Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Clin Infect Dis. 2010 Dec 1;51(11):1314-22. doi: 10.1086/656809. Epub 2010 Oct 29.
Access to antiretroviral therapy may have changed condom use behavior. In January 2008, recommendations on condom use for human immunodeficiency virus (HIV)-positive persons were published in Switzerland, which allowed for unprotected sex under well-defined circumstances ("Swiss statement"). We studied the frequency, changes over time, and determinants of unprotected sex among HIV-positive persons.
Self-reported information on sexual preference, sexual partners, and condom use was collected at semi-annual visits in all participants of the prospective Swiss HIV Cohort Study from April 2007 through March 2009. Multivariable logistic regression models were fit using generalized estimating equations to investigate associations between characteristics of cohort participants and condom use.
A total of 7309 participants contributed to 21,978 visits. A total of 4291 persons (80%) reported sexual contacts with stable partners, 1646 (30%) with occasional partners, and 557 (10%) with stable and occasional partners. Of the study participants, 5838 (79.9%) of 7309 were receiving antiretroviral therapy, and of these, 4816 patients (82%) had a suppressed viral load. Condom use varied widely and differed by type of partner (visits with stable partners, 10,368 [80%] of 12,983; visits with occasional partners, 4300 [88%] of 4880) and by serostatus of stable partner (visits with HIV-negative partners, 7105 [89%] of 8174; visits with HIV-positive partners, 1453 [48%] of 2999). Participants were more likely to report unprotected sex with stable partners if they were receiving antiretroviral therapy, if HIV replication was suppressed, and after the publication of the "Swiss statement." Noninjection drug use and moderate or severe alcohol use were associated with unprotected sex.
Antiretroviral treatment and plasma HIV RNA titers influence sexual behavior of HIV-positive persons. Noninjection illicit drug and alcohol use are important risk factors for unprotected sexual contacts.
获得抗逆转录病毒疗法可能改变了 condom 的使用行为。2008 年 1 月，瑞士发表了关于人类免疫缺陷病毒（HIV）阳性者 condom 使用的建议，在明确规定的情况下允许无保护性行为（“瑞士声明”）。我们研究了 HIV 阳性者无保护性行为的频率、随时间的变化及其决定因素。
2007 年 4 月至 2009 年 3 月期间，前瞻性瑞士 HIV 队列研究的所有参与者每半年进行一次随访，收集性偏好、性伴侣和 condom 使用情况的自我报告信息。使用广义估计方程拟合多变量逻辑回归模型，以调查队列参与者的特征与 condom 使用之间的关联。
共有 7309 名参与者贡献了 21978 次访问。共有 4291 人（80%）报告与稳定伴侣有性接触，1646 人（30%）与偶尔伴侣有性接触，557 人（10%）与稳定和偶尔伴侣有性接触。在研究参与者中，7309 人中共有 5838 人（79.9%）正在接受抗逆转录病毒治疗，其中 4816 名患者（82%）病毒载量得到抑制。 condom 的使用情况差异很大，且因伴侣类型而异（与稳定伴侣发生的性行为，12983 次中有 10368 次[80%]；与偶尔伴侣发生的性行为，4880 次中有 4300 次[88%]），也因稳定伴侣的血清学状况而异（与 HIV 阴性伴侣发生的性行为，8174 次中有 7105 次[89%]；与 HIV 阳性伴侣发生的性行为，2999 次中有 1453 次[48%]）。参与者如果正在接受抗逆转录病毒治疗、HIV 复制得到抑制，以及在“瑞士声明”发表后，更有可能报告与稳定伴侣发生无保护性行为。非注射药物使用和中度或重度饮酒与无保护性行为有关。
抗逆转录病毒治疗和血浆 HIV RNA 滴度影响 HIV 阳性者的性行为。非注射类非法药物和酒精的使用是无保护性行为的重要危险因素。
