Abstract #60  -  Pattern of inconsistent condom use in individuals HIV-infected through drug use: results from the MANIF 2000 cohort study
Authors:   Presenting Author:   Dr Spire Bruno - INSERM U912
Additional Authors:  Ms Perrine Roux, Mr  Julien Cohen, Ms Virginie Villes, Dr Isabelle Poizot-Martin, Dr Isabelle Ravaux, Dr Patrizia Carrieri, Dr Bruno Spire,
Aim: Many studies have shown that ongoing drug injection is associated with unsafe sexual risk behaviours in individuals HIV-infected through drug use (IDUs). However, it is still unknown to what extent care for HIV and opioid dependence can contribute to reduce unsafe sexual behaviours in HIV-infected IDUs and which groups engage in unsafe sexual practices in the HAART era. We used longitudinal data from the MANIF 2000 cohort of individuals HIV-infected through drug use to investigate the pattern of correlates of inconsistent condom use (ICU) with an HIV-negative or a partner of unknown HIV-status.
Method / Issue: : Outpatient hospital services delivering HIV care in Marseilles, Avignon, Nice, Ile de France. Information about drug and alcohol use and sexual behaviours was collected through a self-administered questionnaire while clinical information was based on medical records. Only individuals reporting sexual activity were selected (N=244, 1045 visits). At any given visit, patients were classified in three categories according to their sexual activity: only with main partner (used as reference category), only occasional partner(s) or both main and occasional partner(s). A logit model based on generalised estimating equations (GEE) was used to identify predictors of ICU.
Results / Comments: ICU was reported at least one by 155 patients in 377 visits. At baseline, the selected population had median[IQR] age 33 [30-37], median[IQR] CD4 cell count was 421 [320-589], 46 were receiving HAART and 118 OST. After multiple adjustment, a significant increased risk of ICU was observed among women (OR=1.8 95%CI[1.1-2.9]) and in individuals engaging in sex with both main and occasional partner(s) (OR=3.1 95%CI[2.2-4.2]). Individuals reporting drinking more than four alcohol units per day (OR=1.6 95%CI[1.2-2.3]) were at higher risk of ICU as well as those with depressive symptoms (OR=1.7 95%CI[1.3-2.3]). Ongoing drug injection, receiving OST or HAART was not found associated with ICU.
Discussion: In HIV infected IDUs in the HAART era, ICU remains a frequent practice especially among women, individuals reporting sex with both main and occasional partners and those needing care for depression and alcohol abuse. OST and HAART have a negligible impact in reducing ICU. Targeted interventions for women as well as for other groups should be properly envisaged at different entry points including OST and HAART delivery programs, primary care, psychiatric services and women counselling. Multiplying the entry points and calibrating the intervention for the population engaging in unsafe sexual behaviours can be beneficial to prevent not only HIV but other sexually transmitted diseases.
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