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Understanding the factors of heterosexual HIV-1 serodiscordant couples that lead to risky behaviors for HIV transmission are essential in controlling the HIV epidemic in sub-Saharan Africa. Predictors of HIV transmission within stable discordant couples and trends in family planning over time, as well as predictors of ART initiation provide important information for future studies and prevention and treatment program development. This dissertation evaluates these aspects of HIV-1 serodiscordant couple transmission in an ART naive 10-year observational cohort in Kigali, Rwanda. The first study evaluated the incident HIV-1 infections and the predictors of HIV-1 transmission in ART na?ve HIV-1 heterosexual serodiscordant couples. Eighty-three partner linked incident HIV-1 infections occurred in the cohort with 37 in women (IR=2.2/100 CY; 95%CI: 1.53.299) and 46 in men (IR=2.49/100 CY; 95%CI: 1.83-3.33). In the adjusted final model of linked HIV infection in females, baseline VL (aHR 2.33; 95%CI: 1.28-4.24), female genital inflammation (cHR 4.77; 95%CI: 1.72-13.21), and having unprotected sex with study partner since last visit (cHR 3.29; 95%CI: 1.27-8.51) were significant predictors. Predictors of linked incident HIV-1 infection in males included baseline VL (aHR 2.14; 95%CI: 1.50-3.07), female genital inflammation (aHR 3.91; 95%CI: 1.71-8.94), any unprotected sex with study partner since previous visit (aHR 3.56; 95%CI: 1.48-8.56), and presence of sperm on a wet prep (aHR 3.35; 95%CI: 0.99-11.36). These findings support the need to include sexual partners in the assessment of risk and target risk reduction strategies.The second study described pregnancy and analyzed predictors of women ever using hormonal contraception (HC) by HIV status. Overall pregnancy incidence rate was 12.7/100 PY (95%CI: 11.3-14.1) while in M-F+ couples it was 13.2/100 PY (95%CI: 11.3-15.3) and 12.1/100 PY (95%CI: 10.2-14.1) in M+F- couples. 34% of HIV positive women, 26% of HIV- women who did not seroconvert, and 25% of HIV- women who seroconverted had used hormonal contraception at point during the study. In adjusted analyses, being younger (aRR 0.97; 95%CI: 0.95-0.99), ability to read Kinyarwandan easily (aRR 1.28; 95%CI: 1.06-1.55), and no STI in the past year (aRR 0.80; 95%CI: 0.67-0.95) was associated with ever HC use in HIV+ women. Among HIV negative women who did not seroconvert, HC ever use was associated with younger age (aRR 0.98; 95%CI: 0.96-1.0) and not being pregnant at baseline (aRR 0.72; 95%CI: 0.55-0.94). Across HIV groups, injectable methods were the most frequently used type of hormonal contraception at last visit and during most of study follow-up. The overall low uptake of hormonal contraception and high pregnancy rates in both HIV + and HIV- women suggest the need for more effective and widely accessible safer conception methods. The third study evaluated predictors of time to ART initiation, stratified by gender of seropositive partner. Of the 1837 couples (882 M+F- / 955 M-F+), 30% had an HIV positive partner initiate ART. Of those, 39% had a seropositive male partner (M+F-) and 61% had a seropositive female partner (M-F+). Shorter time to ART initiation in M+F- couples was predicted by baseline viral load (aHR1.54; 95%CI:1.01-2.34), while both baseline viral load (aHR1.43; 95%CI:1.02-2.02) and baseline WHO stage IV (aHR 4.85; 95%CI:1.45-16.26) predicted earlier time to ART initiation in M-F+ couples. As expected, clinical values were the main predictors of time to ART initiation. In conclusion, partner and partnership characteristics play an important in risk of HIV-1 acquisition and transmission in heterosexual serodiscordant couples. Family planning and fertility desires are particularly complex and important risk factors that may change over time for serodiscordant couples. These findings can help improve the targeted HIV prevention, safer conception and family planning services, and ART treatment programs focusing on sustained viral load suppression among heterosexual serodiscordant couples in Africa.

