Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan.
J Adolesc Health. 2020 Jul;67(1):61-68. doi: 10.1016/j.jadohealth.2020.01.008. Epub 2020 Mar 10.
HIV treatment as prevention is effective for reducing the risk of HIV transmission and the messaging campaign, undetectable = untransmittable, is gaining recognition. As youth living with HIV (YLWH) who have condomless sex may acquire and potentially transmit other sexually transmitted infections (STIs), the purpose of this study was to assess potential differences in transmission risk of HIV and other STIs among YLWH to inform subsequent HIV and STI prevention efforts.
A cohort of 600 HIV behaviorally infected youth aged 13-24 years who were engaged in medical care completed an audio computer-assisted self-interview including questions about demographics, HIV disclosure, mental health, substance use, and sexual behaviors and beliefs. HIV viral loads and the presence of other STIs were abstracted from medical records. A viral load <200 copies/mL was considered undetectable. Univariate and bivariate analyses were conducted to examine differences by viral load and STIs.
Participants were categorized into four groups: (1) undetectable without STIs (55.2%); (2) undetectable with STIs (14.2%); (3) detectable without STIs (22.8%); and (4) detectable with STIs (7.8%). In comparison to the other three groups, youth in the undetectable group with STIs reported more favorable sexual risk reduction attitudes and beliefs, internet use for finding sex partners, anal sex with male partners, and condomless anal sex with male partners.
YLWH with undetectable viral loads and other STIs engaged in higher risk behaviors. To realize the promise of the messaging campaign, undetectable = untransmittable, efforts must focus on sustained viral suppression and prevention of STIs among YLWH.
艾滋病毒治疗即预防措施对于降低艾滋病毒传播风险是有效的，且“检测不到即无法传播”的宣传活动正得到越来越多的认可。由于感染艾滋病毒的青年（YLWH）如果发生无保护措施的性行为，可能会感染并潜在传播其他性传播感染（STIs），本研究旨在评估 YLWH 中 HIV 和其他 STIs 的传播风险的潜在差异，以为后续的 HIV 和 STI 预防工作提供信息。
本队列纳入了 600 名年龄在 13-24 岁、因行为感染 HIV 而接受医疗护理的青年，他们完成了一份包含人口统计学、HIV 披露、心理健康、物质使用以及性行为和信念等问题的音频计算机辅助自我访谈。HIV 病毒载量和其他 STIs 的存在情况从病历中提取。采用单变量和双变量分析来检查病毒载量和 STIs 之间的差异。
参与者被分为四组：（1）无 STIs 且病毒载量检测不到（55.2%）；（2）有 STIs 但病毒载量检测不到（14.2%）；（3）无 STIs 但病毒载量可检测到（22.8%）；（4）有 STIs 且病毒载量可检测到（7.8%）。与其他三组相比，有 STIs 但病毒载量检测不到的青年报告了更有利的性行为减少风险的态度和信念，使用互联网寻找性伴侣、与男性发生肛交以及与男性发生无保护措施的肛交。
病毒载量检测不到但有其他 STIs 的 YLWH 发生了更高风险的行为。为了实现“检测不到即无法传播”宣传活动的承诺，必须努力实现 YLWH 中持续的病毒抑制和 STI 预防。
