Behaviour changes following HIV diagnosis among men who have sex with men in the era of treatment as prevention: data from a prospective study

Figures & data

Table 1. Baseline characteristics among 90 newly diagnosed with HIV MSM participating in the Guy’s and St. Thomas’ Hospital observational study.

Characteristics	n	%
Total sample^a	90	100
Demographic
Age category, years < 25 25–29 30–34 35–39 40–44 ≥ 45 Mean age (SD)	7 20 17 13 16 17 36 (9.6)	7.8% 22.2% 18.9% 14.4% 17.8% 18.9%
Racial identity^b White Other race	75 15	83.3% 16.7%
Country of birth UK Outside the UK	38 52	42.2% 57.8%
Socio-economic and partnership status
University education status Yes No	58 32	64.4% 35.6%
Employment status^c Full time / part time employment Unemployed / other	77 13	85.6% 14.4%
Housing status^d Homeowner Renting Other	20 65 4	22.2% 72.2% 4.5%
Difficulty to pay for the heating cost in winter Yes No or not applicable	15 75	16.7% 83.3%
Receive benefits Yes No	5 85	5.6% 94.4%
Relationship status Yes, living with partner Yes, not living with partner No	29 15 46	32.2% 17.7% 51.1%
Patient and HIV
Have a partner with HIV Yes No	7 83	7.8% 92.2%
Disclosure of HIV status to others Yes No	71 19	78.9% 21.1%
Ever taken ART Yes No	13 74	14.9% 85.1%
Views on HIV transmission risk Agree to statement: A person on HIV treatment who has an undetectable viral load is less likely to transmit HIV to a sexual partner than someone with a high viral load. Agree to statement: If an HIV positive person’s viral load is undetectable, it is not necessary to use a condom to prevent transmission of HIV	76 16	84.4% 17.8%
HIV viral load (VL) at diagnosis ≤ 200 copies/mL > 200 copies/mL Mean days of VL measurement since diagnosis (SD) Median days of VL measurement since diagnosis (IQR)	2 88 14 days (16.4) 8 days (4–18)	2.2% 97.8%
Time from diagnosis to baseline completion ≤ 14 days 15–30 days 31 days – 3 months Mean days from diagnosis to baseline (SD) Median days from diagnosis to baseline (IQR)	26 36 28 29 days (23.2) 22 days (14–36)	28.9% 40.0% 31.1%
Sexual behaviour
STI diagnoses in the past 3 months Yes No	43 47	47.8% 52.2%
Any sex in the past 3 months Yes No	77 13	85.6% 14.4%
Condomless sex in the past 3 months Yes No	56 34	62.2% 37.8%
Number of partners in the past 3 months 0 or no sex 1 – regular or long-term partner 1 – casual or short-term partner 2–4 partners 5–10 partners > 10 partners	13 15 7 30 11 14	14.4% 16.7% 7.8% 33.3% 12.2% 15.6%
Lifestyle, health and wellbeing
Recreational drugs use in the past 3 months Yes No	61 29	67.8% 32.2%
Depressive symptoms (PHQ-9 score ≥10) Yes No Mean PHQ-9 score (SD) Median PHQ-9 score (IQR)	22 68 6.9 (6.8) 4 (2–10)	24.4% 75.6%
Alcohol dependency symptoms (CAGE score >=2) Yes No	7 83	7.8% 92.2%

^aThere were no missing data except for: housing status: 1; ever taken ART: 3 ^bOther race includes Black, Asian, Mixed, and other race group ^cUnemployed or other group includes student, retired and disabled or sick ^dOther housing status includes temporary accommodation, staying with partner, and homeless. MSM: men who have sex with men; SD: standard deviation, IQR: interquartile range; STI: sexually transmitted infection; PHQ-9: patient health questionnaire-9; CAGE: alcohol questionnaire.

Figure 1. Prevalence of any sex, condomless sex, seroconcordant condomles sex, serodiscordant condomless sex and number of sexual partners over time. Top figure: Trends over one-year follow-up period in any sex, CLS, CLS-C, CLS-D and the prevalence of CLS-D-HIV risk, sample sizes at baseline: 90 men, week 12: 84 men, week 48: 76 men; CLS-C and CLS-D data were not available at baseline, three missing questionnaires on CLS-C. Prevalence of sexual behaviours in the past three months at baseline corresponds to three months pre-diagnosis – diagnosis day; Bottom figure: Trends over one-year follow-up period in number of sexual partners, sample sizes at baseline: 90 men, week 12: 84 men, week 48: 76 men, no missing questionnaires. Prevalence of sexual behaviours in the past three months at baseline corresponds to three months pre-diagnosis – diagnosis.

