AEGiS-15IAC: Is unsafe sexual behavior increasing among HIV-infected individuals? The Swiss HIV cohort study (SHCS).

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Is unsafe sexual behavior increasing among HIV-infected individuals? The Swiss HIV cohort study (SHCS).

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrD1211)

Glass TR, Vernazza PL, Young J, Rickenbach M, Flepp M, Furrer H, Bernasconi E, Weber R, Cavassini M, Hirschel B, Battegay M, Bucher HC
Basel Institute for Clinical Epidemiology, Basel, Switzerland

BACKGROUND: Sexual contact is the primary mode of HIV transmission worldwide and in the last few years there has been an increase in the incidence of HIV infection in the northwestern hemisphere. We evaluated whether reported unsafe sexual behavior among HIV-infected individuals, both treated and untreated, is increasing over time.

METHODS: We evaluated the sexual behavior of individuals in relation to age, gender, risk group for HIV transmission, ethnicity, education, HIV-status of partner, having occasional partners, living alone, having progressed to AIDS, optimal viral suppression, antiretroviral therapy (ART), and interruptions in ART. All participants in the SHCS who completed at least one questionnaire on safe sex practices between April 1, 2000 and March 31, 2003 were included in the analysis. Logistic regression models were fit using Generalized Estimating Equations assuming a constant correlation between responses from the same individual.

RESULTS: 6545 individuals responded to the questionnaire and the median number of questionnaires per individual was 5 (range 1-7). Response rate was 99%. There was no evidence of an increase in reported unsafe sex over time (OR 1.0, 95% CI: 0.96-1.05). Females (OR 1.38, 95% CI: 1.19-1.60), 15-30 year olds (OR 1.26, 95% CI: 1.09-1.47), those with HIV-positive partners (OR 12.58, 95% CI: 10.84-14.07) and those with occasional partners (OR 3.25, 95% CI: 2.87-3.67) were more likely to report unsafe sex. Homosexuals, individuals over 40, living alone, having progressed to AIDS, on ART, and with any interruption in ART were less likely to report unsafe sex. There was no evidence of a response bias across time, but individuals were less willing to leave questions about their sexual behavior unanswered or ambiguous (OR 0.93, 95% CI: 0.90-0.97).

CONCLUSIONS: There was no evidence of a time trend in reported unsafe sex behavior. However, several subgroups were identified as being more likely to report unsafe sex and should be targeted for specific interventions.

Keywords: AEGIS, HIV, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Sexual Behavior, Unsafe Sex, Cohort Studies, HIV Infections, Safe Sex, Homosexuality, European Continental Ancestry Group, HIV Seronegativity, Anti-HIV Agents, Humans, Female, immunology

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