Unprotected sex in regular partnerships among homosexual men living with HIV: a comparison between sero-nonconcordant and seroconcordant couples (ANRS-EN12-VESPA Study)
Résumé
Objective: We investigated factors associated with unprotected sex in regular partnerships
among homosexual men living with HIV.
Method: We used data from a French national representative sample of people living
with HIV (ANRS-EN12-VESPA survey). This analysis included men in a regular partnership
with another man for at least twelve months. Unprotected sex was defined as
reporting at least one episode of sexual intercourse without a condom with this regular
partner in the previous 12 months. Separate analyses were conducted in sero-nonconcordant
couples and in HIV-positive seroconcordant couples.
Results: 285 and 193 homosexual men respectively reported a regular sero-nonconcordant
and seroconcordant partner. Unprotected sex was reported by a higher number
of respondents within seroconcordant (46.7%) than within sero-nonconcordant couples
(15.6%).
In both seroconcordant and sero-nonconcordant partnerships, unprotected sex was
significantly more frequent when episodes of unprotected sex with casual partners were
reported. In seroconcordant couples, those who had more than four casual partners
were also more likely to practise unprotected sex with their regular partner. Among
sero-nonconcordant couples, binge drinking and absence of disclosure of one’s HIVpositive
status to the partner were also independently associated with unprotected sex.
Conclusions: A limited number of sero-nonconcordant homosexual couples persist in
reporting risky sexual behaviour. Prevention messages should encourage communication
and HIV disclosure. The relationship between unprotected sex with both casual
and regular partners also calls attention about the underlying psycho-social and
interactional factors that may influence sexual behaviours of people living with HIV
in regular relationships, independently of the status of the partner.