Marion Di Ciaccio1,2, Luis Sagaon-Teyssier1,3, Mohamed Mimi1,3, Marie Suzan-Monti1,3, Christel Protiere1,3, Daniela Rojas Castro1,2,4,5, Laurence Meyer6, Cécile Tremblay7, Christian Chidiac8, Catherine Capitant9, Marie Préau1,2, Jean-Michel Molina9, Bruno Spire1,3. 1. Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille. 2. Groupe de Recherche en Psychologie Sociale (GRePS), Université Lyon 2, Lyon. 3. Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille. 4. AIDES (Mission Innovation Recherche Expérimentation), Pantin. 5. Coalition Internationale Sida, Pantin. 6. INSERM SC 10 US 19, Villejuif, France. 7. Centre Hospitalier de l'Université de Montréal- Hôtel Dieu, Montréal, Canada. 8. Département des maladies infectieuses, Hôpital de la Croix Rousse, Centre Hospitalier et Universitaire de Lyon, Lyon. 9. Département des maladies infectieuses, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Université de Paris Diderot Paris 7, INSERM U941, Paris, France.
Abstract
OBJECTIVE: This study aimed to identify situational and behavioral factors associated with condomless anal sex without on-demand PrEP in the open-label extension (OLE) study of the ANRS-IPERGAY trial. METHODS: Univariable and multivariable modified Poisson regressions with a generalized estimating equation (GEE) were used. The attributable risk percentage for each explanatory variable and for condomless anal sex without PrEP was calculated. RESULTS: In the OLE, 19% of anal intercourses were unprotected (i.e. no PrEP or condom). Of these, 85% were attributable to sexual intercourse with main partners and 47% with HIV-negative partners. The following factors were positively associated with condomless anal sex without PrEP: a depressive episode in the previous 12 months [aR (95% CI), P-value: 1.49 (1.02--2.17), 0.039], a higher number of sexual intercourses during the previous 4 weeks [1.01 [1.002--1.02], 0.014], and sexual intercourses under the influence of alcohol [1.45 (1.10--1.92), 0.008]. By contrast, condomless anal sex without PrEP was less frequent during sexual intercourses with known casual, unknown casual and multiple partners [0.20 (0.14--0.30), <0.001; 0.10 (0.05--0.20), <0.001; 0.11 (0.05--0.29), <0.001, respectively], as well as with HIV+ partners with an undetectable viral load and HIV+ partners with a detectable/unknown viral load or unknown serology status [0.57 (0.38--0.86), 0.007; 0.52 (0.32--0.87), 0.012, respectively]. CONCLUSION: Choosing to have condomless anal sex without PrEP depends primarily on the sexual partner's characteristics (level of intimacy, serological status). This reflects a form of rationality in HIV risk management. However, our results raise questions about the true efficacy of managing HIV risk using this approach.
OBJECTIVE: This study aimed to identify situational and behavioral factors associated with condomless anal sex without on-demand PrEP in the open-label extension (OLE) study of the ANRS-IPERGAY trial. METHODS: Univariable and multivariable modified Poisson regressions with a generalized estimating equation (GEE) were used. The attributable risk percentage for each explanatory variable and for condomless anal sex without PrEP was calculated. RESULTS: In the OLE, 19% of anal intercourses were unprotected (i.e. no PrEP or condom). Of these, 85% were attributable to sexual intercourse with main partners and 47% with HIV-negative partners. The following factors were positively associated with condomless anal sex without PrEP: a depressive episode in the previous 12 months [aR (95% CI), P-value: 1.49 (1.02--2.17), 0.039], a higher number of sexual intercourses during the previous 4 weeks [1.01 [1.002--1.02], 0.014], and sexual intercourses under the influence of alcohol [1.45 (1.10--1.92), 0.008]. By contrast, condomless anal sex without PrEP was less frequent during sexual intercourses with known casual, unknown casual and multiple partners [0.20 (0.14--0.30), <0.001; 0.10 (0.05--0.20), <0.001; 0.11 (0.05--0.29), <0.001, respectively], as well as with HIV+ partners with an undetectable viral load and HIV+ partners with a detectable/unknown viral load or unknown serology status [0.57 (0.38--0.86), 0.007; 0.52 (0.32--0.87), 0.012, respectively]. CONCLUSION: Choosing to have condomless anal sex without PrEP depends primarily on the sexual partner's characteristics (level of intimacy, serological status). This reflects a form of rationality in HIV risk management. However, our results raise questions about the true efficacy of managing HIV risk using this approach.
Authors: Marion Di Ciaccio; Rosemary M Delabre; Antoine Vilotitch; Giulio Maria Corbelli; Virginie Villes; Alejandro Ros Sánchez; Paul Zantkuijl; Holger Sweers; Flor Sanchez; Michael Meulbroek; Gus Cairns; Adeline Bernier; Jade Ghosn; Luìs Miguel Carvalho Rocha; Maria Luisa Cosmaro; Sascha Béla Duken; Monica Dan; Vincent Schlegel; Richard Stranz; Kai J Jonas; Bruno Spire; Daniela Rojas Castro Journal: Arch Sex Behav Date: 2022-06-20