HIV This Week

Rey D, Bouhnik AD, Peretti-Watel P, Obadia Y, Spire B; the VESPA Study Group. Awareness of non-occupational HIV postexposure prophylaxis among French people living with HIV: the need for better targeting. AIDS 2007;21(Suppl 1):S71-S76.

Since 1998, French HIV prevention guidelines have recommended the use of HIV post-exposure prophylaxis (PEP) after unprotected sex with an HIV-positive partner. This study analysed factors associated with PEP awareness in a population of individuals living with HIV. In 2003, a face-to-face survey was conducted among people living with HIV selected from a random stratified sample of 102 French hospital departments delivering HIV care. Those who knew about PEP and those who did not were compared to identify factors related to PEP awareness in the sub-sample who reported that they had been sexually active in the prior 12 months. Among the 2,280 sexually active people living with HIV, the median age was 40 years. Women comprised 26% of the sample, 41% were homosexual men and 16% were immigrants. Thirty percent of individuals reported not being aware of the availability of PEP. After multiple adjustment, factors associated with lack of PEP awareness were a low educational level, unemployment, older age, and CD4 cell counts <200. In addition, homosexual men showed a higher level of PEP awareness compared with the other participants, especially when compared with immigrant heterosexual men and women. Individuals who reported having unprotected sex with a non-HIV-positive steady partner also independently showed lower levels of PEP awareness. Finally, reporting having casual partners was associated with better awareness. Awareness of PEP is insufficient among people living with HIV, especially among immigrants. Programmes aimed at improving positive prevention among people living with HIV are much needed and should be promoted.

Elford J, Ibrahim F, Bukutu C, Anderson J. Sexual behaviour of people living with HIV in London: implications for HIV transmission. AIDS 2007;21(Suppl 1):S63-70.

Elford examined the sexual behaviour of gay men as well as black African heterosexual men and women living with diagnosed HIV in London, and considered the implications for HIV transmission. People living with HIV receiving treatment and care in outpatient clinics in north east London were asked to complete a confidential, self-administered questionnaire in 2004-2005. Respondents were asked about unprotected anal or vaginal intercourse in the previous 3 months, and the type (main or casual) and HIV status of their partner(s). A total of 1687 people with diagnosed HIV returned a completed questionnaire (response rate 73% of eligible clinic attenders) including 480 black African heterosexual women, 224 black African heterosexual men and 758 gay/bisexual men (464 white, 112 ethnic minority). One in five gay men with HIV (20.1%, 144/715) reported unprotected anal intercourse with a partner of unknown or discordant HIV status (usually a casual partner). This presents a risk of HIV transmission. By comparison, one in 20 (5.1%, 32/623) black African heterosexual men and women with HIV reported unprotected vaginal intercourse that presented a risk of HIV transmission; odds ratio (gay men versus black African men and women combined) 5.28, 95% confidence interval 3.52, 7.91, P < 0.001. Neither viral load nor being on HAART were significantly associated with unprotected intercourse among gay men or black African heterosexual men and women. The authors conclude that behavioural research among people with diagnosed HIV in London shows that gay men are more likely than black African heterosexual men and women to engage in sexual behaviour that presents a risk of HIV transmission.