Need for disclosure and communication in serodiscordant gay couples

An analysis of data from a French national representative sample of people living with HIV (ANRS-EN12-VESPA survey) has emphasised the need to encourage communication and HIV disclosure in HIV-discordant gay couples. The analysis found that, where the HIV-positive partner had not disclosed their status, unprotected sex was more likely. The study is published in a supplement to the January 2^nd edition of AIDS.

The research used data from the 2003 VESPA study to investigate factors associated with inconsistent condom use among homosexual men in regular male partnerships living with HIV. HIV-concordant regular partners were reported by 193 men while 285 were in HIV-discordant relationships. Only those men reporting a regular male partner for a minimum of twelve months were included in the analysis and unprotected sex was defined as reporting at least one episode of sexual intercourse without a condom with this regular partner in the previous twelve months. Unprotected sex was reported by 47% of those whose partners were HIV-concordant and fewer cases (16%) were reported when the partner’s status was discordant or unknown.

Several variable factors were analysed to try and determine any associations they might have with unprotected sex. These included: sexual behaviour-related characteristics (such as total lifetime partners and bisexual behaviour), occurrence of unprotected sex, socioeconomic characteristics (including employment and housing conditions), alcohol consumption and clinical characteristics (such as CD4 cell count).

In both HIV-concordant and HIV-discordant partnerships, unprotected sex was significantly more frequent with the regular partner when episodes of unprotected sex had also occurred with casual partners. In HIV-concordant couples, those who had more than four casual partners were also more likely to practise unprotected sex with their regular partner. Among HIV-discordant couples, there were several factors which appeared to have a link with unprotected sex. If the HIV-positive partner had not disclosed their status to the negative or untested regular partner, the likelihood of unprotected sex was higher. Binge-drinking was also independently associated with inconsistent condom use in HIV discordant partnerships.

Interestingly, this analysis showed that an undetectable viral load was not associated with unprotected sex amongst gay men engaging in regular partnerships. Previous studies had expressed concern that gay men were taking sexual risks because they incorrectly assumed that an undetectable viral load would reduce the chances of passing on the virus.

While it is possible that high risk behaviours were underreported because of the associated stigma or social desirability bias, this was minimised by using a fifth level variable to assess the frequency of condom use. Respondents were asked how often they used condoms for penetrative sex with their partner: never/hardly ever/ sometimes/almost always/always. Only the fifth option and highest threshold indicated consistent condom use.

The researchers concluded that a limited number of HIV-discordant homosexual couples persist in reporting risky sexual behaviour and urged those involved in HIV prevention to focus their campaigns on the need for communication and HIV disclosure.