Figure 2. Prevalence of other HIV-related characteristics over time. Top figure: Trends over one-year follow-up period in undetectable VL, ART use and views on HIV transmission risk, sample sizes at baseline: 90 men, week 12: 84 men, week 48: 76 men; no missing questionnaires. Prevalence the past three months at baseline corresponds to three months pre-diagnosis – diagnosis day; Bottom figure: Trends over one-year follow-up period in STI diagnoses and recreational drug use, sample sizes at baseline: 90 men, week 12: 84 men, week 48: 76 men, no missing questionnaires. Prevalence in the past three months at baseline corresponds to three months pre-diagnosis – diagnosis.

Table 2. Adjusted associations of factors with any sex, condomless sex, seroconcordant condomless sex, and serodiscordant condomless sex among 90 newly diagnosed with HIV MSM participating in the Guy’s and St. Thomas’ Hospital observational study (n = 160 observations from month 3 and month 12).^a

Characteristics	Any sex^b		condomless sex^b		CLS-C^c		CLS-D^d
	aOR (95% CI)	p-value	aOR (95% CI)	p-value	aOR (95% CI)	p-value	aOR (95% CI)	p-value
Age < 25 25–29 30–34 35–39 40–44 ≥ 45	ref 0.33 (0.02–6.91) 0.59 (0.03–13.18) 0.33 (0.01–7.92) 0.39 (0.01–10.22) 0.38 (0.02–8.89)	0.692	ref 0.30 (0.04–2.02) 0.40 (0.05–2.97) 0.37 (0.05–2.73) 0.31 (0.04–2.62) 0.38 (0.05–3.08)	0.775	156 obs refv 0.38 (0.08–1.82) 0.73 (0.14–3.88) 0.27 (0.05–1.51) 0.67 (0.11–3.85) 0.25 (0.05–1.36)	0.272	ref 0.58 (0.12–2.74) 0.44 (0.07–2.79) 1.21 (0.25–5.77) 0.30 (0.04–2.17) 1.09 (0.23–5.21)	0.611
Racial identity White Other race	ref 1.54 (0.39–6.07)	0.535	ref 1.11 (0.42–2.90)	0.831	156 obs ref 0.51 (0.17–1.56)	0.241	ref 2.39 (0.84–6.83)	0.102
Country of birth UK Outside the UK	ref 1.16 (0.42–3.24)	0.773	ref 0.98 (0.45–2.09)	0.952	ref 1.09 (0.45–2.62)	0.849	ref 0.93 (0.42–2.06)	0.853
University education status Yes No	ref 0.77 (0.29–2.06)	0.611	ref 0.82 (0.35–1.92)	0.652	ref 0.87 (0.36–2.11)	0.764	ref 0.84 (0.31–2.28)	0.735
Employment status Full time / part time employment Unemployed / other	ref 1.42 (0.46–4.39)	0.543	ref 1.24 (0.46–3.33)	0.669	ref 1.56 (0.59–4.12)	0.369	ref 0.70 (0.21–2.39)	0.574
Housing status Homeowner Renting Other	ref 0.52 (0.16–1.61) 1.02 (0.18–5.82)	0.687	ref 0.61 (0.24–1.56) 1.38 (0.29–6.45)	0.959	ref 0.45 (0.13–1.49) 0.27 (0.03–2.76)	0.212	ref 1.07 (0.27–4.22) 4.56 (0.55–37.79)	0.265
Difficulty to pay for heating cost Yes No	ref 1.52 (0.66–3.49)	0.322	ref 1.17 (0.55–2.49)	0.687	ref 1.62 (0.56–4.75)	0.375	ref 0.81 (0.30–2.18)	0.671
