (PrEP) use, the incidence of HIV infection among HIV-negative GBMSM, and risk behaviours among HIV-positive GBMSM shortly after diagnosis is needed to improve HIV prevention efforts and is crucial to assess the potential risk of HIV spread in the community. Data from UK prospective studies are lacking. Data from two prospective studies were used in this thesis. The AURAH2 (Attitudes to, and Understanding of, Risk of Acquisition of HIV over time) study recruited GBMSM who were HIV-negative from three large sexual health clinics in England with four-monthly online follow-up (2013 – 2018, 1,162 men completed baseline questionnaire, 622 men completed at least one follow-up questionnaire). The Guy’s and St. Thomas’ study enrolled newly diagnosed people from an HIV clinic in London and followed them up at weeks 12, 24, and 48 (2015 – 2018, 90 GBMSM included in analyses). Among all men enrolled in AURAH2, past three months condomless anal sex with two or more partners (CLS2+, 46% to 47%, p-trend=0.010) increased slightly between 2013 and 2018. PrEP use in the past year also increased from 0% in 2013 to 43% in 2018 (p<0.001). HIV incidence declined from 1.47 per 100 PYs in 2013/2014 to 0.25 per 100 PYs in 2018/2019. Among a subset of men in AURAH2 with at least two consecutive questionnaires during follow-up, men reporting CLS2+ had an overall 78% probability of reporting CLS2+ in the subsequent questionnaires, and of men who reported none or one CLS partner, 88% reported the same in the subsequent period. Among GBMSM newly diagnosed with HIV in the Guy’s and St. Thomas study, the within-individual tendency for reporting CLS was that men reduced their behaviours from baseline (62%) to week 12 (45.2%), then increased again by 48 weeks (62%). The greatest increase at week 48 was seen in the frequency of CLS with serodiscordant partners (CLS-D; 14% at week 12 to 36% at week 48). The proportion of men having CLS-D with the most recent documented plasma viral load (VL) > 200 copies/mL at week 12 was almost 11%. With HIV incidence declining among GBMSM in England and coinciding with a substantial increase in the use of PrEP, there is a clear need to focus prevention efforts on potential transmission risk. HIV providers should emphasize the importance of knowledge of viral suppression in decision making about CLS among newly diagnosed GBMSM.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Changes in sexual behaviour, pre-exposure prophylaxis use and HIV incidence among gay, bisexual, and other men who have sex with men in England
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10152278
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