Biomarker-Based HIV Incidence in a Community Sample of Men Who Have Sex with Men in Paris, France

BACKGROUND: Population-based estimates of HIV incidence in France have revealed that men who have sex with men (MSM) are the most affected population and contribute to nearly half of new infections each year. We sought to estimate HIV incidence among sexually active MSM in Paris gay community social venues. METHODOLOGY/ PRINCIPAL FINDINGS: A cross-sectional survey was conducted in 2009 in a sample of commercial venues such as bars, saunas and backrooms. We collected a behavioural questionnaire and blood sample. Specimens were tested for HIV infection and positive specimens then tested for recent infection by the enzyme immunoassay for recent HIV-1 infection (EIA-RI). We assessed the presence of antiretroviral therapy among infected individuals to rule out treated patients in the algorithm that determined recent infection. Biomarker-based cross-sectional incidence estimates were calculated. We enrolled 886 MSM participants among which 157 (18%) tested HIV positive. In positive individuals who knew they were infected, 75% of EIA-RI positive results were due to ART. Of 157 HIV positive specimens, 15 were deemed to be recently infected. The overall HIV incidence was estimated at 3.8% person-years (py) [95%CI: 1.5-6.2]. Although differences were not significant, incidence was estimated to be 3.5% py [0.1-6.1] in men having had a negative HIV test in previous year and 4.8% py [0.1-10.6] in men having had their last HIV test more than one year before the survey, or never tested. Incidence was estimated at 4.1% py [0-8.3] in men under 35 years and 2.5% py [0-5.4] in older men. CONCLUSIONS/ SIGNIFICANCE: This is the first community-based survey to estimate HIV incidence among MSM in France. It includes ART detection and reveals a high level of HIV transmission in sexually active individuals, despite a high uptake of HIV testing. These data call for effective prevention programs targeting MSM engaged in high-risk behaviours

What is the empirical basis for converting banded ordinal data on numbers of sex partners among MSM into a continuous scale level variable? A secondary analysis of 13 surveys across 17 countries

BACKGROUND: To provide empirically based guidance for substituting partner number categories in large MSM surveys with mean numbers of sexual and condomless anal intercourse (CAI) partners in a secondary analysis of survey data. METHODS: We collated data on numbers of sexual and CAI partners reported in a continuous scale (write-in number) in thirteen MSM surveys on sexual health and behaviour across 17 countries. Pooled descriptive statistics for the number of sexual and CAI partners during the last twelve (N = 55,180) and 6 months (N = 31,759) were calculated for two sets of categories commonly used in reporting numbers of sexual partners in sexual behaviour surveys. RESULTS: The pooled mean number of partners in the previous 12 months for the total sample was 15.8 partners (SD = 36.6), while the median number of partners was 5 (IQR = 2-15). Means for number of partners in the previous 12 months for the first set of categories were: 16.4 for 11-20 partners (SD = 3.3); 27.8 for 21-30 (SD = 2.8); 38.6 for 31-40 (SD = 2.4); 49.6 for 41-50 (SD = 1.5); and 128.2 for 'more than 50' (SD = 98.1). Alternative upper cut-offs: 43.4 for 'more than 10' (SD = 57.7); 65.3 for 'more than 20' (SD = 70.3). Self-reported partner numbers for both time frames consistently exceeded 200 or 300. While there was substantial variation of overall means across surveys, the means for all chosen categories were very similar. Partner numbers above nine mainly clustered at multiples of tens, regardless of the selected time frame. The overall means for CAI partners were lower than those for sexual partners; however, such difference was completely absent from all categories beyond ten sexual and CAI partners. CONCLUSIONS: Clustering of reported partner numbers confirm common MSM sexual behaviour surveys' questionnaire piloting feedback indicating that responses to numbers of sexual partners beyond 10 are best guesses rather than precise counts, but large partner numbers above typical upper cut-offs are common

What is the empirical basis for converting banded ordinal data on numbers of sex partners among MSM into a continuous scale level variable? A secondary analysis of 13 surveys across 17 countries