Receive benefits Yes No	ref 1.86 (0.39–8.65)	0.431	ref 1.06 (0.23–4.94)	0.941	ref 0.86 (0.09–8.19)	0.900	ref 2.31 (0.19–27.79)	0.510
In relationship status No Yes, living with partner Yes, not living with partner	ref 1.69 (0.65–4.35) 1.46 (0.62–3.45)	0.255	ref 0.96 (0.43–2.13) 1.00 (0.41–2.48)	0.930	ref 1.64 (0.71–3.79) 0.77 (0.26–2.22)	0.260	ref 0.52 (0.24–1.13) 0.92 (0.35–2.46)	0.109
Have a partner with HIV No Yes	1 (success perfectly)	-	ref 4.19 (0.91– 19.35)	0.066	ref 2.75 (0.80–9.44)	0.108	ref 1.25 (0.35–4.53)	0.730
Disclosure of HIV status to others Yes No	ref 0.54 (0.23–1.23)	0.143	ref 0.53 (0.21–1.36)	0.189	ref 0.83 (0.32–2.13)	0.699	ref 0.45 (0.15–1.36)	0.157
Currently on ART Yevs No	ref 1.70 (0.26–10.91)	0.574	ref 1.06 (0.38–2.95)	0.906	ref 2.82 (1.10–7.22)	0.031	1	-
Detectable viral load Yes No	ref 1.10 (0.60–2.01)	0.757	ref 2.17 (1.22–3.84)	0.008	ref 0.94 (0.49–1.80)	0.843	ref 4.18 (1.61–10.84)	0.003
Recreational drug use in the past 3 months No Yes	ref 3.03 (1.40–6.54)	0.005	ref 3.03 (1.47–6.24)	0.003	ref 4.56 (1.62–12.76)	0.004	ref 1.22 (0.54–2.74)	0.626
STI diagnoses in the past 3 months No Yes	ref 1.80 (1.03–3.15)	0.038	ref 1.15 (0.53–2.52)	0.715	ref 1.21 (0.54–2.69)	0.638	ref 1.04 (0.39–2.71)	0.938
Depressive symptoms (PHQ-9 sc ore ≥10) No Yes	ref 1.32 (0.26–6.85)	0.738	ref 0.47 (0.15–1.49)	0.200	ref 0.30 (0.07–1.34)	0.115	ref 0.72 (0.18–2.77)	0.628
Alcohol dependency symptoms (CAGE score ≥2) No Yes	ref 0.92 (0.19–4.42)	0.918	ref 1.35 (0.37–4.95)	0.650	ref 1.06 (0.29–3.89)	0.930	ref 1.17 (0.36–3.86)	0.793
Views on HIV transmission risk Agree to statement: A person on HIV treatment who has an undetectable viral load is less likely to transmit HIV to a sexual partner than someone with a high viral load No Yes Agree to statement: If an HIV positive person’s viral load is undetectable, it is not necessary to use a condom No Yes	ref 0.85 (0.42–1.72) ref 2.55 (1.34–4.86)	0.643 0.004	ref 1.63 (0.54–4.92) ref 3.41 (1.58–7.38)	0.384 0.002	ref 0.87 (0.23–3.36) ref 1.42 (0.66–3.07)	0.842 0.369	ref 2.39 (0.38–15.05) ref 3.02 (1.33–6.84)	0.354 0.008
Visit 3 months 12 months	ref 1.11 (0.65–1.92)	0.696	ref 1.84 (1.12–3.02)	0.016	ref 0.85 (0.46–1.56)	0.603	ref 3.58 (1.78–7.21)	<0.001
Calendar Year 2015 2016 2017 / 2018	ref 0.62 (0.27–1.40) 0.81 (0.29–2.21)	0.683	ref 1.22 (0.68–2.19) 1.24 (0.56–2.80)	0.607	ref 0.91 (0.44–1.87) 0.45 (0.15–1.30)	0.127	ref 2.11 (0.69–6.40) 3.85 (1.08–13.69)	0.030

