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Title: Sexual networks, partnership patterns and behaviour of HIV positive men who have sex with men : implications for HIV/STIs transmission and partner notification
Author: Wayal, S.
Awarding Body: University College London (University of London)
Current Institution: University College London (University of London)
Date of Award: 2013
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Background: In the UK, men who have sex with men (MSM) continue to be disproportionately affected with HIV and sexually transmitted infections (STI). Due to the increasing emphasis on using biomedical strategies like cART for prevention of sexual transmission of HIV, I examined HIV positive MSM’s sexual partnerships and behaviours; their attitudes towards biomedical and behavioural HIV transmission risk reduction strategies, and their association with sexual behaviour. I also examined their attitudes towards partner notification for STI, willingness and preferred methods to notify partners of STI in the future. Methods: 429 HIV positive MSM attending a central London clinic completed a computer assisted self-interview on sexual partnerships and behaviours, attitudes, preferences and willingness to notify partners for STI in the future. 24 purposively selected men participated in in-depth interviews. Results: Of 429 men, 380 men had been sexually active in the last year. The survey data showed that the prevalence of unprotected anal intercourse (UAI) with a serodiscordant (i.e., HIV negative or unknown status) primary partner and the most recent non-primary partner was high, 18.3% and 16.9% respectively. A substantial minority of men had positive attitudes towards biomedical and various behavioural HIV transmission risk reduction strategies. Duration of partnership, recreational drug use, and belief that undetectable viral load reduces the risk of HIV transmission during UAI were all independently associated with HIV transmission risk behaviours with a serodiscordant primary partner. Disclosure of HIV status and recreational drug use during sex were independently associated with UAI with the most recent serodiscordant non-primary partner. Of the 258 men who had new partners, 53% had engaged in UAI with new partners. Prevalence of anonymous partnerships was high. Stigma associated with HIV/STI diagnosis, and the venues for meeting sexual partners also influenced men’s sexual partnerships and behaviour, and disclosure of HIV status. Approximately one in five sexually active men had not tested for STI and 25% of men had been diagnosed with STI in the last year. Young age; self-reported detectable viral load status; greater number of new anal sex partners; UAI with new and concurrent partners; having a seroconcordant primary partner; frequency of engagement in group sex were independently associated with STI diagnosis in the last year. The qualitative data highlighted that the majority of men felt an emotional responsibility towards and acknowledged the personal health benefits of notifying primary and regular partners of STI. A greater proportion of men would be less willing to notify casual partners of STI in the future (21%) compared to a primary partner (5.3%) and regular partners (7.5%). Attitudes such as ‘it is not my responsibility to notify partners of STI’, and the lack of previous experience of notification were independently associated with unwillingness to notify casual partners of STI in the future. The qualitative study indicates that the lack of emotional responsibility; fear of stigma and breach of HIV-related confidentiality due to partner notification; and fear of criminalisation for HIV/STI transmission were barriers to notifying sexual partners of STI, especially casual and group sex partners. Patient-referral was the most preferred method of notifying partners of STI in the future, particularly a primary partner; whereas there was greater willingness for notifying regular, casual, and group sex partners using remote self-led methods, provider referral or an anonymous e-card. The acceptability of sending an anonymous e-card and taking a home sampling kit for partners, and telephone assessment of partners for STI by clinic staff was low to moderate. Conclusion: The findings of this study underscore the need for sustained interventions to ensure sexual health of HIV positive MSM and prevent HIV/STI in MSM. They highlight that cART should be offered to sexually active HIV positive MSM, especially those in serodiscordant partnerships irrespective of CD4 cell count to minimize the risk of onward HIV transmission in this population. Frequent STI testing of sexually active men should be integral part of routine HIV care. Various partner notification choices should be offered to those diagnosed with STI. Interventions to reduce stigma associated with homosexuality and HIV continue to remain vital in this population. Research examining the feasibility, acceptability, effectiveness, and cost effectiveness of integrating brief behavioural interventions to enhance regular STI testing, adherence to cART, address recreational drug use and mental health needs, and promote safer sex with routine HIV care is urgently needed.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available