Black gay, bisexual, and other Black sexual minority men (BSMM) continue to experience some of the largest sexual health disparities in the U.S. Engaging BSMM in PrEP is crucial to improving sexual health outcomes and reducing disparities. However, knowledge of the profiles of sexual risk and PrEP initiation among this group is limited.This study used latent class analysis to identify HIV risk and PrEP initiation patterns among BSMM in the HPTN 073 Study (n = 226). Guided by current Centers for Disease Control screening guidelines, latent class indicators included relationship status, condom use, number of sexual partners, substance use, sexually transmitted infection (STI) history, and partner HIV status. Age and PrEP initiation were used in a multinomial regression to identify correlates of class membership. Three latent classes were identified: Single, Condomless Partners, Single, Multiple Partners, and Serodiscordant Partners. Single, Condomless Partners had the highest conditional probabilities of having greater than three male partners, substance use before sex, and receiving an STI diagnosis. Serodiscordant Partners had a 100% conditional probability of condomless sex and having a male partner living with HIV. BSMM who initiated PrEP were less likely to be classified as Single, Condomless Partners than Serodiscordant Partners (AOR = 0.07, 95% CI = 0.02, 0.66). Findings support the need forculturally relevanttailored and targeted messaging for BSMM with multiple sexual risk indicators.

We assessed whether disclosure of HIV status is significantly associated with reported HIV sexual risk behaviors among HIV positive Black/African American men who have sex with men (MSM) (Black MSM) in six cities in the USA. Participants from the BROTHERS (HIV Prevention Trials Network [HPTN 061]) study focused on assessing the feasibility and acceptability of a multifaceted HIV prevention intervention to reduce HIV infections among Black MSM enrolled between July 2009 and October 2010. All participants completed a behavioral assessment using an audio computer-assisted self-interview that included questions about HIV status disclosure, HIV sexual risk behaviors, and other behaviors. Biological samples were also collected. This analysis focused on baseline data of HIV-positive Black MSM in the HPTN 061 study. Of the 143 HIV-positive Black MSM (majority ≥ 35years of age) included in this analysis, 58% reported disclosing their HIV status to their last male anal sex partner. Forty-three percent and 42% reported condomless insertive and receptive anal intercourse respectively with their last male partner; whereas, 17% and 18% of the sample engaged in condomless insertive and receptive anal intercourse with a serodiscordant/unknown status partner, respectively. In multivariable logistic regression models, there was no statistically significant association between HIV status disclosure and condomless insertive anal intercourse (aOR = 0.35, 95% CI 0.11, 1.08; p = 0.30), condomless receptive anal intercourse (aOR = 2.48, 95% CI 0.94, 6.52; p = 0.20), or condomless receptive anal intercourse with a serodiscordant/unknown status partner (aOR = 0.55, 95% CI 0.20, 1.49; p = 0.45). However, HIV status disclosure was significantly associated with lower odds of reporting condomless insertive anal intercourse with a serodiscordant/unknown status partner (aOR = 0.19, 95% CI 0.06, 0.68; p ≤ 0.01). Among this multi-city sample of HIV-positive Black MSM, disclosure of HIV status was common and associated with lower HIV sexual risk behaviors. These findings should motivate and guide research to develop prevention messages to increase HIV status disclosures.

Introduction Among gay, bisexual, and other men who have sex with men (GBM), collinearity between polysubstance use and mental health concerns has obscured their combined effects on HIV risk with multivariable results often highlighting only one or the other. Methods We used mediation and moderation analyses to examine the effects of polysubstance use and depressive symptoms on high-risk sex (i.e., condomless anal sex with serodiscordant/unknown status partner) in a sample of sexually-active GBM, aged ≥16 years, recruited in Metro Vancouver using respondent driven sampling. Hospital Anxiety and Depression Scale scores assessed mental health. Alcohol Use Disorder Identification Test scores assessed alcohol disorders. Poly-use of multiple drug types (e.g., stimulants, sedatives, opiates, hallucinogens) was assessed over the previous six months. Results Among 719 predominantly white (68.0%), gay-identified (80.7%) GBM, alcohol use was not associated with increased prevalence of high-risk sex. Controlling for demographic factors and partner number, an interaction between polysubstance use and depressive symptoms revealed that the combined effects were additively associated with increased odds for high-risk sex. Mediation models showed that polysubstance use partially mediated the relationship between depressive symptoms and high-risk sex. Conclusion An interaction effect between polysubstance use (defined by using 3 or more substances in the past six months) and depressive symptoms (defined by HADS scores) revealed that the combination of these factors was associated with increased risk for high-risk sex – supporting a syndemic understanding of the production of HIV risk.

