Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER)

Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study

The Lancet, Published Online May 2, 2019

Background

The level of evidence for HIV transmission risk through condomless sex in serodifferent gay couples with the HIV-positive partner taking virally suppressive antiretroviral therapy (ART) is limited compared with the evidence available for transmission risk in heterosexual couples. The aim of the second phase of the PARTNER study (PARTNER2) was to provide precise estimates of transmission risk in gay serodifferent partnerships.
Findings
Between Sept 15, 2010, and July 31, 2017, 972 gay couples were enrolled, of which 782 provided 1593 eligible couple-years of follow-up with a median follow-up of 2·0 years (IQR 1·1–3·5). At baseline, median age for HIV-positive partners was 40 years (IQR 33–46) and couples reported condomless sex for a median of 1·0 years (IQR 0·4–2·9). During eligible couple-years of follow-up, couples reported condomless anal sex a total of 76 088 times. 288 (37%) of 777 HIV-negative men reported condomless sex with other partners. 15 new HIV infections occurred during eligible couple-years of follow-up, but none were phylogenetically linked within-couple transmissions, resulting in an HIV transmission rate of zero (upper 95% CI 0·23 per 100 couple-years of follow-up).

Interpretation

Our results provide a similar level of evidence on viral suppression and HIV transmission risk for gay men to that previously generated for heterosexual couples and suggest that the risk of HIV transmission in gay couples through condomless sex when HIV viral load is suppressed is effectively zero. Our findings support the message of the U=U (undetectable equals untransmittable) campaign, and the benefits of early testing and treatment for HIV.

 

Are We Blinded by Desire? Relationship Motivation and Sexual Risk-Taking Intentions during Condom Negotiation

The Journal of Sex Research, Shayna Skakoon-Sparling & Kenneth M. Cramer (2019) DOI: 10.1080/00224499.2019.1579888

ABSTRACT

Effective condom negotiation skills support better sexual health for both men and women. The current study explored relationship motivation (motivation to establish and maintain long-term romantic relationships), gender, and sexual orientation as factors influencing the condom negotiation process.

Participants (177 heterosexual women, 157 heterosexual men, and 106 men who have sex with men) read a vignette describing an encounter with a hypothetical new sexual/romantic partner and responded to embedded items and scales.

Stronger relationship motivation predicted increased willingness to have condomless sex among women who perceived greater familiarity with the hypothetical partner. Gender and sexual orientation predicted different preferences for condom insistence strategies.

The findings suggest that there are a number of conditions that make it more difficult to recognize risk during a sexual encounter and demonstrate how the process of condom negotiation can be impacted by gender, sexual orientation, and relationship motivation.

Condom handouts in schools prevent disease without encouraging sex

The Guardian,

Making condoms available to teenagers at school does not make them more promiscuous – but neither does it reduce teenage pregnancy rates.

According to a major review by the UN Population Fund (UNFPA), giving out condoms in secondary schools does not increase sexual activity, or encourage young people to have sex at an earlier age.

The research, thought to be the largest review of scientific literature on the issue, found that introducing condoms to schools reduced sexually transmitted infections (STIs).

Understanding U=U for women living with HIV

ICASO, September 2018

Since its announcement, Undetectable equals Untransmittable (U=U) has
become a call to action to assert that when someone living with HIV has an
undetectable viral load they cannot transmit HIV. Additionally, the U=U message
is evolving to challenge notions of HIV infectivity, vulnerability and stigma.

The science behind the U=U message provides the evidence that we can reduce the anxiety related to the sexual transmission of the HIV virus with confidence.

To contribute to getting this message out, ICASO produced a Community Brief on U=U. This community brief explains why it is so important to understand what ‘U=U’ means for women. The brief documents the experiences and needs of individual women living with HIV from all over the world. Important questions still remain that need to be answered to make the U=U message relevant, understandable and more meaningful to women in their diversity.

  • Download the community brief in English here

HIV diagnoses hit seven year low: Australia’s annual HIV figures released

Kirby Institute, UNSW, Monday, 24 September 2018

Australia has recorded its lowest level of HIV diagnoses in seven years, according to a new report from the Kirby Institute at UNSW Sydney.

The report, released at the Australasian HIV&AIDS Conference in Sydney, found that there were 963 new HIV diagnoses in 2017, the lowest number since 2010.

Researchers are attributing the promising results to more people getting tested for HIV, more people living with HIV starting treatment which reduces the risk of HIV transmission to effectively zero, and an increased use of pre-exposure prophylaxis (or PrEP, an HIV prevention pill).

However, it is not all good news. According to the report, a quarter of new HIV diagnoses in 2017 were among heterosexuals, with a 10% increase in diagnoses over the past five years.

Among Aboriginal and Torres Strait Islander populations, HIV diagnoses have been increasing over the past five years, with rates almost two times higher than the Australian-born non-Indigenous population in 2017.

Giving gay men self-test kits increases HIV testing by 50% – but STI tests decrease

aidsmap/nam, 21 August 2018

Gay men who were offered HIV home-testing kits took 50% more tests than men who only took HIV tests at clinics or community organisations, a randomised controlled study from Seattle in the USA has found.

The men who could self-test took fewer tests for sexually transmitted infections (STIs), though it is not completely clear whether this was because they went less often for STI checkups or had fewer STI symptoms.