Benjamin r bavinton

Benjamin R Bavinton, Fengyi Jin, Garrett P Prestage, Iryna Zablotska, Beatriz Grinsztejn, Nittaya Phanuphak, Ruth Khalili Friedman, and Andrew E Grulich for the Opposites Attract Study Group

• Benjamin R Bavinton, Fengyi Jin, Garrett P Prestage, Iryna Zablotska, Beatriz Grinsztejn, Nittaya Phanuphak, Ruth Khalili Friedman, and Andrew E Grulich for the Opposites Attract Study Group

• 21 July 2015

• 8th International AIDS Society Conference on HIV Pathogenesis, Treatment & Prevention Vancouver, Canada

Sexual risk behaviour in serodiscordant couples:

• Sexual risk behaviour in serodiscordant couples:

• In most clinical trials, there is no evidence of increased condomless intercourse due to the protection provided by antiretrovirals.
• It is a rapidly changing field; new evidence and community education may impact upon sexual behaviour within couples in different settings.

Prospective longitudinal cohort study.

• Prospective longitudinal cohort study.

• Unit of recruitment is a couple comprising two men in an ongoing sexual relationship where one is HIV-positive and the other HIV-negative at baseline.

• Couples attend at least 2 clinic visits per year:

• Viral load and CD4 in HIV-positive partners
• HIV antibody tests in HIV-negative partners
• Tests for sexually transmissible infections in both partners.

• Both partners complete a questionnaire at each clinic visit.

• Phylogenetic analysis conducted for the interim analysis and at the end of the study.

Do the HIV-negative partners in Opposites Attract report more condomless anal intercourse (CLAI) with their HIV-positive study partner when they perceive their partner to have undetectable viral load?

• Do the HIV-negative partners in Opposites Attract report more condomless anal intercourse (CLAI) with their HIV-positive study partner when they perceive their partner to have undetectable viral load?

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• Are there differences between the three countries participating in Opposites Attract?

By 30 June 2015, 269 couples were enrolled.

• By 30 June 2015, 269 couples were enrolled.

Any sex with outside partners in previous 3 months:

• Any sex with outside partners in previous 3 months:

HIV-positive partners taking ART:

• HIV-positive partners taking ART:

Of the HIV-negative partners who ‘knew’ their HIV-positive partner’s last viral load result:

• Of the HIV-negative partners who ‘knew’ their HIV-positive partner’s last viral load result:

Overall, HIV-negative partners were more likely to report CLAI with their study partner when the perceived viral load was undetectable.

• Overall, HIV-negative partners were more likely to report CLAI with their study partner when the perceived viral load was undetectable.

This association between perceived undetectable viral load and increased CLAI was evident only amongst Australian couples.

• This association between perceived undetectable viral load and increased CLAI was evident only amongst Australian couples.

At the level of the individual, there may be differences in:

• At the level of the individual, there may be differences in:

• Understanding and awareness of viral load (e.g. in Thailand, viral load monitoring is not routinely conducted until ART initiation)
• Research literacy
• Capacity to determine how to incorporate new scientific findings about viral load and prevention into sexual lives

• At the level of clinicians and health care workers, there may be differences in:

• Limited dialogue about treatment as prevention, despite guidelines recommending treatment for all
• Support for the idea of undetectable viral load as a prevention strategy
• Willingness to share treatment as prevention findings openly with patients

At the level of the gay community, in Australia there has been widespread discussion of viral load in the context of ‘treatment as prevention’ for several years:

• At the level of the gay community, in Australia there has been widespread discussion of viral load in the context of ‘treatment as prevention’ for several years:

• The Swiss Statement (2008)
• Community education campaigns targeting HIV-positive men to consider early treatment (2013-2015)
• Community education campaigns explicitly on the reduced risk of undetectable viral load targeting all gay men (2013-2015)

In our sample, Australian men had more optimistic attitudes towards ‘treatment as prevention’.

• In our sample, Australian men had more optimistic attitudes towards ‘treatment as prevention’.

Logistic regression models:

• Logistic regression models:

• Outcome = Any condomless anal intercourse with study partner in the previous 3 months

Condomless anal intercourse is relatively common in these male serodiscordant couples (53%), and was more prevalent in Australia (68%).

• Condomless anal intercourse is relatively common in these male serodiscordant couples (53%), and was more prevalent in Australia (68%).

• HIV-negative partners outside Australia, particularly in Thailand, were less likely to know their study partner’s last viral load result.

• There was a strong association between perceived undetectable viral load and increased condomless intercourse in Australia, but not in Brazil or Thailand.

• Optimistic beliefs about ‘treatment as prevention’ were related to increased CLAI, and may affect sexual behaviour more than viral load results in Brazil and Thailand.