BACKGROUND: To provide empirically based guidance for substituting partner number categories in large MSM surveys with mean numbers of sexual and condomless anal intercourse (CAI) partners in a secondary analysis of survey data. METHODS: We collated data on numbers of sexual and CAI partners reported in a continuous scale (write-in number) in thirteen MSM surveys on sexual health and behaviour across 17 countries. Pooled descriptive statistics for the number of sexual and CAI partners during the last twelve (N = 55,180) and 6 months (N = 31,759) were calculated for two sets of categories commonly used in reporting numbers of sexual partners in sexual behaviour surveys. RESULTS: The pooled mean number of partners in the previous 12 months for the total sample was 15.8 partners (SD = 36.6), while the median number of partners was 5 (IQR = 2-15). Means for number of partners in the previous 12 months for the first set of categories were: 16.4 for 11-20 partners (SD = 3.3); 27.8 for 21-30 (SD = 2.8); 38.6 for 31-40 (SD = 2.4); 49.6 for 41-50 (SD = 1.5); and 128.2 for 'more than 50' (SD = 98.1). Alternative upper cut-offs: 43.4 for 'more than 10' (SD = 57.7); 65.3 for 'more than 20' (SD = 70.3). Self-reported partner numbers for both time frames consistently exceeded 200 or 300. While there was substantial variation of overall means across surveys, the means for all chosen categories were very similar. Partner numbers above nine mainly clustered at multiples of tens, regardless of the selected time frame. The overall means for CAI partners were lower than those for sexual partners; however, such difference was completely absent from all categories beyond ten sexual and CAI partners. CONCLUSIONS: Clustering of reported partner numbers confirm common MSM sexual behaviour surveys' questionnaire piloting feedback indicating that responses to numbers of sexual partners beyond 10 are best guesses rather than precise counts, but large partner numbers above typical upper cut-offs are common

High clustering of acute HCV infections and high rate of associated STIs among Parisian HIV-positive male patients.

BACKGROUND: Increasing incidence of hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-positive men having sex with men (MSM) has been described in recent years. Phylogenetic analyses of acute HCV infections were undertaken to characterize the dynamics during the epidemic in Paris, and associated sexually transmitted infections (STIs) were evaluated. METHODS: Sanger sequencing of polymerase gene was performed. Maximum likelihood phylogenies were reconstructed using FastTree 2.1 under a GTR+CAT model. Transmission chains were defined as clades with a branch probability ≥0.80 and intraclade genetic distances <0.02 nucleotide substitutions per sites. STIs detected ≤1 month before HCV diagnosis were considered. RESULTS: Among the 85 studied patients, at least 81.2% were MSM. Respectively, 47.6%, 39.0%, 11.0% and 2.4% were infected with genotypes 1a, 4d, 3a and 2k. At least 91.8% were co-infected with HIV. HCV re-infection was evidenced for 24.7% of patients and STIs for 20.0% of patients. Twenty-two transmission chains were identified, including 52 acute hepatitis C (11 pairs and 11 clusters from three to seven patients). CONCLUSIONS: These results revealed strong clustering of acute HCV infections. Thus, rapid treatment of both chronic and acute infections is needed among this population to decrease the prevalence of HCV, in combination with preventive behavioural interventions

Social and behavioural determinants of syphilis: Modelling based on repeated cross-sectional surveys from 2010 and 2017 among 278,256 men who have sex with men in 31 European countries.

