Los hombres gays modifican su comportamiento sexual tras el diagnóstico de VIH

El diagnóstico de VIH conduce a cambios en los comportamientos de  y sexuales en la población masculina homosexual, según informa un equipo de investigadores de EE UU en la edición digital de Journal of Acquired Immune Deficiency Syndromes.

Se produjo una reducción en el número de parejas sexuales que fueron comunicadas y, en los primeros meses posteriores al diagnóstico, se apreció un descenso de las relaciones sexuales sin protección con parejas sin VIH o con hombres de estado serológico desconocido.

Las tasas de consumo declarado de metanfetamina disminuyeron, aunque siguieron siendo elevadas. Por otro lado, no se encontraron indicios de que los hombres estuvieran usando sus niveles de carga viral para orientar sus decisiones respecto a la práctica de sexo sin protección.

“Nuestros hallazgos demuestran cómo los comportamientos sexuales, el estado serológico de la pareja, el consumo de sustancias y la elección de parejas de los hombres que practican sexo con hombres () con una infección por VIH reciente han cambiado durante el primer año tras el diagnóstico”, escriben los investigadores.

Los hombres  y otros hombres que practican sexo con hombres continúan siendo un foco principal de la epidemia de VIH en los países industrializados, como es el caso de EE UU. Estudios recientes sugieren que entre el 25 y el 50% de todas las nuevas infecciones se originan en personas que han sido infectadas recientemente por el virus.

Esta población constituye un centro de atención creciente de los esfuerzos preventivos del VIH. Para entender mejor los comportamientos de riesgo de estos pacientes, un equipo de investigadores del sur de California diseñó un estudio en el que participaron 193 varones homosexuales que habían sido infectados por VIH hacía muy poco tiempo.

En el momento de su diagnóstico -y posteriormente, a intervalos regulares a lo largo de los siguientes doce meses-, los pacientes fueron entrevistados sobre el tipo de relaciones sexuales que mantenían y su consumo de drogas.

Los hombres tenían un promedio de 35 años de edad y el 71% eran de etnia blanca. Además, mostraban un elevado nivel educativo y el 88% habían asistido a la universidad.

Al inicio del estudio, los varones comunicaron haber tenido una media de nueve parejas sexuales en los tres meses anteriores, porcentaje que se redujo a una media de siete parejas en los tres meses posteriores al diagnóstico. A los doce meses, se registró otro descenso más leve (media de seis parejas).

La proporción de hombres que declararon tener una pareja principal pasó del 20 al 48% en el intervalo entre el comienzo y el final del estudio. Este aumento fue significativo (p<0,001).

Al empezar el estudio, casi la mitad (46%) de los hombres afirmaron haber mantenido relaciones sexuales sin protección con una pareja reciente. Transcurridos nueve meses, este porcentaje se redujo hasta el 39%, pero posteriormente aumentó de forma brusca hasta situarse en el 57% al final del ensayo.

Hubo algunos indicios de que los hombres practicaban serosorting. Al inicio del estudio, el 14% de los hombres declararon tener una pareja con VIH; esta proporción aumentó hasta llegar al 33% a los tres meses y a un 39% al concluir el ensayo. El porcentaje de varones que afirmaron haber mantenido relaciones sexuales de forma reciente sin protección con una pareja sin VIH, o con un hombre de estado serológico desconocido, descendió del 42% inicial al 23% en nueve meses. Sin embargo, transcurridos 12 meses, la proporción subió al 50%.

El consumo de metanfetamina fue generalizado. Al comienzo del ensayo, el 30% de los participantes comunicaron haber usado dicha droga durante su última relación sexual. Este nivel descendió al 11% en el tercer mes y se mantuvo estable durante el resto del estudio. No obstante, a lo largo de los doce meses que duró este, la proporción de usuarios de metanfetamina que afirmaron practicar sexo de riesgo se incrementó de forma significativa (p= 0,05).

“El consumo de metanfetamina declarado en esta muestra resulta muy preocupante”, comentan los autores. En su análisis estadístico, el sexo anal sin protección se relacionó con el uso de esta droga al inicio el estudio (cociente de probabilidades ajustado [CPA]: 7,65; intervalo de confianza del 95% [IC95%]: 1,87 – 31,30), así como el empleo de metanfetamina durante el transcurso de estudio (CPA: 14,4; IC95%: 2,02 – 103,0).

No se registraron pruebas de que los participantes orientaran su comportamiento sexual en función de la carga viral. El 44% de los varones con una carga viral indetectable declararon haber practicado sexo sin protección, al igual que el 48% de las varones con un nivel detectable de VIH.

“En esta cohorte, los hombres que tenían una infección reciente por VIH redujeron su número total de parejas durante el año siguiente al diagnóstico; el mayor descenso se dio en los primeros seis meses”, comentan los autores.

Las tasas de relaciones sexuales sin protección con hombres que no tenían VIH o cuyo estado serológico era desconocido descendieron inicialmente, para luego volver a aumentar, lo que lleva a los investigadores a creer que “existe la posibilidad de que se produzca la transmisión del VIH a muchos varones diferentes”.

La modificación de los comportamientos tendió a producirse en los seis meses siguientes al diagnóstico; los autores consideran que debería darse prioridad a los “programas que favorezcan que estos cambios se mantengan en el tiempo (…) sobre todo después de los nueve meses”.

Fuente: gTt Grupo de trabajo sobre tratamientos de VIH

Referencia: Gorbach PM, et al. Behaviors of recently HIV-infected men who have sex with men in the year post-diagnosis: effects of drug use and partner types. J Acquir Immune Defic Syndr, online edition: DOI: 10.1097/QAI.0bo13e3181ff9750, 2010E


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