Changing the odds: motives for and barriers to reducing HCV-related sexual risk behaviour among HIV-infected MSM previously infected with HCV

Femke Lambers, Wendy van der Veldt, Maria Prins, Udi Davidovich, MOSAIC study, Femke Lambers, Wendy van der Veldt, Maria Prins, Udi Davidovich, MOSAIC study

Abstract

Background: Among HIV-infected MSM who have been treated for HCV infection, the HCV reinfection rate is high. It is therefore essential to understand their perceptions of HCV risk behaviour and risk-reducing strategies.

Methods: This qualitative study among 20 HCV-infected MSM, the majority treated in the era before direct acting antivirals, provides insight into their ideas, motives, and barriers concerning HCV risk reduction, and aims to strengthen prevention strategies for both primary HCV infection and HCV reinfection.

Results: The strongest motive to implement risk reduction strategies was the reward of avoiding HCV retreatment and its side effects, but this may change with the current implementation of less burdensome HCV treatment. Also, the sexual risk norms in the MSM scene, including social pressure towards risk-taking, HCV stigma, and non-disclosure of HCV status, all form barriers to safe sex. Drug use, strongly present in the context of clubs and group sex, directly impedes the self-efficacy of men to take risk reduction measures.

Conclusions: Tailored prevention messages, empowerment of self-efficacy for risk reduction, and more insight into risk behaviour over time are ingredients for effective HCV prevention among these men.

Keywords: HCV; HIV; Men who have sex with men; Protection motivation theory; Qualitative; Sexual health.

