title: Trends in unsafe sex and influence of viral load among patients followed since primary HIV infection, 2000-2009.
abstract: BACKGROUND
  In the current context of increasing unsafe sex, HIV incidence may have evolved, depending on HIV prevalence in sexual networks and, among HIV-infected persons who practice unsafe sex, on their infectivity and partners' HIV serostatus. We examined calendar trends in sexual behaviours at risk of HIV-1 transmission (SBR) among 967 adults followed since primary HIV infection (ANRS PRIMO cohort) and relationship with current treatments and viral load.
  
  
  METHODS
  Patients completed since 2000 self-administered questionnaires on sexual practices every 6 months. SBR with HIV-negative/unknown partners were analyzed among 155 heterosexual women, 142 heterosexual men and 670 MSM by using logistic generalized estimating equation models (6656 visits).
  
  
  RESULTS
  During 2000-2009, the frequency of SBR did not increase significantly among women with steady partners; risk factors were a low education level and alcohol/smoking use. Among heterosexual men with steady partners, the frequency of SBR doubled since 2006; during this period, the only associated factor was combined antiretroviral treatment for at least 6 months or viral load less than 400 copies/ml. Among MSM, SBR increased gradually over time; SBR with steady partners was associated with a low education level and alcohol use. SBR was more frequent among MSM with casual partners; no association with viral load was found.
  
  
  CONCLUSIONS
  In France, recent trends and risk factors in unprotected sex with HIV-negative/unknown partners differ according to sex/sexual preference. The recent increase in SBR among heterosexual men with low viral load may be related to increasing awareness of the 'treatment-as-prevention' concept. The lack of association between SBR and viral load among MSM supports use of treatment-as-prevention as part of diversified prevention strategies.
authors.affiliation: CESP-INSERM U1018, University Paris Sud 11, Epidemiology Service, AP-HP, Bicêtre Hospital,82 rue du Général Leclerc, Le Kremlin Bicêtre, France. remonie.seng@inserm.fr
authors.forename: Rémonie
authors.initials: R
authors.lastname: Seng
authors.forename: Matthieu
authors.initials: M
authors.lastname: Rolland
authors.forename: Geneviève
authors.initials: G
authors.lastname: Beck-Wirth
authors.forename: Faouzi
authors.initials: F
authors.lastname: Souala
authors.forename: Christiane
authors.initials: C
authors.lastname: Deveau
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Delfraissy
authors.forename: Cécile
authors.initials: C
authors.lastname: Goujard
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
mesh_terms: D000328:Adult; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology* / Q000635:transmission; D015497:HIV-1; D007722:Health Knowledge, Attitudes, Practice; D020010:Heterosexuality / Q000523:psychology* / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000523:psychology* / Q000706:statistics & numerical data; D019562:Viral Load