Barcelona 2013
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| Abstract #152 - Risk | ||||
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Session: 18.3: Risk (Symposium) on Monday @ 16.30-18.30 in Teatre Chaired by Susan Kiene, Olivia Castillo Authors: Presenting Author: Ms Lisanne Möller - Public Health Service Amsterdam, Netherlands |
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| Additional Authors: Professor Edwin Wouters , Mrs. Caroline Masquiller, | ||||
| Aim: Evidence suggests that the introduction of combination antiretroviral therapy (cART) is responsible for increases in risky sex among men who have sex with men (MSM). We hypothesized that men who experienced the impact of the early years of the HIV/AIDS epidemic, when many men died from AIDS, may nowadays be less risky than men who did not experience this period. Therefore, we examined cohort effects in risky sex among HIV negative MSM in recent years, making a distinction between men who became sexually active before the start of the HIV epidemic, during the pre-cART era and during the cART era. | ||||
| Method / Issue: The Amsterdam Cohort Studies (ACS) is an ongoing prospective cohort study that started in 1984 to investigate the epidemiology, pathogenesis, and prevention of HIV/AIDS in HIV-negative and positive men. Men return for follow-up and complete behavioural questionnaires every 6 months. For this study, we included only HIV negative men. Risky sex was defined as unprotected anal intercourse (UAI) with casual partners in the past six months. Safe sex fatigue was measured by questionnaire in 2005, 2006 and 2007. Random coefficient logistic regression models were used to assess differences in risky sex trends in the period 2005-2012 between the three sexual onset groups. A possible mediating effect of safe sex fatigue was examined by checking if there was an association between safe sex fatigue and both sexual risk behaviour and period of sexual onset. | ||||
| Results / Comments: Overall, the association between period of sexual onset and risky sex was borderline significant (P=0.080). Men who became sexually active in the pre-HIV period had the highest proportion of UAI in 2005 (ORadj 2.44, 95% CI 1.18-5.26, compared with pre-cART). There was a significant interaction between period of sexual onset and calendar year (P=0.047), indicating that the development of sexual risk behaviour over time differed across the three sexual onset groups. The pre-HIV group showed a slight decrease of risky sex between 2005 and 2012 (ORadj 0.88 per year, 95% CI 0.77-1.00), whereas the pre-cART and cART groups showed small, non-significant increases, with an adjusted OR of 1.05 (95% CI 0.97-1.13) per year for the pre-cART group and 1.05 (95% CI 0.94-1.18) for the cART group. The differences between the groups were not explained by safe sex fatigue, as there was no association between safe sex fatigue scores and period of sexual onset (P=0.902). | ||||
| Discussion: MSM from the pre-HIV generation started with higher levels of risky sex in 2005 but showed a slight decrease thereafter, whereas men from the pre-cART and cART generations showed a statistically non-significant increase in risky sex proportions. This may indicate that there are differential trends in risky sex, which could have implications for targeting interventions for different generations of MSM. Although the differences in time trends between the groups were small, it may be useful to take cohort effects into account when evaluating time trends in sexual risk behaviour. | ||||
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