The effect of an HIV diagnosis on subsequent behavior of men who have sex with men (MSM) remains unclear. From 2009 to 2012 the NIDA funded Metromates Study enrolled and followed for one year MSM seeking testing for HIV in Los Angeles, assessing those with new HIV diagnoses for acute/recent HIV infection. Behavioral data were collected via Computer-Assisted Self-Interview from 321 men of whom 125 were classified as recently HIV infected, 91 as not recently HIV infected, and 105 as HIV-negative. Differences over time between those with recent HIV infection, not recent HIV infection, and no HIV were evaluated using bivariate and multivariable analyses for repeat measures to assess associations between HIV group, behaviors and condomless receptive (CRAI), intersertive (CIAI), or any condomless anal intercourse (CAI). Participants were mostly young (59%

In this paper we evaluate the effects of heavy alcohol consumption on sexual behavior, HIV acquisition, and antiretroviral treatment (ART) initiation in a longitudinal open cohort of 1929 serodiscordant couples in Lusaka, Zambia from2002 to2012. We evaluated factors associated with baseline heavy alcohol consumption and its association with condomless sex with the study partner, sex outside of the partnership, and ART initiation using multivariable logistic regression. We estimated the effect of alcohol consumption on HIV acquisition using multivariable Cox models. Baseline factors significantly associated with women's heavy drinking (drunk weekly or more in 12-months before enrollment) included woman's older age (adjusted prevalence odds ratio [aPOR]=1.04), partner heavy drinking (aPOR=3.93), and being HIV-infected (aPOR=2.03). Heavy drinking among men was associated with less age disparity with partner (aPORper year disparity=0.97) and partner heavy drinking (aPOR=1.63). Men's being drunk daily (aOR=1.18), women's being drunk less than monthly (aOR=1.39) vs. never drunk and being in a male HIV-negative and female HIV-positive union (aOR=1.45) were associated with condomless sex. Heavy alcohol use was associated with having 1 or more outside sex partners among men (aOR drunk daily=1.91, drunk weekly=1.32, drunk monthly =2.03 vs. never), and women (aOR drunk monthly=2.75 vs. never). Being drunk weekly or more increased men's risk of HIV acquisition (adjusted hazard ratio [aHR]=1.72). Men and women being drunk weekly or more was associated (p&nbsp

