AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #111 - Discussions of viral load in negotiating sexual episodes with primary and casual partners among men who have sex with men
Authors: Presenting Author: Dr. Keith Horvath - University of Minnesota
Additional Authors: Dr. Derek Smolenski, Dr. Alex Iantaffi, Mr. Jeremy Grey, Dr. B.R. Simon Rosser,
Aim: At least one study shows that perceived viral load (VL), not actual VL, is associated with higher risk behaviors among HIV+ men who have sex with men (MSM). However, relatively little is known about discussions of viral load in sexual negotiation scenarios among groups at high risk for HIV. The objective of this study is to understand how frequently VL is discussed in unprotected anal intercourse (UAI) events with primary and casual sexual partners.
Method / Issue: MSM (n=326) completed an online survey of their sexual practices and attitudes about pornography in January, 2011. Where relevant (i.e., for sexual episodes involving a HIV-positive participants on antiretroviral therapy [ART] or HIV- or unknown men who report HIV+ sexual partners), participants reported UAI and discussions about VL in the past 3 months with a) 1 primary partner, b) up to 3 sexual episodes with casual partners with whom they had sex one time, and c) up to 3 sexual episodes with casual partners with whom they had sex more than once.
Results / Comments: Mean age of participants was 32, and men were mostly Caucasian (82%), HIV- (83%), college educated (62%), and single (65%). Twelve HIV+ men in the study had a primary relationship, of which 7 were seroconcordant. All HIV+ participants had discussed viral load with their primary partners. Among the 5 HIV+ participants on ART and in seroconcordant primary relationships, a median of 2 UAI episodes occurred in the past 3 months; no UAI episodes were reported by the 2 HIV- men in serodiscordant primary relationships and their partners were on ART. One hundred twenty-nine participants reported at least one causal partner with whom they had sex only once, representing 213 reported sexual episodes. One hundred twenty-eight participants reported at least one casual partner with whom they had sex on more than one occasion, representing 218 sexual episodes. Among the nine sexual episodes involving HIV+ participants on ART, four included discussions of their VL. Of those four, two episodes of UAI were reported. In comparison, UAI was reported in all five sexual episodes in which HIV+ participants did not discuss their VL. Among the eight sexual episodes involving HIV- participants and HIV+ casual partners, five included discussions about VL. Of those five, three episodes of UAI were reported. In comparison, of the three episodes between HIV- participants and HIV+ partners in which VL was not discussed, only one case of UAI was reported. Overall, UAI was reported in 56% (5/9) of casual sexual episodes involving at least one HIV+ partner where VL was discussed, while UAI was reported in 75% (6/8) of casual sexual episodes involving at least one HIV+ partner were VL was not discussed.
Discussion: Relatively few discussions of VL took place in comparison to the total number of sexual episodes reported. Discussion of VL in primary relationships involving at least one HIV+ partner on ART were universal. In casual partnerships, a higher overall percentage of sexual episodes involving UAI was reported when VL was not discussed than when it was discussed.
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