^aOR adjusted for age, racial identity, country of birth, and education. ^bTotal complete observations for any sex and CLS: 160; housing status: 154 observations; difficulty to pay for heating and ever taken ART: 156 observations. No missing data for the other variables in the table. ^cTotal complete observations for CLS-C: 156; housing status: 150 observations; difficulty to pay for heating and ever taken ART: 152 observations. ^dTotal complete observations for CLS-D: 160; housing status: 154 observations; difficulty to pay for heating and ever taken ART: 156 observations. MSM: men who have sex with men; aOR: adjusted odds ratio; CI: confidence interval; CLS: condomless sex; STI: sexually transmitted infection; PHQ-9: patient health questionnaire-9; CAGE: alcohol questionnaire.

Table 3. Adjusted associations of factors with number of sex partners among 90 newly diagnosed men who have sex with men in the St. Thomas observational study (n = 160 observations from month 3 and month 12).^a

Characteristics	2–4 partners^b		5–10 partners^b		>10 partners^†
	aOR (95% CI)	p-value	aOR (95% CI)	p-value	aOR (95% CI)	p-value
Age < 25 25–29 30–34 35–39 40–44 ≥ 45	ref 3.21 (0.62–16.71) 3.31 (0.59–18.66) 3.36 (0.65–17.33) 6.48 (1.25–33.45) 4.30 (0.79–23.38)	0.167	ref 0.11 (0.01–1.26) 0.06 (0.01–0.70) 0.57 (0.09–3.59) 0.24 (0.03–1.74) 0.15 (0.02–1.09)	0.262	ref 0.31 (0.04–2.24) 0.86 (0.08–9.33) 0.82 (0.09–6.76) empty empty	0.566
Racial identity White Other race	ref 1.19 (0.95–1.49)	0.122	ref 0.17 (0.02–1.42)	0.101	ref 1.22 (0.26–5.69)	0.796
Country of birth UK Outside the UK	ref 1.99 (0.86–4.62)	0.107	ref 2.43 (0.79–7.45)	0.118	ref 1.00 (0.19–5.21)	0.999
University education status Yes No	ref 0.71 (0.32–1.54)	0.383	ref 0.92 (0.30–2.80)	0.884	ref 0.25 (0.02–3.08)	0.282
Employment status Full time / part time employment Unemployed / other	ref 0.43 (0.16–1.19)	0.105	ref 1.13 (0.24–5.41)	0.876	ref 1.76 (0.24–12.53)	0.574
Housing status Homeowner Renting Other	ref 1.20 (0.46–3.09) 0.58 (0.12–2.79)	0.785	ref 0.73 (0.15–3.55) 0.87 (0.10–7.54)	0.789	ref 0.29 (0.01–6.13) 2.67 (0.11–64.95)	0.486
Difficulty to pay for heating cost Yes No	ref 1.99 (0.71–5.56)	0.189	ref 1.19 (0.32–4.48)	0.788	ref 0.75 (0.13–4.39)	0.749
Receive benefits No Yes	1	-	1	-	ref 25.13 (2.38-265.07)	0.007
In relationship status Yes, living with partner Yes, not living with partner No	ref 1.49 (0.51–4.33) 2.35 (1.10–5.00)	0.026	ref 0.37 (0.04–3.67) 0.96 (0.31–2.93)	0.996	ref 1.04 (0.06–17.76) 2.87 (0.55–14.93)	0.195
Have a partner with HIV No Yes	ref 1.67 (0.51–5.44)	0.394	1	-	1	-
Disclosure of HIV status to others Yes No	ref 1.27 (0.55–2.96)	0.574	ref 0.68 (0.17–2.81)	0.599	ref 2.83 (0.55–14.39)	0.210
Currently on ART Yes No	ref 0.81 (0.27–2.46)	0.718	ref 0.34 (0.06–1.97)	0.230	1	-
Detectable viral load Yes No	ref 1.47 (0.72–3.02)	0.286	ref 1.27 (0.48–3.40)	0.627	ref 1.28 (0.26–6.28)	0.759
Recreational drug use in the past 3 months No Yes	ref 1.75 (0.74–4.09)	0.200	ref 4.46 (1.01–19.65)	0.048	ref 3.51 (0.39–31.57)	0.262
STI diagnosis in the past 3 months No Yes	ref 3.44 (1.59–7.44)	0.002	ref 1.08 (0.32–3.59)	0.898	ref 0.69 (0.14–3.48)	0.655
Depressive symptoms (PHQ-9 score ≥10) No Yes	ref 0.60 (0.17–2.10)	0.424	ref 0.88 (0.17–4.57)	0.878	ref 0.93 (0.09–9.82)	0.952
Alcohol dependency symptoms (CAGE score ≥2) No Yes	ref 0.50 (0.14–1.75)	0.279	ref 0.42 (0.06–3.29)	0.413	ref 3.05 (0.37–25.04)	0.298
Views on HIV transmission risk Agree to statement: A person on HIV treatment who has an undetectable viral load is less likely to transmit HIV to a sexual partner than someone with a high viral load No Yes Agree to statement: If an HIV positive person’s viral load is undetectable, it is not necessary to use a condom No Yes	ref 1.27 (0.44–3.67) ref 1.03 (0.48–2.22)	0.655 0.939	1 ref 5.36 (1.79–15.98)	- 0.003	ref 0.27 (0.05–1.55) ref 6.73 (1.17–38.62)	0.143 0.032
Visit 3 months 12 months	ref 0.84 (0.45–1.59)	0.598	ref 1.08 (0.44–2.61)	0.870	ref 1.40 (0.39–5.03)	0.603
Calendar Year 2015 2016 2017 / 2018	ref 1.01 (0.44–2.32) 0.72 (0.27–1.90)	0.972	ref 0.63 (0.17–2.27) 1.81 (0.46–7.08)	0.478	ref 1.02 (0.24–4.24) 1.23 (0.20–7.61)	0.821

^aOR adjusted for age, racial identity, country of birth, and education. ^bTotal complete observations for any sex and CLS; 160; housing status; 154 observations; difficulty to pay for heating and ever taken ART: 156 observations. No missing data for the other variables in the table. aOR: adjusted odds ratio, CI confidence interval, CLS condomless sex, STI sexually transmitted infection, PHQ-9 patient health questionnaire-9, CAGE alcohol questionnaire.

Figure A1. Changes in the frequency of any sex (panel A), condomless sex (panel B), seroconcordant condomless sex (panel C) and serodiscordant condomless sex (panel D) over time. Total number questionnaires for panel A and B: 219, panel C and panel D: 146 from 73 men who completed all three visits.

Figure A2. Changes in the frequency of reporting (A) one regular partner, (B) one casual partner, (C) 2–5 partners, (D) 5–10 partners, and (E) more than 10 partners over time. No missing questionnaires.

