Background: Antiretroviral therapy (ART) non-adherence is associated with increased risk of HIV-disease progression, transmission, and development of ART resistance. High-risk sexual behaviors and recreational drug use may be associated with ART non-adherence. Among a cohort of HIV-positive men who have sex with men (MSM) who are linked to care, we examined the prevalence of high-risk sexual behaviors and recreational drug use and their associations with ART non-adherence.
Methods: We analyzed data from an ongoing cross-sectional study of HIV-positive MSM attending an HIV clinic at an academic medical center between March 2015 and February 2016. Through a self-administered survey, participants reported on their current ART use, ART adherence (number of doses missed in the previous 7 days), recent sexual behaviors (last 3 months), and recent recreational drug use (last 3 months).
Results: Among the 158 HIV-positive MSM enrolled, 87 (55%) reported recent unprotected anal intercourse (UAI), 32 (20%) repoted recent sex with an anonymous partner, and 72 (46%) reported recent use of recreational drug(s) (marijuana, MDMA, methamphetamines, alkyl nitrites, nitrous oxide, or cocaine). Overall, 127 (80%) participants reported currently being on ART. Among those taking ART, 104 (82%) reported never missing a dose in the previous 7 days. There was a trend toward higher ART non-adherence among participants who reported recent UAI (prevalence ratio (PR): 1.77, 95% confidence interval (CI): 0.74–4.20, p=0.19), recent sex with an anonymous partner (PR: 1.24, 95% CI: 0.50–3.02, p=0.64), or recent recreational drug use (PR: 1.71, 95% CI: 0.75–3.89, p=0.19).
Conclusions: A high-proportion of HIV-positive MSM who are linked to care reported recently engaging in high-risk behaviors such as UAI, anonymous sex, or recreational drug use. These high-risk behaviors trended towards increased ART non-adherence and could result in ongoing risk for HIV-disease progression, transmission and development of ART resistance.