Human immunodeficiency virus (HIV) antiretroviral therapy (ART) use results in substantial improvements in HIVrelated morbidity and mortality [1, 2] and leads to dramatic reductions in sexual transmission of HIV among heterosexual serodiscordant couples when ART suppresses HIV viremia in the infected partner [3]. Yet 6000 new HIV infections continue to occur daily across the globe. Use of oral antiretrovirals as chemoprophylaxis has substantial potency for HIV prevention among diverse populations [4–8]. However, effectiveness is highly dependent on consistent daily or neardaily product use. For women, even morerigorous adherence may be necessary to realize optimal protection [9], a finding borne out by complete abrogation of effectiveness when either oral or topical vaginal preparations are used infrequently [10, 11]. Long-acting injectable antiretroviral (ARV) preparations, ideally administered bimonthly or quarterly, have the potential to obviate the need for daily dosing, thereby improving adherence during exposure events, and, in theory, maximizing reductions in HIV infection incidence. In this issue of The Journal of Infectious Diseases, Walensky et al provide important additional context for the advent of long-acting injectable preexposure prophylaxis (PrEP). Although the medication costs after approval of these agents are unknown, the authors present a well-considered modeling exercise of the type we have come to expect from the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) group, demonstrating potential advantages and costs, as well as cost-effectiveness thresholds for the use of long-acting injectable PrEP for young South African women. This work builds on previous studies by the same authors that evaluated daily oral PrEP in a similar theoretical cohort [12]. The authors propose a base case rooted in an almost unthinkably high-incidence population, in which the cumulative lifetime probability of HIV acquisition is >60%. Initially, looking at use during the 18–25 years of age timeframe, the CEPAC model predicts substantial improvements in cumulative lifetime risk of HIV acquisition and life expectancy, compared with no PrEP, and an incremental improvement over standard daily oral PrEP. Similarly, the incidence of HIV infections and HIV-related deaths during the 5-year period of treatment are reduced incrementally, compared with standard PrEP. Both standard PrEP and long-acting PrEP are cost saving in this scenario, with long-acting PrEP costing an incremental $150 per year of life saved, compared with standard PrEP. Fascinatingly, despite initial higher up-front financial investment costs for programmatic scale-up, in the long-run (after approximately 30 years), long-acting PrEP actually is the most cost-saving intervention, driven by overall reduced HIV infection incidence and HIV treatment and care costs. It would be interesting to re-model the cost-effectiveness of standard PrEP and long-acting PrEP after considering the lifetime postseroconversion costs of ART implied by the new World Health Organization guidelines that recommend ART for all who are HIV infected, although such guidelines will likely only increase the cost efficiency of any HIV prevention intervention, including all PrEP modalities. Importantly, extensive sensitivity analyses demonstrate the robustness of the findings against the obligate assumptions intrinsic to working with mathematical models. As the overall population-level HIV incidence declines, long-acting PrEP is no longer cost saving; however, it is still very cost-effective as compared to standard PrEP(incremental cost-effectiveness ratio, $680 per year of life saved as the incidence halves from the base case). Interestingly, even longer use of long-acting PrEP (ie, past the age of 25 years) only incrementally increases costs but has impressive impact on reductions in the lifetime HIV risk, whereas shorter durations of use (eg, only to 19 years of age), while requiring less investment of capital, do not avert enough HIV infections to make that smaller investment cost-effective. This finding highlights the importance of a nuanced and thorough understanding of the acceptability and predictors of persistence to injectable PrEP required to optimize prevention benefits. In a sobering analysis, the authors note that, to achieve 50% coverage of high-risk young women in South Africa, it would cost $1.6 billion over 5 years. This signals the massive investment that would be required to deploy and scale-up injectable PrEP use, assuming that its safety and efficacy are demonstrated. This dollar Received and accepted 29 October 2015. Correspondence: R. J. Landovitz, UCLA Center for Clinical AIDS Research and Education, 11075 Santa Monica Blvd, Ste 100, Los Angeles, CA 90025 (rlandovitz@mednet.ucla.edu). The Journal of Infectious Diseases © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com. DOI: 10.1093/infdis/jiv524

Introduction : Antiretroviral therapy (ART) prevents HIV transmission within HIV serodiscordant couples (SDCs), but slow implementation and low uptake has limited its impact on population-level HIV incidence. Home HIV testing and counselling (HTC) campaigns could increase ART uptake among SDCs by incorporating couples’ testing and ART referral. We estimated the reduction in adult HIV incidence achieved by incorporating universal ART for SDCs into home HTC campaigns in KwaZulu-Natal (KZN), South Africa, and southwestern (SW) Uganda. Methods : We constructed dynamic, stochastic, agent-based network models for each region. We compared adult HIV incidence after 10 years under three scenarios: (1) “Current Practice,” (2) “Home HTC” with linkage to ART for eligible persons (CD4

Introduction : Since 2015, the World Health Organization recommends pre-exposure prophylaxis (PrEP) for all persons at substantial risk for HIV, including HIV-uninfected partners in serodiscordant relationships in resource-limited settings. As PrEP moves from clinical trials to real-world use, understanding facilitators of and barriers to PrEP initiation and adherence is critical to successful PrEP implementation and rollout. Methods : We conducted 44 in-depth individual or couple interviews with 63 participants (30 without HIV and 33 with HIV) enrolled in the Partners Demonstration Project in Kisumu, Kenya, between August and September 2014. The semi-structured interviews discussed the following: 1) perceived advantages and disadvantages of antiretroviral therapy (ART)/PrEP; 2) reasons for accepting or declining ART/PrEP and 3) influence of prevention of transmission to partner or infant on ART/PrEP use. Transcripts from the interviews were iteratively analyzed using inductive content analysis. Results : Our study identified three key factors that may facilitate initiation of PrEP in this population. First, participants using PrEP felt reduced stress and increased trust in their HIV serodiscordant relationships. Second, greater community-wide knowledge of PrEP was thought to likely increase PrEP acceptance. Third, greater education and counselling by providers on PrEP use was also considered to likely increase the adoption of PrEP. We also identified three key barriers to initiation of and adherence to PrEP. First, most participants who declined PrEP expressed doubts about the relative additional effectiveness of PrEP in combination with other prevention tools. Second, perceived stigma related to PrEP use was an important barrier to PrEP initiation. Third, many struggled with overcoming perceived side effects or logistical challenges of taking daily PrEP, particularly when they themselves were not ill. Conclusions : Leveraging the facilitators and overcoming barriers to PrEP uptake may enhance the successful rollout of PrEP among HIV serodiscordant couples in Kenya and other areas in sub-Saharan Africa, thereby reducing sexual transmission of HIV. Further research focused on how best to provide counselling on combination HIV prevention tools in the context of PrEP use is a crucial next step to delivering PrEP. Keywords: pre-exposure prophylaxis; barriers; facilitators; heterosexual; HIV serodiscordant couples; Kenya. (Published: 12 December 2016) Citation: Patel RC et al. Journal of the International AIDS Society 2016, 19 :21134 http://www.jiasociety.org/index.php/jias/article/view/21134 | http://dx.doi.org/10.7448/IAS.19.1.21134