Conflict of interest statement

Ethics approval and consent to participate

This study is part of the MOSAIC study which was approved for by the ‘Medical ethics committee of the Academic Medical Center Amsterdam (Medisch Ethische Toetsings Commissie AMC). The participants gave written consent for participating in the MOSAIC study and verbal consent for participating in the interview (substudy) and using the collected data for the study; the consent was documented by audio recording and and transcription together with the interview.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. van de Laar TJ, et al. Acute hepatitis C in HIV-infected men who have sex with men: an emerging sexually transmitted infection. AIDS. 2010;24(12):1799–1812. doi: 10.1097/QAD.0b013e32833c11a5.
    1. van de Laar TJ, Richel O. Emerging viral STIs among HIV-positive men who have sex with men: the era of hepatitis C virus and human papillomavirus. Sex Transm Infect. 2017;93(5):368–373. doi: 10.1136/sextrans-2016-052677.
    1. Terrault NA, et al. Sexual transmission of hepatitis C virus among monogamous heterosexual couples: the HCV partners study. Hepatology. 2013;57(3):881–889. doi: 10.1002/hep.26164.
    1. van den Berg CH, et al. Major decline of hepatitis C virus incidence rate over two decades in a cohort of drug users. Eur J Epidemiol. 2007;22(3):183–193. doi: 10.1007/s10654-006-9089-7.
    1. Danta M, Rodger AJ. Transmission of HCV in HIV-positive populations. Curr Opin HIV AIDS. 2011;6(6):451–458. doi: 10.1097/COH.0b013e32834b4974.
    1. Schmidt AJ, et al. Trouble with bleeding: risk factors for acute hepatitis C among HIV-positive gay men from Germany--a case-control study. PLoS One. 2011;6(3):e17781. doi: 10.1371/journal.pone.0017781.
    1. Vanhommerig JW, et al. Risk Factors for Sexual Transmission of Hepatitis C Virus Among Human Immunodeficiency Virus-Infected Men Who Have Sex With Men: A Case-Control Study. Open. Forum Infect. Dis. 2015;2(3):ofv115. doi: 10.1093/ofid/ofv115.
    1. Micallef JM, Kaldor JM, Dore GJ. Spontaneous viral clearance following acute hepatitis C infection: a systematic review of longitudinal studies. J Viral Hepat. 2006;13(1):34–41. doi: 10.1111/j.1365-2893.2005.00651.x.
    1. Brillanti S, et al. A pilot study of combination therapy with ribavirin plus interferon alfa for interferon alfa-resistant chronic hepatitis C. Gastroenterology. 1994;107(3):812–817. doi: 10.1016/0016-5085(94)90131-7.
    1. Doyle JS, et al. Response to treatment following recently acquired hepatitis C virus infection in a multicentre collaborative cohort. J Viral Hepat. 2015;22(12):1020–1032. doi: 10.1111/jvh.12429.
    1. Guidelines for the Screening Care and Treatment of Persons with Chronic Hepatitis C Infection: Updated Version. Geneva; 2016.
    1. Lambers FA, et al. Alarming incidence of hepatitis C virus re-infection after treatment of sexually acquired acute hepatitis C virus infection in HIV-infected MSM. AIDS. 2011;25(17):F21–F27. doi: 10.1097/QAD.0b013e32834bac44.
    1. Martin TC, et al. Hepatitis C virus reinfection incidence and treatment outcome among HIV-positive MSM. AIDS. 2013;27(16):2551–2557. doi: 10.1097/QAD.0b013e32836381cc.
    1. Thomas XV, et al. Genetic characterization of multiple hepatitis C virus infections following acute infection in HIV-infected men who have sex with men. AIDS. 2015;29(17):2287–2295. doi: 10.1097/QAD.0000000000000838.
    1. Ingiliz P, et al. HCV reinfection incidence and spontaneous clearance rates in HIV-positive men who have sex with men in Western Europe. J Hepatol. 2017;66(2):282–287. doi: 10.1016/j.jhep.2016.09.004.
    1. Rogers RW. Cognitive and physiological processes in fear appeals and attitude change: A Revised theory of protection motivation. In: Cacioppo JT, Petty R, editors. Social psychophysiology. New York: Guilford Press; 1983.
    1. Prachi Srivastava NH. A Practical Iterative Framework for Qualitative Data Analysis. International Journal of Qualitative Methods, 2009. 8(Issue 1).
    1. Le Talec JY. When ‘raw sex’ turns to a ‘raw deal’. taking the opportunity to think about sex? Interviews with HIV-positive gay men diagnosed with acute hepatitis C. Cult. Health Sex. 2013;15(10):1133–1147. doi: 10.1080/13691058.2013.809478.
    1. Vogel M, Boesecke C, Rockstroh JK. Acute hepatitis C infection in HIV-positive patients. Curr Opin Infect Dis. 2011;24(1):1–6. doi: 10.1097/QCO.0b013e3283422e09.
    1. Fierer DS, et al. Rapid progression to decompensated cirrhosis, liver transplant, and death in HIV-infected men after primary hepatitis C virus infection. Clin Infect Dis. 2013;56(7):1038–1043. doi: 10.1093/cid/cis1206.
    1. Lambers FA, et al. High awareness of hepatitis C virus (HCV) but limited knowledge of HCV complications among HIV-positive and HIV-negative men who have sex with men. AIDS Care. 2014;26(4):416–424. doi: 10.1080/09540121.2013.832721.
    1. Urbanus AT, et al. Hepatitis C virus infections among HIV-infected men who have sex with men: an expanding epidemic. AIDS. 2009;23(12):F1–F7. doi: 10.1097/QAD.0b013e32832e5631.
    1. Hoornenborg E, et al. Men who have sex with men starting pre-exposure prophylaxis (PrEP) are at risk of HCV infection. AIDS. 2017;31(11):1603–1610. doi: 10.1097/QAD.0000000000001522.
    1. Dowson L, et al. Why some MSM present late for HIV testing: a qualitative analysis. AIDS Care. 2012;24(2):204–209. doi: 10.1080/09540121.2011.597711.
    1. Newsum, A.M., et al., Development and validation of the HCV-MOSAIC risk score to assist testing for acute hepatitis C virus (HCV) infection in HIV-infected men who have sex with men (MSM). Euro Surveill, 2017. 22(21): pii 30540.
    1. Berg RC. High rates of unprotected sex and serosorting among men who have sex with men: a national online study in Norway. Scand J Public Health. 2012;40(8):738–745. doi: 10.1177/1403494812465032.
    1. van den Boom W, et al. Is anyone around me using condoms? Site-specific condom-use norms and their potential impact on condomless sex across various gay venues and websites in the Netherlands. Health Psychol. 2015;34(8):857–864. doi: 10.1037/hea0000230.
    1. Heiligenberg M, et al. Recreational drug use during sex and sexually transmitted infections among clients of a city sexually transmitted infections clinic in Amsterdam, the Netherlands. Sex Transm Dis. 2012;39(7):518–527. doi: 10.1097/OLQ.0b013e3182515601.
    1. Mimiaga MJ, et al. A pilot trial of integrated behavioral activation and sexual risk reduction counseling for HIV-uninfected men who have sex with men abusing crystal methamphetamine. AIDS Patient Care STDs. 2012;26(11):681–693. doi: 10.1089/apc.2012.0216.
    1. Semple SJ, et al. Drug assertiveness and sexual risk-taking behavior in a sample of HIV-positive, methamphetamine-using men who have sex with men. J Subst Abus Treat. 2011;41(3):265–272. doi: 10.1016/j.jsat.2011.03.006.
    1. Bourne A, Weatherburn P. Substance use among men who have sex with men: patterns, motivations, impacts and intervention development need. Sex Transm Infect. 2017;93(5):342–346. doi: 10.1136/sextrans-2016-052674.
    1. Lammers M, Davidovich U, Prins M, Stolte I. 17th International AIDS Conference; August 5–8, 2008. Mexico City: Abstract THPDC205; 2008. Condom induced erectile dysfunction (COINED): a unique predictor of deliberate sexual risk.
    1. Hart TA, et al. A pilot trial of a sexual health counseling intervention for HIV-positive gay and bisexual men who report anal sex without condoms. PLoS One. 2016;11(4):e0152762. doi: 10.1371/journal.pone.0152762.
    1. Herrick A, et al. Pathways towards risk: syndemic conditions mediate the effect of adversity on HIV risk behaviors among young men who have sex with men (YMSM) J Urban Health. 2014;91(5):969–982. doi: 10.1007/s11524-014-9896-1.
    1. Mimiaga MJ, et al. High prevalence of multiple syndemic conditions associated with sexual risk behavior and HIV infection among a large sample of Spanish- and Portuguese-speaking men who have sex with men in Latin America. Arch Sex Behav. 2015;44(7):1869–1878. doi: 10.1007/s10508-015-0488-2.
    1. Owen G. An ‘elephant in the room’? Stigma and hepatitis C transmission among HIV-positive ‘serosorting’ gay men. Cult Health Sex. 2008;10(6):601–610. doi: 10.1080/13691050802061673.

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