Appendix 2. Unadjusted associations of factors with any sex, condomless sex, seroconcordant condomless sex, and serodiscordant condomless sex among 90 newly diagnosed HIV MSM participating in the Guy’s and St. Thomas’ Hospital observational study (n = 160 observations from week 12 and week 48).^a

Characteristics	Any sex^b		Condomless sex^c		CLS-C^d		CLS-D^e
	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
Age < 25 25–29 30–34 35–39 40–44 ≥ 45	ref 0.35 (0.01–10.16) 0.58 (0.18–18.71) 0.30 (0.01–9.76) 0.38 (0.01–13.44) 0.35 (0.01–11.34)	0.604	ref 0.31 (0.05–1.95) 0.41 (0.06–2.95) 0.37 (0.05–2.60) 0.32 (0.04–2.51) 0.39 (0.05–2.89)	0.786	ref 0.31 (0.06–1.49) 0.64 (0.13–3.23) 0.25 (0.05–1.34) 0.66 (0.12–3.52) 0.25 (0.05–1.32)	0.266	ref 0.83 (0.19–3.64) 0.56 (0.09–3.18) 1.38 (0.29–6.60) 0.31 (0.04–2.45) 1.15 (0.24–5.54)	0.513
Racial identity White Other race	ref 1.99 (0.52–7.74)	0.316	ref 1.06 (0.43–2.58)	0.904	ref 0.55 (0.18–1.61)	0.274	ref 2.10 (0.80–5.51)	0.132
Country of birth UK Outside the UK	ref 1.20 (0.49–3.28)	0.620	ref 0.99 (0.48–2.08)	0.993	ref 1.17 (0.51–2.66)	0.707	ref 0.87 (0.38–1.95)	0.733
University degree Yes No	ref 0.71 (0.27–1.86)	0.485	ref 0.86 (0.39–1.89)	0.709	ref 0.98 (0.42–2.30)	0.973	ref 0.76 (0.30–1.90)	0.559
Employment Full time / part time employment Unemployed / other	ref 1.31 (0.43–3.96)	0.632	ref 1.20 (0.46–3.16)	0.711	ref 1.33 (0.50–3.54)	0.563	ref 0.78 (0.24–2.52)	0.676
Housing status Own house Renting Other	ref 0.67 (0.24–1.92) 1.36 (0.30–6.06)	0.369	ref 0.66 (0.29–1.51) 1.55 (0.39–6.13)	0.277	ref 0.60 (0.23–1.61) 0.42 (0.07–2.38)	0.508	ref 1.01 (0.32–3.13) 4.25 (0.83–21.84)	0.125
Difficulty to pay for heating cost Yes No	ref 1.56 (0.70–3.45)	0.272	ref 1.18 (0.56–2.52)	0.661	ref 1.59 (0.55–4.59)	0.385	ref 0.86 (0.32–2.27)	0.755
Receive benefits Yes No	ref 2.35 (0.52–10.71)	0.268	ref 1.16 (0.27–5.06)	0.839	ref 1.14 (0.14–9.37)	0.904	ref 2.26 (0.20–25.35)	0.509
In relationship status No Yes, living with partner Yes, not living with partner	Ref 1.66 (0.64–4.31) 1.44 (0.66–3.09)	0.488	ref 0.97 (0.44–2.13) 1.00 (0.41–2.48)	0.997	ref 1.59 (0.71–3.56) 0.70 (0.24–2.03)	0.272	ref 0.55 (0.24–1.24) 1.02 (0.38–2.73)	0.315
Have a partner with HIV No Yes	ref 1 (success perfectly)		ref 4.05 (0.89–18.36)	0.069	ref 2.91 (0.83–10.22)	0.095	ref 1.13 (0.26–4.79)	0.872
Disclosure of HIV status to others Yes No	ref 0.57 (0.25–1.27)	0.167	ref 0.53 (0.21–1.35)	0.186	ref 0.80 (0.33–1.95)	0.626	ref 0.49 (0.16–1.54)	0.225
Currently on ART Yes No	ref 1.59 (0.26–9.54)	0.611	ref 1.04 (0.39–2.83)	0.930	ref 2.85 (1.17–6.91)	0.021	1	-
Detectable viral load Yes No	ref 1.17 (0.67–2.07)	0.575	ref 2.19 (1.25–3.83)	0.006	ref 0.96 (0.51–1.80)	0.903	ref 4.19 (1.62–10.84)	0.003
Recreational drug use (past 3 months) No Yes	ref 2.90 (1.39–6.05)	0.004	ref 3.04 (1.48–6.22)	0.002	ref 4.29 (1.59–11.62)	0.004	ref 1.21 (0.55–2.67)	0.631
STI diagnosis (past 3 months) No Yes	ref 1.82 (1.00–3.30)	0.050	ref 1.16 (0.53–2.53)	0.707	ref 1.26 (0.57–2.77)	0.565	ref 0.95 (0.39–2.35)	0.921
Depressive symptoms (PHQ-9 score ≥10) No Yes	ref 1.26 (0.25–6.45)	0.778	ref 0.47 (0.15–1.43)	0.182	ref 0.30 (0.07–1.33)	0.114	ref 0.73 (0.22–2.50)	0.623
Alcohol dependency symptoms (CAGE score ≥2) No Yes	ref 0.76 (0.18–3.28)	0.717	ref 1.22 (0.37–4.06)	0.742	ref 0.99 (0.29–3.41)	0.985	ref 1.03 (0.35–3.05)	0.960
Views on HIV transmission risk Agree to statement: A person on HIV treatment who has an undetectable viral load is less likely to transmit HIV to a sexual partner than someone with a high viral load No Yes Agree to statement: If an HIV positive person’s viral load is undetectable, it is not necessary to use a condom No Yes	ref 0.85 (0.43–1.67) ref 2.43 (1.33–4.47)	0.637 0.004	ref 1.63 (0.56–4.79) ref 3.33 (1.56–7.10)	0.370 0.002	ref 0.85 (0.24–3.05) ref 1.32 (0.63–2.78)	0.806 0.458	ref 2.45 (0.44–13.66) ref 2.99 (1.36–6.56)	0.307 0.006
Visit 12 weeks 48 weeks	ref 1.11 (0.65–1.91)	0.694	ref 1.83 (1.12–2.99)	0.017	ref 0.82 (0.45–1.49)	0.524	ref 3.59 (1.80–7.17)	<0.001
Calendar Year 2015 2016 2017 / 2018	ref 0.62 (0.27–1.41) 0.82 (0.30–2.22)	0.403	ref 1.20 (0.68–2.14) 1.22 (0.55–2.72)	0.808	ref 0.89 (0.44–1.79) 0.42 (0.15–1.15)	0.192	ref 2.11 (0.71–6.31) 4.13 (1.21–14.08)	0.050

