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Condomless Sex Among Virally Suppressed Women With HIV With Regular HIV-Serodiscordant Sexual Partners in the Era of Treatment as Prevention

Patterson, Sophie MBChB, PhD*,†; Carter, Allison MPH*,†; Nicholson, Valerie*; Webster, Kath*; Ding, Erin MSc; Kestler, Mary MD‡,§; Ogilvie, Gina MD, PhD‡,§; de Pokomandy, Alexandra MSc, MD‖,¶; Loutfy, Mona MD, MPH#,**; Kaida, Angela MSc, PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1, 2017 - Volume 76 - Issue 4 - p 372–381
doi: 10.1097/QAI.0000000000001528

Background: Sexual HIV transmission does not occur with sustained undetectable viral load (VL) on antiretroviral therapy (ART). Awareness of ART prevention benefits and its influence on condom use among women with HIV (WWH) remain unexplored. We estimated prevalence and correlates of condomless sex with regular HIV-serodiscordant partners among WWH with undetectable VL on ART.

Methods: We used baseline questionnaire data from the community-based longitudinal Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). We included WWH self-reporting vaginal/anal sex with ≥1 HIV-negative/unknown status regular partner within 6 months, and undetectable VL (<50 copies/mL) on ART. We excluded participants exclusively reporting female partners or missing condom-use data. Condomless sex was defined as <100% condom use within 6 months. The primary explanatory variable was awareness of ART prevention benefits. Logistic regression identified factors independently associated with condomless sex.

Results: Of 271 participants (19% of the CHIWOS cohort), median age was 41 (interquartile range: 34–47), 51% were in a relationship, 55% reported condomless sex, and 75% were aware of ART prevention benefits. Among women aware, 63% reported condomless sex compared with 32% of women not aware (P < 0.001). Factors independently associated with condomless sex included being aware of ART prevention benefits (adjusted odds ratio: 4.08; 95% confidence interval: 2.04 to 8.16), white ethnicity, ≥high-school education, residing in British Columbia, and being in a relationship.

Conclusions: Virally suppressed women aware of ART prevention benefits had 4-fold greater odds of condomless sex. Advancing safer sex discussions beyond condoms is critical to support women in regular serodiscordant partnerships to realize options for safe and satisfying sexuality in the Treatment-as-Prevention era.

*Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada;

Department of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada;

Oak Tree Clinic, British Columbia Women's Hospital and Healthcare Centre, Vancouver, British Columbia, Canada;

§Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada;

Chronic Viral Illness Service, McGill University Health Centre, Montreal, Québec, Canada;

Department of Family Medicine, McGill University, Montreal, Québec, Canada;

#Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; and

**Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Correspondence to: Angela Kaida, MSc, PhD, Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC V5A 1S6, Canada (e-mail:

CHIWOS is funded by the Canadian Institutes of Health Research (CIHR), the CIHR Canadian HIV Trials Network (CTN 262), the Ontario HIV Treatment Network (OHTN), and the Academic Health Science Centres (AHSC) Alternative Funding Plans (AFP) Innovation Fund. S.P. received support in the form of a Study Abroad Studentship from the Leverhulme Trust, A.C. received support from a CIHR Doctoral Award, A.d.P. received salary support through the Fonds de Recherche du Quebéc—Santé (FRQS) (Chercheur-boursier clinicien), and A.K. received salary support through a Tier 2 Canada Research Chair in Global HIV and Sexual and Reproductive Health.

Presented at 25th Annual Canadian Conference on HIV/AIDS Research; May 13, 2016; Winnipeg, Manitoba, Canada as an oral presentation.

The authors have no conflicts of interest to disclose.

S.P., A.C., and A.K. conceived the idea for this analysis. A.K., A.d.P., and M.L. contributed to design and acquisition of data. Data preparation and statistical analysis were conducted by E.D. Data interpretation was performed by S.P., E.D., and A.K. S.P. drafted the initial manuscript under the supervision of A.K., and all authors contributed to the final version. All authors have critically reviewed and approved the final manuscript, gave approval for publication and act as guarantors of the work.

The CHIWOS Research Team members are listed in Appendix 1.

Received April 13, 2017

Accepted July 21, 2017

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