Background International travel poses potential challenges to HIV prevention. A number of studies have observed an association between travel and behavioural disinhibition. In the present study, we assessed differences in sexual behaviour while travelling internationally and within the USA, compared with being in the home environment. Methods A probability-based sample of men who have sex with men (MSM) from the San Francisco Bay Area who had travelled internationally in the previous 12 months was recruited through an adapted respondent-driven sampling methodology (N=501). Participants completed interviewer-administered, computer-assisted surveys. Results Detailed partner-by-partner behavioural data by destination type were collected on 2925 sexual partnerships: 1028 while travelling internationally, 665 while travelling within the USA and 1232 while staying in the San Francisco Bay Area. The proportion of partnerships during international travel that involved unprotected anal intercourse (UAI) was lower compared with during domestic travel and staying locally. International travel was associated with decreased odds of receptive UAI (AOR=0.65, p=0.02) compared with staying locally and there was a trend towards decreased odds of insertive UAI (AOR=0.70, p=0.07). Conclusions MSM engaged in proportionately fewer sexual activities which present a high HIV transmission risk when travelling internationally, namely unprotected receptive and insertive anal intercourse and particularly with HIV serodiscordant partners. The lower sexual risk-taking during international travel was robust to controlling for many factors, including self-reported HIV serostatus, age, relationship status and type of partnership. These findings suggest that when travelling internationally, MSM may experience behavioural disinhibition to a lesser extent than had been described previously.

Background We aim to identify optimal strategies for deploying pre-exposure prophylaxis among men who have sex with men (MSM) in the United States and Peru to maximize population-level effectiveness in an efficient manner. We use epidemic models to simulate the impact of targeting strategies. Most studies have focused on targeting either the general population or high-risk MSM. Alternative strategies, including serodiscordant couples, may better balance effectiveness and efficiency. Methods We use dynamic stochastic sexual network models based on exponential-family random graph modeling, parameterized from behavioral surveys of MSM in the United States and Peru. These models represent main partnerships and casual contacts separately, permitting modeling of interventions targeting men whose risk derives from combinations of relational types. We also model varying rates of uptake and adherence to pre-exposure prophylaxis (PrEP). We assess sensitivity of results to risk compensation through increases in condomless casual contacts and condomless sex in main partnerships. Results Targeting all men who are not exclusively insertive has the largest impact on HIV incidence, but targeting only those with high levels of casual activity yields comparable results using fewer person-years on PrEP. The effect is robust to risk compensation in the United States, but less so in Peru. Targeting serodiscordant main partnerships does not significantly impact incidence, but requires fewer person-years on PrEP per infection averted than other strategies. Conclusions PrEP could be effective in reducing new infections at the population level in both settings. Serodiscordant partnerships are an attractive component of a targeting program, but targeting should include other high-risk men.

