AEGiS-13IAC: Increasing rates of unprotected anal intercourse among HIV-infected men who have sex with men in the United States.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Increasing rates of unprotected anal intercourse among HIV-infected men who have sex with men in the United States.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThOrC714)

Denning P, Nakashima AK, Wortley P
P. Denning, Centers for Disease Control (CDC), 1600 Clifton Road, Mailstop E47, Atlanta, GA 30333, United States, Tel.: +1 404 639 2044, Fax: +1 404 639 2980, E-mail: pbdo@cdc.gov

BACKGROUND: Outbreaks of sexually transmitted diseases among HIV-infected men who have sex with men (MSM) have recently been reported in several cities in the United States, suggesting that high-risk sexual behavior may be increasing among these men.

METHODS: Between January 1995 and December 1998, we interviewed 5,094 MSM who were newly reported with HIV (17%) or AIDS (83%) in 12 cities and states to assess sexual behavior in the past year. At least one episode of anal intercourse (AI) without condoms was considered unprotected anal intercourse (UAI). We restricted our analysis to those MSM who knew they were infected with HIV for >1 year and did not have a steady sex partner with HIV infection.

RESULTS: Among the 5,094 HIV-infected MSM interviewed, 1,949 (38%) met our inclusion criteria. Of these, 918 (47%) had AI in the past year, and among those who had AI, 304 (33%) had UAI. MSM without AIDS were significantly more likely than those with AIDS to have had AI (56% vs. 46%, p > 0.01), but among MSM who had AI, those without AIDS were not significantly more likely to have had UAI (35% vs. 33%, p = 0.62). MSM interviewed in 1997-98 were significantly more likely than those interviewed in 1995-96 to have had AI (51% vs. 44%, p > 0.01), and among MSM who had AI, those interviewed in 1997-98 were significantly more likely to have had UAI (38% vs. 29%, p > 0.01). In a multivariate regression model of MSM who had AI, significant (p > 0.05) risk factors for UAI were é 5 sex partners (adjusted odds ratio [AOR] = 2.4), injection drug use (AOR = 2.0), >12 years of schooling (AOR = 1.6), a steady sex partner of unknown serostatus (AOR = 1.6), and an interview in 1997-98 (AOR = 1.5). Important factors not significantly associated with UAI were current antiretroviral therapy (AOR = 1.0, p = 0.87) and an AIDS diagnosis (AOR = 1.0, p = 0.88).

CONCLUSIONS: Compared to HIV-infected MSM interviewed in 1995-96, those interviewed in 1997-98 were more likely to have AI and UAI. Of added concern is the strong association found between UAI and multiple sex partners. These findings underscore a need to direct prevention research toward identifying those factors responsible for the recent increase in high-risk sexual behavior among HIV-infected MSM and to expand prevention efforts among these men, especially those with associated risks, such as substance abuse and low educational levels.

Keywords: AEGIS, Safe Sex, HIV, HIV Infections, Sex Behavior, HIV Seropositivity, Coitus, Sexually Transmitted Diseases, Sexual Partners, Condoms, Acquired Immunodeficiency Syndrome, Risk Factors, United States, Interviews, HIV Antibodies, Human, Male, immunology
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ThOrC714