Background: Syphilis case notifications among men-who-have-sex-with-men (MSM) have increased markedly over the past two decades in Europe. We tested several potential factors for this resurgence. Methods: Self-reported data from two cross-sectional waves of the European MSM Internet Survey (EMIS-2010 and EMIS-2017, N = 278,256 participants living in 31 European countries) were used to fit multivariable hierarchical logistic regression models designed to evaluate potential social, behavioural, and interventional determinants of syphilis diagnosis. Additional multivariable hierarchical negative binomial models investigated determinants of the number of non-steady male condomless anal intercourse (CAI) partners. We tested the hypothesis that more CAI and syphilis-screening are associated with syphilis resurgence, both linked to use of pre-exposure prophylaxis (PrEP). Findings: Between 2010 and 2017, incidence of syphilis diagnosis in the previous 12 months rose from 2.33% (95%CI: 2.26-2.40) of respondents reporting a syphilis diagnosis in 2010 compared with 4.54% (95%CI: 4.42-4.66) in 2017. Major factors contributing to syphilis diagnosis were living with diagnosed HIV (adjusted odds ratio (aOR) 2.67, 95%CI: 2.32-3.07), each additional non-steady male CAI partner (aOR 1.01, 95%CI: 1.01-1.01), recency of STI-screening (previous month vs no screening, aOR 25.76, 95%CI: 18.23-36.41), selling sex (aOR 1.45, 95%CI: 1.27-1.65), and PrEP use (aOR 3.02, 95%CI: 2.30-3.96). Living with diagnosed HIV (adjusted incidence rate ratio (aIRR) 3.91, 95%CI: 3.77-4.05), selling sex (aIRR 4.39, 95%CI: 4.19-4.59), and PrEP use (aIRR 5.82, 95%CI: 5.29-6.41) were associated with a higher number of non-steady male CAI partners. The association between PrEP use and increased chance of syphilis diagnosis was mediated by STI-screening recency and number of non-steady male CAI partners, both substantially higher in 2017 compared to 2010. Interpretation: Syphilis cases are concentrated in three MSM population groups: HIV-diagnosed, PrEP users, and sex workers. Behavioural and interventional changes, particularly more non-steady male CAI partners and recency of STI-screening, are major contributing factors for increasing syphilis diagnoses among MSM in Europe. Funding: European Centre for Disease Prevention and Control

Gaining Greater Insight into HCV Emergence in HIV-Infected Men Who Have Sex with Men: The HEPAIG Study

OBJECTIVES: The HEPAIG study was conducted to better understand Hepatitis C virus (HCV) transmission among human immuno-deficiency (HIV)-infected men who have sex with men (MSM) and assess incidence of HCV infection among this population in France. METHODS AND RESULTS: Acute HCV infection defined by anti-HCV or HCV ribonucleic acid (RNA) positivity within one year of documented anti-HCV negativity was notified among HIV-infected MSM followed up in HIV/AIDS clinics from a nationwide sampling frame. HIV and HCV infection characteristics, HCV potential exposures and sexual behaviour were collected by the physicians and via self-administered questionnaires. Phylogenetic analysis of the HCV-NS5B region was conducted. HCV incidence was 48/10 000 [95% Confidence Interval (CI):43-54] and 36/10 000 [95% CI: 30-42] in 2006 and 2007, respectively. Among the 80 men enrolled (median age: 40 years), 55% were HIV-diagnosed before 2000, 56% had at least one sexually transmitted infection in the year before HCV diagnosis; 55% were HCV-infected with genotype 4 (15 men in one 4d-cluster), 32.5% with genotype 1 (three 1a-clusters); five men were HCV re-infected; in the six-month preceding HCV diagnosis, 92% reported having casual sexual partners sought online (75.5%) and at sex venues (79%), unprotected anal sex (90%) and fisting (65%); using recreational drugs (62%) and bleeding during sex (55%). CONCLUSIONS: This study emphasizes the role of multiple unprotected sexual practices and recreational drugs use during sex in the HCV emergence in HIV-infected MSM. It becomes essential to adapt prevention strategies and inform HIV-infected MSM with recent acute HCV infection on risk of re-infection and on risk-reduction strategies

Enquêter les hommes ayant des relations sexuelles avec des hommes : Enjeux méthodologiques, sociologiques et de santé publique