Author(s): Pilcher, Christopher D; Bisol, Claudia Alquati; Paganella, Machline Paim; Vallabhaneni, Snigdha; da Motta, Leonardo Rapone; Kato, Sergio Kakuta; Sperhacke, Rosa Dea; Kallas, Esper G; Hecht, Frederick M; Diaz, Ricardo Sobhie | Abstract: ObjectiveTo examine the feasibility of identifying HIV negative at risk individuals in HIV serodiscordant couples, during voluntary HIV testing in South Brazil.MethodsWe surveyed HIV testers at 4 public testing sites in Rio Grande do Sul. We obtained information on risk behaviors and sexual partnerships. HIV testing and testing for recent infection were performed; HIV prevalence and risk behaviors were assessed among subjects who reported having a steady partner who was HIV positive (serodiscordant group) and compared with the general testing population.ResultsAmong 3100 patients, 490 (15.8%) reported being in a steady relationship with an HIV positive partner. New HIV infections were diagnosed in 23% of the serodiscordant group (vs. 13% in the general population, p = 0.01); among newly positive subjects, recent HIV infections were more frequent (23/86, 26.7%) among testers with positive partners than among the general testing group (52/334; 15.6%; p = 0.016). Less than half of the serodiscordant testers reported having used a condom during the last sexual intercourse with their HIV-positive partner. Participants with inconsistent condom use with steady partner were four times more likely to test positive for HIV compared to those who reported always using condoms with the steady partner (OR: 4.2; 95% CI: 2.3 to 7.5).ConclusionIt is highly feasible to identify large numbers of HIV susceptible individuals who are in HIV serodiscordant relationships in South Brazil testing sites. Condom use within HIV serodiscordant couples is low in this setting, suggesting urgent need for biomedical prevention strategies to reduce HIV transmission.

Author(s): Gorbach, Pamina M; Pines, Heather; Javanbakht, Marjan; Weiss, Robert E; Jeffries, Robin; Cranston, Ross D; Fuchs, Edward J; Hezerah, Marjan; Brown, Stephen; Voskanian, Alen; Anton, Peter | Abstract: BackgroundFor women, the order of penile insertion, condom use, and ejaculation by orifice during sexual events affects the probability of HIV transmission and design of HIV prevention methods.MethodsFrom October 2006 to June 2009, 431 women in Los Angeles and Baltimore in a rectal health study reported the sequence of penile insertion, condom use, and ejaculation by orifice location by computer-assisted self-interview. Multinomial logistic regression identified predictors of condom use by orifice among women who reported vaginal intercourse (VI) during their last anal intercourse (AI) event.ResultsOf the 192 reporting on a last AI event, 96.3% (180/187) reported VI. Of these, 83.1% had VI before AI. Including the 36% who ejaculated in both the rectum and vagina, 66% report any ejaculation in the vagina and 45% in the rectum. One-third used a condom for both VI and AI, l10% for VI only or AI only, and half used no condoms. After adjusting for race, partner type, and substance use, compared with women who used condoms for both VI and AI at last AI, being older (units = 5 years) [adjusted odds ratio (AOR) = 0.76; 95% confidence interval (CI): 0.60 to 0.96], with serodiscordant partners (AOR = 0.22; 95% CI: 0.08 to 0.61), and HIV-positive with seroconcordant partners (AOR = 0.15; 95% CI: 0.04 to 0.54) were associated with not using condoms.ConclusionsFor most of the women in our study VI accompanied AI, with AI usually occurring after VI. This evidence for use of multiple orifices during the same sexual encounter and low use of condoms across orifices supports the need for a multicompartment HIV prevention strategy.

The objective of this mixed methods study was to examine current sexual risk behaviors, acceptability and potential adoption of pre-exposure prophylaxis (PrEP) for HIV prevention, and sexual behavior intentions with PrEP adoption among HIV-negative gay and bisexual men (GBM) in HIV serodiscordant relationships. A multiracial/ethnic sample of 25 HIV-negative GBM in serodiscordant relationships completed a qualitative interview and a brief interviewer-administered survey. A modified grounded theory approach was used to identify key themes relating to acceptability and future adoption of PrEP. Participants reported engaging in sexual risk behaviors that place them at risk for HIV infection. Participants also reported a high level of acceptability for PrEP and willingness to adopt PrEP for HIV prevention. Qualitative themes explaining future PrEP adoption included: (1) the opportunity to engage in sex using a noncondom HIV prevention method, (2) protection from HIV infection, and (3) less anxiety when engaging in sex with an HIV-positive partner. Associated with the future adoption of PrEP, a majority (64%) of participants indicated the likelihood for an increase in sexual risk behaviors and a majority (60%) of participants also indicated the likelihood for a decrease or abandonment of condom use, both of which are in contrast to the findings from the large iPrEx study. These findings suggest that the use of PrEP by HIV-negative GBM in serodiscordant relationships carries with it the potential for risk compensation. The findings suggest that PrEP only be offered as part of a comprehensive HIV prevention strategy that includes ongoing risk reduction counseling in the delivery of PrEP to help moderate risk compensation. © Mary Ann Liebert, Inc.

