Dislike of condoms main reason why some HIV-positive UK heterosexuals are not having protected sex

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A high level of condom use has been found amongst HIV-positive heterosexuals receiving HIV care at an inner London clinic. In a study published in the May edition of Sexually Transmitted Infections investigators found that 73% of HIV-positive heterosexuals used condoms the last time they had vaginal sex. The main reasons for not using condoms were dislike by either the study participant or their partner.

An increasing proportion of all HIV infections in the United Kingdom involve heterosexuals. However, little is known about the sexual risk behaviours of HIV-infected heterosexuals in the United Kingdom even though the government’s HIV and sexual health strategy emphasised that HIV services could help prevent the onward transmission of HIV from individuals who were already known to be infected.

Between 2000 and 2001, a total of 300 heterosexuals attending the Bloomsbury Clinic in central London for their HIV treatment and care were invited to complete a questionnaire detailing their sexual activity in the last year. They were also asked to provide demographic details and information about their viral load and CD4 cell count.

Glossary

disclosure

In HIV, refers to the act of telling another person that you have HIV. Many people find this term stigmatising as it suggests information which is normally kept secret. The terms ‘telling’ or ‘sharing’ are more neutral.

response rate

The proportion of people asked to complete a survey who do so; or the proportion of people whose health improves following treatment.

superinfection

When somebody already infected with HIV is exposed to a different strain of HIV and becomes infected with it in addition to their existing virus.

 

The response rate was poor, with only 142 (47%) of eligible individuals completing the questionnaire. Of these individuals, 100 reported sexual activity in the previous twelve months and were included in the investigators’ analysis.

Condoms were used by 73% if individuals the last time they had vaginal sex. The investigators found no relationship between condom use and gender, age, and undetectable viral load. They were surprised, however, to see that patients who had a CD4 cell count below 200 cells/mm3 were significantly less likely to have used a condom the last time they had vaginal sex than individuals with higher CD4 cell counts (p = 0.047). The investigators could offer no explanation for this finding.

The two most common reasons offered for using a condom during the last episode of vaginal sex were “I do not want to give my partner HIV” (39%), followed by “I do not want to catch another sexually transmitted infection” (32%). Three people mentioned a fear of superinfection as a reason for condom use.

Common reasons for not using condoms the last time participants had vaginal sex were “my partner does not like using condoms" (13%), followed by “I don’t like using condoms” (7%). Drug use and alcohol was not a cause of unprotected sex and was only offered as an explanation for the non-use of condoms by one man.

A total of 86% of all participants had disclosed their HIV status to their partner. Amongst individuals who had disclosed their status, knowledge of their partners HIV infection status was significantly linked to the use of condoms (p = 0.03). Condoms were used by only 56% of the 13 individuals who did not know their partner’s HIV status.

“Our study highlights the importance of discussing sexual behaviour with HIV infected patients to reduce secondary transmission”, write the investigators. The add that the study also showed “the need to strengthen efforts to facilitate disclosure of HIV status.”

The investigators acknowledge limitations with their study, particularly its single-centre design and the large number of eligible patients who refused to participate.

References

Dave SS et al. Sexual behaviour, condom use, and disclosure of HIV status in HIV infected heterosexuals attending an inner London HIV clinic. Sex Transm Infect 82: 117-120, 2006.