^aRacial identity, country of birth, education, ever taken ART were fixed variables derived from baseline questionnaires: all other variables were time-updated variables in week 12 and 48.

^b Total complete observations for any sex and CLS: 160; housing status: 154 observations; difficulty to pay for heating and ever taken ART: 156 observations. No missing data for the other variables in the table.

^c Total complete observations for CLS-C: 156; housing status: 150 observations; difficulty to pay for heating and ever taken ART: 152 observations.

^d Total complete observations for CLS-D: 160; housing status: 154 observations; difficulty to pay for heating and ever taken ART: 156 observations.

Appendix 3. Factors associated with CLS, CLS-C and CLS-D at week 12 and week 48 among 90 newly diagnosed HIV MSM participating in the Guy’s and St. Thomas’ observational study.^a

Characteristics	CLS at week 12^b		CLS at week 48^c		CLS-C at week 12^d		CLS-C at week 48^e		CLS-D at week 12^f		CLS-D at week 48^g
	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
Age < 25 25–29 30–34 35–39 40–44 ≥ 45	ref 0.35 (0.05–2.49) 0.44 (0.06–3.15) 0.22 (0.03–1.77) 0.90 (0.12–6.86) 0.44 (0.06–3.15)	0.552	ref 0.44 (0.04–5.09) 0.80 (0.21–3.06) 1.40 (0.26–7.67) 1.50 (0.32–7.06) 0.52 (0.11–2.30)	0.691	ref 0.23 (0.03–1.79) 0.70 (0.11–4.59) 0.30 (0.04–2.37) 0.86 (0.12–6.02) 0.25 (0.03–1.95)	0.386	ref 0.40 (0.02–7.63) 0.43 (0.02–9.56) 0.17 (0.01–3.97) 0.62 (0.03–12.65) 0.23 (0.01–4.94)	0.699	ref 1.07 (0.01–13.02) 0.31 (0.02–6.07) 0.42 (0.02–8.19) 0.83 (0.06–11.59) 1.07 (0.09–13.02)	0.893	ref 0.40 (0.02–7.63) 0.67 (0.03–14.3) 1.33 (0.07–26.4) 0.08 (0.01–2.66) 0.78 (0.04–15.0)	0.237
Racial identity White Other race	ref 0.69 (0.22–2.15)	0.518	ref 1.47 (0.45–4.79)	0.526	ref 0.28 (0.06–1.37)	0.116	ref 0.92 (0.26–3.28)	0.894	ref 3.22 (0.79–12.98)	0.100	ref 1.55 (0.50–4.82)	0.444
Country of birth UK Outside the UK	ref 1.27 (0.52–3.05)	0.599	ref 0.80 (0.31–2.06)	0.646	ref 1.28 (0.48–3.41)	0.625	ref 0.98 (0.35–2.77)	1.00	ref 1.22 (0.32–4.58)	0.767	ref 0.81 (0.31–2.09)	0.659
Education University In between secondary level and university Secondary or high school	ref 2.58 (0.88–7.53) 1.11 (0.27–4.64)	0.217	ref 0.37 (0.12–1.15) 0.25 (0.05–1.19)	0.086	ref 1.69 (0.57–4.98) 1.01 (0.17–5.87)	0.629	ref 0.78 (0.20–2.65) 0.34 (0.04–3.07)	0.597	ref 2.72 (0.72–10.28) 1.00 ∼	0.140	ref 0.44 (0.12–1.55) 0.48 (0.09–2.62)	0.352
Employment Full time / part time employment Unemployed / other	ref 1.11 (0.33–3.82)	0.859	ref 1.27 (0.29–5.57)	0.753	ref 1.30 (0.34–4.98)	0.696	ref 1.47 (0.33–6.59)	0.615	ref 0.56 (0.06–4.92)	0.604	ref 0.89 (0.20–3.95)	0.884
Housing status Own house Renting Other	ref 0.64 (0.23–1.79) 0.82 (0.09–7.11)	0.698	ref 0.64 (0.19–2.19) 1.50 (0.22–10.45)	0.533	ref 0.68 (0.23–2.07) 0.57 (0.05–6.71)	0.776	ref 0.59 (0.16–2.13) 0.67 (0.09–4.64)	0.727	ref 0.76 (0.17–3.31) 1.89 (0.14–25.18)	0.742	ref 1.00 (0.29–3.45) 2.0 (0.34–11.69)	0.661
