Abstract
BackgroundWhile HIV incidence among men who have sex with men (MSM) is increasing in Hong Kong, unprotected sex apparently remains prevalent among those infected but virally non-suppressed. Little is known about how sexual behaviours and sexual connections may change among MSM along their HIV care continuum.MethodsIn this retrospective cross-sectional study, HIV-positive MSM attending the largest HIV specialist clinic in Hong Kong between October and December 2014 were invited to complete a self-administrated structured questionnaire. Their behavioural profile and partner sourcing patterns during the one-year period respectively (a) before HIV diagnosis, (b) after HIV diagnosis, (c) after initiation of antiretroviral treatment and (d) preceding the survey were examined.ResultsOf 345 recruited MSM, 304 (88.1%) had treatment initiated and 272 (78.8%) had viral load suppressed. In the first year after HIV diagnosis, the proportion reporting inconsistent condom use dropped from 47.0% to 17.5% (p<0.05) and from 49.6% to 17.8% (p<0.01) for anal sex with main and casual partners respectively. Except for mobile applications, usage of most sex-networking venues decreased significantly after diagnosis. Inconsistent condom usage rate remained at around 20% after treatment initiation and viral load suppression, but the frequency of use of sex-networking venues further varied among virally suppressed MSM.ConclusionsMost HIV-positive MSM had persistently low level of sexual risk behaviours along their care continuum and achieved viral load suppression, conferring a general reduction of secondary transmission risk in Hong Kong. To increase the effectiveness of Treatment as Prevention strategy, uptake of HIV testing for undiagnosed HIV-positive MSM shall be emphasised.
Highlights
Antiretroviral therapy (ART) can suppress the viral load of people living with HIV to an undetectable level, a phenomenon that decreases potential risk of secondary transmission [1]
Little is known about how sexual behaviours and sexual connections may change among men who have sex with men (MSM) along their HIV care continuum
In the first year after HIV diagnosis, the proportion reporting inconsistent condom use dropped from 47.0% to 17.5% (p
Summary
Antiretroviral therapy (ART) can suppress the viral load of people living with HIV to an undetectable level, a phenomenon that decreases potential risk of secondary transmission [1]. This has become the rationale for a new public health strategy, named Treatment as Prevention (TasP). Effectiveness of the TasP strategy would hinge on the inter-play among high risk behaviours, viral load suppression and changes in the sexual connections among MSM before and after HIV diagnosis. While HIV incidence among men who have sex with men (MSM) is increasing in Hong Kong, unprotected sex apparently remains prevalent among those infected but virally nonsuppressed. Little is known about how sexual behaviours and sexual connections may change among MSM along their HIV care continuum
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