Sexual risk behaviors among heterosexual HIV serodiscordant couples in theera of post-exposure prevention and viral suppressive therapy

Objectives: To describe awareness and use of antiretroviral treatments, vir al load monitoring, and post-exposure prevention; to assess changing concer ns about HIV transmission; and to examine the effect of these advances on s exual behavior in HIV-serodiscordant heterosexual couples. Methods: Cross-sectional analysis of a baseline sample of 104 couples (n = 208 individuals) from the California Partners Study II, an intervention tri al for HIV-serodiscordant couples in California. Questions on sexual practi ces, viral load testing, HIV treatment, post-exposure prevention, and their effect on sexual behaviors, risk taking and transmission concerns were mea sured at intake. Results: Over two-thirds of couple members surveyed reported unprotected se x with their partner in the past 6 months. Among seropositive respondents, 37% were taking protease inhibitor therapy, 92% had undergone viral load te sting, and of those, 40% said it had ben undetectable at their most recent test. Most respondents, regardless of serostatus, said that viral load test ing and awareness of post-exposure prevention had no effect on their condom use. In addition, perceiving that their partner had an undetectable viral load was associated with having protected sex among seronegative subjects ( P < 0.05). Seropositive respondent taking protease inhibitors were 2.4 time s less likely to report unprotected sex compared with those not taking prot ease inhibitors (P = 0.05). However, up to 33% of seropositive and 40% of s eronegative respondents acknowledged decreased transmission concerns in the light of the new HIV treatments. In comparison with their seropositive par tners, seronegative individuals were more likely to acknowledge increased r isk taking and decreased HIV transmission concerns (P < 0.05). Conclusions: New medical advances were not associated with unprotected sex in HIV-serodiscordant couples. However, new treatment options may decrease concerns about HIV transmission, particularly among seronegative partners. Providers should discuss the effect of antiretroviral treatments on sexual transmission risk with theirpatients. The inclusion of seronegative partner s in counseling interventions may decrease risk taking in serodiscordant co uples. (C) 2000 Lippincott Williams & Wilkins.