Men who have sex with men (MSM) have been greatly affected by HIV infection. Indeed in France, the highest HIV incidence rate was estimated in 2008 at 1% in this population. In this context, it is essential, more than ever, to have in-depth knowledge of the sexual behavior and lifestyles of the MSM population in order to implement efficient prevention programs. Obtaining such data is not easy because of the difficulty in understanding and describing the MSM population both as a whole and in all its diversity.Since its creation in 1985, the Gay Press Surveys (EPG) have focused on the comprehensive approach of the impact of HIV medical advances, patterns of socialization and changes in the homosexuality’s representations on preventive sexual practices. In the last Gays and Lesbians Press Survey conducted in 2011, 10,448 MSM were recruited on a voluntary basis. With the diversification of recruitment methods including community websites, new socio-demographic and sexual profiles were described in addition to those usually recruited. The updating of the at-risk sexual indicators took into account the HIV therapeutic advances and the profane practices of prevention. A high level of HIV exposure among MSM was still observed, depending on the respondents’ HIV serological status and level of education. A generational approach of the last seven EPGs highlighted a strong period effect suggesting that sexual behaviors in MSM are influenced more by contextual than generational factors.To progress in ending the HIV epidemic, it is essential to continue to monitor sexual and preventive behaviors among MSM. Behavioral surveillance has to maintain consistency in methods and measures over time but needs to successfully adapt to follow new and emerging practices.Les hommes ayant des relations sexuelles avec des hommes (HSH) sont particulièrement touchés par le VIH depuis le début de l’épidémie. En France, le taux annuel d’incidence du VIH est le plus élevé, estimé en 2008 à 1% dans cette population. Dans ce contexte, il est primordial de disposer de données comportementales efficientes sur les pratiques sexuelles et préventives ainsi que sur les modes de vie afin de mettre en œuvre des programmes de prévention au plus proche des habitudes de vie des HSH et d’évaluer leurs impacts sur les comportements. Mais appréhender la population HSH dans sa globalité est complexe de par sa diversité est difficile. Depuis leur création en 1985, les Enquêtes Presse Gay (EPG) se sont attachées à comprendre l’impact des progrès médicaux, des modes de socialisation et les modifications des représentations de l’homosexualité sur les pratiques sexuelles préventives.La dernière édition de l’Enquête Presse Gays et Lesbiennes réalisée, en 2011, a recruté 10 448 HSH sur la base du volontariat. Grâce à la diversification des modes de recrutement incluant les sites internet communautaires, de nouveaux profils socio-démographiques et sexuels sont décrits à côté de ceux habituellement recrutés. L’actualisation des indicateurs de prises de risque sexuel qui prennent en compte les avancées thérapeutiques et les pratiques profanes de prévention permet de constater que le niveau d’exposition au VIH des HSH reste toujours élevé. Il varie selon le statut sérologique VIH et le niveau d’étude de ces HSH. L’analyse longitudinale des sept dernières EPG, a mis en évidence, l’impact des dynamiques sociales structurant les comportements sexuels et préventifs des HSH ayant débuté leur sexualité entre 1960 et 2011.Dans l’optique, d’enrayer la dynamique de l’épidémie de VIH, il est essentiel de poursuivre les dispositifs d’observation des comportements sexuels et préventifs des HSH via des enquêtes ad hoc. Ces enquêtes doivent être en adéquation avec les évolutions rapides et soutenues qui caractérisent la lutte contre le VIH. Elles devront faire preuve d’innovation

Investigate Men who Have Sex With Men : Methodological, Epidemiological and Social Issues

