title: Sexual risk behaviour among people living with HIV according to the biomedical risk of transmission: results from the ANRS-VESPA2 survey.
abstract: BACKGROUND
  People living with HIV (PLHIV) on antiretroviral therapy (ART), with sustained undetectable viral load (sUVL) and no history of sexually transmitted infections for at least six months, are considered to have a low risk of HIV transmission (LRT). We aimed to characterize, in a representative sample of French PLHIV, the sexual behaviour of LRT PLHIV compared with non-LRT PLHIV.
  
  
  METHODS
  The cross-sectional ANRS-VESPA2 survey was conducted on adult PLHIV attending French hospitals in 2011. The LRT PLHIV group included participants with sUVL and no sexually transmitted infection for at least 12 months. Socio-behavioural and medical data were collected. Chi-square tests helped compare sexual risk indicators between LRT and non-LRT PLHIV. The survey's retrospective nature allowed us to perform complementary category-based analyses of LRT PLHIV according to whether they had sUVL for at least 18, 24 or 36 months in three socio-epidemiological groups: men who have sex with men (MSM), other men and women.
  
  
  RESULTS
  Analysis included 2638 PLHIV diagnosed > 12 months with available viral load data. The proportion of LRT PLHIV varied from 58% (≥ 12 months sUVL) to 38% (≥ 36 months sUVL). Irrespective of sUVL duration, we found the following: 1) LRT men (MSM and other men) were more likely to report having no sexual partner than their non-LRT counterparts. Among men having sexual partners in the previous 12 months, no significant difference was seen between LRT and non-LRT men in the number of sexual partners. LRT women were less likely to report having more than one sexual partner than non-LRT women; 2) LRT MSM were more likely to report being in sexually inactive couples than their non-LRT counterparts; 3) among sexually active participants, no difference was observed between LRT and non-LRT PLHIV concerning condom use with their serodiscordant steady partner or with their most recent casual sexual partners.
  
  
  CONCLUSIONS
  LRT PLHIV with sUVL ≥ 12 months did not report more sexual risk behaviours than their non-LRT counterparts. Because the same result was obtained for those having a sUVL ≥ 36 months, the hypothesis of increased sexual risk behaviour over time in PLHIV meeting non-transmission biomedical criteria is not supported.
authors.affiliation: INSERM, UMR 912 (SESSTIM), Marseille, France.|Aix Marseille Université, UMR_912, IRD, Marseille, France.|Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France; marie.suzan@inserm.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Suzan-Monti
authors.affiliation: INSERM, UMR 912 (SESSTIM), Marseille, France.|Aix Marseille Université, UMR_912, IRD, Marseille, France.|Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lorente
authors.affiliation: INSERM, UMR 912 (SESSTIM), Marseille, France.|Aix Marseille Université, UMR_912, IRD, Marseille, France.|Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Demoulin
authors.affiliation: INSERM, UMR 912 (SESSTIM), Marseille, France.|Aix Marseille Université, UMR_912, IRD, Marseille, France.|Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Marcellin
authors.affiliation: Groupe de Recherche en Psychologie Sociale, Université Lyon 2, Lyon, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Préau
authors.affiliation: INSERM, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Research Team in Social Epidemiology, Paris, France.|Sorbonne Universités, UPMC Univ Paris 06, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Research Team in Social Epidemiology, Paris, France.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dray-Spira
authors.affiliation: Centre de recherche en épidémiologie et santé des populations, INSERM U1018, Villejuif, France.
authors.forename: France
authors.initials: F
authors.lastname: Lert
authors.affiliation: INSERM, UMR 912 (SESSTIM), Marseille, France.|Aix Marseille Université, UMR_912, IRD, Marseille, France.|Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology / Q000635:transmission*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000209:etiology / Q000517:prevention & control
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; biomedical risk of HIV transmission; sexual risk behaviour; successful ART