Difficulty to pay for heating cost Yes No	ref 0.92 (0.29–2.91)	0.883	ref 1.79 (0.56–5.73)	0.323	ref 1.67 (0.41–6.73)	0.474	ref 1.65 (0.41–6.69)	0.477	ref 0.48 (0.11–2.11)	0.333	ref 1.22 (0.37–4.08)	0.744
Receive benefits Yes No	ref 1.39 (0.22–8.88)	0.728	ref 0.80 (0.07–9.43)	0.862	ref 1.38 (0.13–14.2)	0.784	ref 0.70 (0.06–8.34)	0.781	ref 1.00		ref 1.10 (0.09–13.0)	0.936
In relationship status No Yes, living with partner Yes, not living with partner	ref 0.97 (0.37–2.51) 1.10 (0.32–3.76)	0.979	ref 0.87 (0.31–2.43) 0.79 (0.21–3.03)	0.933	Ref 2.46 (0.86–7.01) 1.07 (0.24–4.89)	0.201	ref 1.04 (0.34–3.14) 0.52 (0.09–2.83)	0.718	ref 0.14 (0.02–1.18) 0.67 (0.12–3.63)	0.193	ref 0.84 (0.29–2.39) 1.26 (0.33–4.84)	0.845
Have a partner with HIV No Yes	ref 10.75 (1.26–91.50)	0.030	ref 0.61 (0.03–10.31)	0.730	ref 4.33 (0.94–20.03)	0.060	ref 1.00		ref 2.09 (0.37–11.81)	0.402	ref 1.85 (0.11–31.32)	0.671
Disclosure of HIV status to others Yes No	ref 0.56 (0.17–1.84)	0.336	ref 0.58 (0.13–2.56)	0.473	ref 0.85 (0.24–3.07)	0.813	ref 0.93 (0.17–5.07)	0.929	ref 0.46 (0.05–3.98)	0.482	ref 0.57 (0.11–3.09)	0.518
Currently on ART Yes No	ref 1.30 (0.45–3.82)	0.625	1	-	ref 2.76 (0.89–8.59)	0.079	1	-	1	-	1	-
Detectable viral load Yes No	ref 1.61 (0.63–4.17)	0.321	ref 2.80 (0.71–11.05)	0.141	ref 1.5 (0.54–4.14)	0.434	ref 0.81 (0.19–3.52)	0.778	ref 1.41 (0.37–5.39)	0.611	ref 5.85 (0.69–49.63)	0.105
Recreational drug use in the past 3 months No Yes	ref 5.14 (1.53–17.23)	0.008	ref 4.77 (1.75–13.01)	0.002	ref 11.67 (1.44–94.52)	0.021	ref 3.47 (1.02–11.78)	0.046	ref 1.47 (0.29–7.53)	0.642	ref 1.93 (0.71–5.29)	0.198
STI diagnosis in the past 3 months No Yes	ref 2.33 (0.88–6.21)	0.090	ref 1.52 (0.35–6.46)	0.573	ref 1.38 (0.48–3.91)	0.547	ref 1.23 (0.28–5.37)	0.778	ref 2.37 (0.64–8.73)	0.195	ref 1.24 (0.32–4.91)	0.753
Depressive symptoms (PHQ-9 score ≥10) No Yes	ref 0.43 (0.12–1.54)	0.197	ref 0.45 (0.11–1.84)	0.264	ref 0.39 (0.08–1.96)	0.253	ref 0.31 (0.04–2.74)	0.296	ref 0.51 (0.06–4.40)	0.539	ref 0.89 (0.20–3.95)	0.884
Alcohol dependency symptoms (CAGE score >2) No Yes	ref 0.81 (0.17–3.90)	0.794	ref 1.27 (0.29–5.57)	0.753	ref 1.11 (0.19–6.56)	0.909	ref 0.78 (0.15–4.14)	0.768	ref 1.00		ref 1.53 (0.37–6.31)	0.556
Views on HIV transmission risk Agree to statement: A person on HIV treatment who has an undetectable viral load is less likely to transmit HIV to a sexual partner No Yes Agree to statement: If an HIV positive person’s viral load is undetectable, it is not necessary to use a condom No Yes	ref 1.10 (0.31–3.97) ref 2.70 (0.99–7.37)	0.878 0.053	ref 1.69 (0.31–9.10) ref 6.52 (1.95–21.83)	0.540 0.002	ref 0.49 (0.13–1.80) ref 1.69 (0.58–4.88)	0.283 0.335	ref 1.86 (0.20–17.24) ref1.20 (0.42–3.45)	0.583 0.735	ref 1.00 ref 1.62 (0.42–6.22)	0.479	ref 1.11 (0.19–6.57) ref 4.48 (1.63–12.35)	0.908 0.004