Les hommes ayant des relations sexuelles avec des hommes (HSH) sont particulièrement touchés par le VIH depuis le début de l’épidémie. En France, le taux annuel d’incidence du VIH est le plus élevé, estimé en 2008 à 1% dans cette population. Dans ce contexte, il est primordial de disposer de données comportementales efficientes sur les pratiques sexuelles et préventives ainsi que sur les modes de vie afin de mettre en œuvre des programmes de prévention au plus proche des habitudes de vie des HSH et d’évaluer leurs impacts sur les comportements. Mais appréhender la population HSH dans sa globalité est complexe de par sa diversité est difficile. Depuis leur création en 1985, les Enquêtes Presse Gay (EPG) se sont attachées à comprendre l’impact des progrès médicaux, des modes de socialisation et les modifications des représentations de l’homosexualité sur les pratiques sexuelles préventives.La dernière édition de l’Enquête Presse Gays et Lesbiennes réalisée, en 2011, a recruté 10 448 HSH sur la base du volontariat. Grâce à la diversification des modes de recrutement incluant les sites internet communautaires, de nouveaux profils socio-démographiques et sexuels sont décrits à côté de ceux habituellement recrutés. L’actualisation des indicateurs de prises de risque sexuel qui prennent en compte les avancées thérapeutiques et les pratiques profanes de prévention permet de constater que le niveau d’exposition au VIH des HSH reste toujours élevé. Il varie selon le statut sérologique VIH et le niveau d’étude de ces HSH. L’analyse longitudinale des sept dernières EPG, a mis en évidence, l’impact des dynamiques sociales structurant les comportements sexuels et préventifs des HSH ayant débuté leur sexualité entre 1960 et 2011.Dans l’optique, d’enrayer la dynamique de l’épidémie de VIH, il est essentiel de poursuivre les dispositifs d’observation des comportements sexuels et préventifs des HSH via des enquêtes ad hoc. Ces enquêtes doivent être en adéquation avec les évolutions rapides et soutenues qui caractérisent la lutte contre le VIH. Elles devront faire preuve d’innovation.Men who have sex with men (MSM) have been greatly affected by HIV infection. Indeed in France, the highest HIV incidence rate was estimated in 2008 at 1% in this population. In this context, it is essential, more than ever, to have in-depth knowledge of the sexual behavior and lifestyles of the MSM population in order to implement efficient prevention programs. Obtaining such data is not easy because of the difficulty in understanding and describing the MSM population both as a whole and in all its diversity.Since its creation in 1985, the Gay Press Surveys (EPG) have focused on the comprehensive approach of the impact of HIV medical advances, patterns of socialization and changes in the homosexuality’s representations on preventive sexual practices. In the last Gays and Lesbians Press Survey conducted in 2011, 10,448 MSM were recruited on a voluntary basis. With the diversification of recruitment methods including community websites, new socio-demographic and sexual profiles were described in addition to those usually recruited. The updating of the at-risk sexual indicators took into account the HIV therapeutic advances and the profane practices of prevention. A high level of HIV exposure among MSM was still observed, depending on the respondents’ HIV serological status and level of education. A generational approach of the last seven EPGs highlighted a strong period effect suggesting that sexual behaviors in MSM are influenced more by contextual than generational factors.To progress in ending the HIV epidemic, it is essential to continue to monitor sexual and preventive behaviors among MSM. Behavioral surveillance has to maintain consistency in methods and measures over time but needs to successfully adapt to follow new and emerging practices

Profil et comportements sexuels des jeunes hommes ayant des rapports sexuels avec d’autres hommes (Net Gay Baromètre 2009)

International audienceThe “Net Gay Barometre” (NGB) is a biennial survey among users of France’s most popular websites for men who have sex with men (MSM), initiated in 2004 and carried out in 2009.Overall, 24,292 MSM filled an online self-administered questionnaire, 3,003 (17%) were 18-25 years old. Compared to older men, these young men had a higher university degree, lived more frequently in region, and defined themselves less as homosexuals. The self-reported HIV prevalence was 2.5% for young respondents.Young MSM frequented less traditional gay venues and had fewer sexual causal partners during the last 12 months than older MSM. Unprotected anal intercourse (UAI) with a steady partner was reported by 62% young men, whereas more than a quarter of them were both in a steady rela- tionship and also had casual partners. UAI with HIV sero-discordant or unknown HIV status steady partner were reported by 36.4% young respondents.Internet allowed the NGB to obtain an important number of question- naires from young MSM. This kind of result is useful for effective target planning of local primary and secondary HIV prevention approaches for the benefit of young MSM.Le Net Gay Baromètre (NGB) est une enquête en ligne périodique, ini- tiée en 2004 et renouvelée en 2009, réalisée auprès d’hommes ayant des rapports sexuels avec des hommes (HSH) recrutés via des sites de ren- contres gays français.Au total, 24 292 HSH ont répondu au questionnaire en ligne, dont 3 003 (17%) étaient âgés de 18 à 25 ans. Par rapport à leurs aînés, ces jeunes hommes avaient plus souvent suivi des études universitaires, habitaient plus souvent en région et se définissaient moins souvent comme homo- sexuels. Leur prévalence déclarée au regard du VIH s’élevait à 2,5%.Plus distant que leurs aînés des lieux de rencontres sexuelles, ils décla- raient moins de partenaires occasionnels avec lesquels ils étaient moins souvent engagés dans les prises de risque « régulières ». Cependant, 62% rapportaient ne pas toujours se protéger avec leur partenaire stable alors que plus du quart étaient en situation de couple « ouvert » et que 36,4% déclaraient des pénétrations anales non protégées avec un parte- naire de couple sérodifférent ou de statut inconnu.Grâce à Internet, le NBG a pu exploiter un nombre important de question- naires de jeunes HSH, pouvant servir la mise en œuvre de programmes de prévention ciblés, adaptés à ce groupe spécifique