The purpose of this study was to identify factors that may facilitate or impede future adoption of preexposure prophylaxis (PrEP) for HIV prevention among gay and bisexual men in HIV-serodiscordant relationships. This qualitative study utilized semistructured interviews conducted with a multiracial/-ethnic sample of 25 gay and bisexual HIV-serodiscordant male couples (n=50 individuals) recruited from community settings in Los Angeles, CA. A modified grounded theory approach was employed to identify major themes relating to future adoption of PrEP for HIV prevention. Motivators for adoption included protection against HIV infection, less concern and fear regarding HIV transmission, the opportunity to engage in unprotected sex, and endorsements of PrEP's effectiveness. Concerns and barriers to adoption included the cost of PrEP, short- and long-term side effects, adverse effects of intermittent use or discontinuing PrEP, and accessibility of PrEP. The findings suggest the need for a carefully planned implementation program along with educational and counseling interventions in the dissemination of an effective PrEP agent. © 2011 Taylor & Francis.

Introduction Stable heterosexual HIV-1 serodiscordant couples in Africa have high HIV-1 transmission rates and are a critical population for evaluation of new HIV-1 prevention strategies. The Partners PrEP Study is a randomized, double-blind, placebo-controlled trial of tenofovir and emtricitabine-tenofovir pre-exposure prophylaxis to decrease HIV-1 acquisition within heterosexual HIV-1 serodiscordant couples. We describe the trial design and characteristics of the study cohort. Methods HIV-1 serodiscordant couples, in which the HIV-1 infected partner did not meet national guidelines for initiation of antiretroviral therapy, were enrolled at 9 research sites in Kenya and Uganda. The HIV-1 susceptible partner was randomized to daily oral tenofovir, emtricitabine-tenofovir, or matching placebo with monthly follow-up for 24–36 months. Results From July 2008 to November 2010, 7920 HIV-1 serodiscordant couples were screened and 4758 enrolled. For 62% (2966/4758) of enrolled couples, the HIV-1 susceptible partner was male. Median age was 33 years for HIV-1 susceptible and HIV-1 infected partners [IQR (28–40) and (26–39) respectively]. Most couples (98%) were married, with a median duration of partnership of 7.0 years (IQR 3.0–14.0) and recent knowledge of their serodiscordant status [median 0.4 years (IQR 0.1–2.0)]. During the month prior to enrollment, couples reported a median of 4 sex acts (IQR 2–8); 27% reported unprotected sex and 14% of male and 1% of female HIV-1 susceptible partners reported sex with outside partners. Among HIV-1 infected partners, the median plasma HIV-1 level was 3.94 log10 copies/mL (IQR 3.31–4.53) and median CD4 count was 496 cells/µL (IQR 375–662); the majority (64%) had WHO stage 1 HIV-1 disease. Conclusions Couples at high risk of HIV-1 transmission were rapidly recruited into the Partners PrEP Study, the largest efficacy trial of oral PrEP. (ClinicalTrials.gov NCT00557245)

This study reports the prevalence of child (CSA) and adult (ASA) sexual abuse among 535 African American HIV serodiscordant couples from four major United State cities, and its relationship to personal and couple related vulnerabilities and HIV risk factors. As part of a randomized, clinical trial, CSA and ASA histories were obtained through face-to-face interviews. Results indicate that HIV positive women were significantly more likely to report one kind of abuse (32.32%), either before or since age 18 or both (32.6%). HIV-positive men (34.9%) were significantly more likely to report CSA than HIV-negative men (22.0%). Overall, 72% of couples reported that one or both had CSA histories. These findings underscore the heightened emotional vulnerability, and STI and HIV transmission risk taking practices, associated with sexual abuse. Sexual abuse histories among couples should be assessed to better understand how these histories may contribute to couples dynamics and risk-taking practices.