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What are the situational and behavioral factors associated with condomless anal sex without pre-exposure prophylaxis in MSM?

Abstract : Objective: This study aimed to identify situational and behavioral factors associated with condomless anal sex without on-demand PrEP in the open-label extension (OLE) study of the ANRS-IPERGAY trial. Methods: Univariable and multivariable modified Poisson regressions with a generalized estimating equation (GEE) were used. The attributable risk percentage for each explanatory variable and for condomless anal sex without PrEP was calculated. Results: In the OLE, 19% of anal intercourses were unprotected (i.e. no PrEP or condom). Of these, 85% were attributable to sexual intercourse with main partners and 47% with HIV-negative partners. The following factors were positively associated with condomless anal sex without PrEP: a depressive episode in the previous 12 months [aR (95% CI), P-value: 1.49 (1.02--2.17), 0.039], a higher number of sexual intercourses during the previous 4 weeks [1.01 [1.002--1.02], 0.014], and sexual intercourses under the influence of alcohol [1.45 (1.10--1.92), 0.008]. By contrast, condomless anal sex without PrEP was less frequent during sexual intercourses with known casual, unknown casual and multiple partners [0.20 (0.14--0.30), <0.001; 0.10 (0.05--0.20), <0.001; 0.11 (0.05--0.29), <0.001, respectively], as well as with HIV+ partners with an undetectable viral load and HIV+ partners with a detectable/unknown viral load or unknown serology status [0.57 (0.38--0.86), 0.007; 0.52 (0.32--0.87), 0.012, respectively]. Conclusion: Choosing to have condomless anal sex without PrEP depends primarily on the sexual partner's characteristics (level of intimacy, serological status). This reflects a form of rationality in HIV risk management. However, our results raise questions about the true efficacy of managing HIV risk using this approach.
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https://www.hal.inserm.fr/inserm-03197778
Contributor : Christine Dupuis <>
Submitted on : Wednesday, April 14, 2021 - 11:04:00 AM
Last modification on : Friday, April 16, 2021 - 3:26:22 AM

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Marion Di Ciaccio, Luis Sagaon-Teyssier, Mohamed Mimi, Marie Suzan-Monti, Christel Protière, et al.. What are the situational and behavioral factors associated with condomless anal sex without pre-exposure prophylaxis in MSM?. AIDS, Lippincott, Williams & Wilkins, 2020, 34 (9), pp.1367-1375. ⟨10.1097/QAD.0000000000002542⟩. ⟨inserm-03197778⟩

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