Young Men With Detectable Viral Loads More Likely to Engage in Risky Behavior

A new study on HIV-positive men and transgender women who have sex with men reported that participants with detectable viral loads were more likely to have anal sex without condoms than those who were virally suppressed, and that condom use was closely related to substance abuse. 

The study conducted by researchers at Columbia University's Mailman School of Public Health examined a group of 991 participants, age 15 to 26, at 20 adolescent HIV clinics across the United States from 2009 to 2012. Of this group, nearly half (46 percent) reported having condomless anal sex within the past three months. Among those who had detectable viral loads, a full 44 percent reported condomless sex, a significant percentage higher than those who were virally suppressed but had condomless sex (which was only 25 percent).

But the study showed more than just a possible correlation between risky behavior and viral suppression. The reserachers also analyzed the group on psychosocial factors. For example, according to Patrick A. Wilson, an assistant professor of Socioeconomic Sciences who led the study, among the young men with detectable viral loads, those with substance abuse problems were more likely to report condomless anal sex. Wilson said that there was a co-occurance with substance abuse problems and motivation to use condoms. 

Economics also played a role, as those who fell into a low income category had lower rates of viral suppression. 

“While many of these young men are engaged in care, and success stories are many, we still have work to do to reduce the rate of new infections,” said Wilson. “We must remain engaged in finding new behavioral approaches for those young men who have yet to seek HIV testing, antiretroviral treatment, and adhere to viral suppression activities.”

About half of the study participants were prescribed antiretroviral medications and linked to care, but the study showed that this strategy was not enough. 

“To truly curb HIV among this group, we cannot solely rely on one strategy,” said Wilson. “These findings speak to the need for targeting substance use and mental health concerns — factors related to viral suppression and sexual risk taking.”