^aRacial identity, country of birth, education, and ever taken ART were derived from baseline questionnaires: all other variables were time-updated variables at week 12 and week 48; multivariable models adjusted for age, racial identity, country of birth, and education did not change the associations.

^b housing status: 83 observations; difficulty to pay for heating: 83 observations; ever taken ART: 82 observations; other variables no missing questionnaires.

^c housing status: 71 observations; difficulty to pay for heating: 73 observations; ever taken ART: 74 observations; other variables no missing questionnaires.

^d housing status and difficulty to pay for heating: 79 observations and ever taken ART: 78 observations; other variables no missing questionnaires

^e housing status: 71 observations; difficulty to pay for heating: 73 observations and ever taken ART: 74 observations; other variables no missing questionnaires

^f housing status and difficulty to pay for heating: 83 observations; received benefits: 79 observations; ever taken ART: 82 observations; CAGE score: 77 observations; other variables no missing questionnaires

^g housing status: 71 observations; difficulty to pay for heating: 73 observations; ever taken ART: 74 observations; other variables no missing questionnaires

^∼ omitted due to collinearity

Factors associated with stopping CLS at week 12 among 52 men who reported condomless sex at baseline in the Guy’s and St. Thomas’ Hospital observational study^a.

Characteristics	Stopping any condomless sex at week 12^b
	OR (95% CI)	p-value
Age < 25 25–29 30–34 35–39 40–44 ≥ 45	ref 1.00 (0.18–5.45) 0.80 (0.14–4.61) 1.50 (0.25–8.98) 0.17 (0.01–1.95) 1 (empty observations) ∼	0.555
Racial identity White Other race	ref 2.33 (0.54–10.16)	0.259
Country of birth UK Outside the UK	ref 3.11 (0.84–11.55)	0.090
Education University In between secondary level and university Secondary or high school	ref 0.33 (0.08–1.41) 0.80 (0.11–5.53)	0.326
Employment Full time / part time employment Unemployed / other	ref 1.35 (0.31–5.85)	0.688
Housing status Own house Renting Other	ref 2.28 (0.52–9.98) 3.00 (0.13–66.25)	0.523
Difficulty to pay for heating cost Yes No	ref 1.67 (0.29–9.70)	0.570
Receive benefits Yes No	ref 0.29 (0.02–3.51)	0.331
In relationship status No Yes, living with partner Yes, not living with partner	ref 1.56 (0.43–5.67) 1.78 (0.39–8.02)	0.696
Have a partner with HIV No Yes	ref 0.16 (0.02–1.40)	0.098
Disclosure of HIV status to others Yes No	ref 1.07 (0.16–7.19)	0.941
Currently on ART Yes No	ref 0.38 (0.06–2.53)	0.316
Recreational drug use in the past 3 months No Yes	ref 0.21 (0.05–0.86)	0.030
STI diagnosis in the past 3 months No Yes	ref 0.82 (0.24–2.75)	0.746
Depressive symptoms (PHQ-9 score ≥10) No Yes	ref 2.33 (0.73–7.40)	0.150
Alcohol dependency symptoms (CAGE score >2) No Yes	ref 1.00∼
Views on HIV transmission risk Agree to statement: A person on HIV treatment who has an undetectable viral load is less likely to transmit HIV to a sexual partner No Yes Agree to statement: If an HIV positive person’s viral load is undetectable, it is not necessary to use a condom to prevent transmission of HIV No Yes	ref 0.59 (0.10–3.29) ref 0.64 (0.18–2.24)	0.544 0.482

^aRacial identity, country of birth, education, and ever taken ART were derived from baseline questionnaires: all other variables were time-updated in week 12.

^bhousing status: 51 observations; CAGE score: 49 observations.

∼ omitted due to collinearity