Dynamics of Sexual Risk Behavior in HIV-Infected Men Who Have Sex with Men

Much is known about the factors associated with risky sexual behavior among HIV-negative men who have sex with men (MSM) and among MSM whose HIV antibody status is unknown. However, little is known about the dynamics of continuing risky behavior among HIV-positive MSM. This research employed both questionnaire and extensive individual interview techniques to assess the levels of risky behavior, as well as the factors associated with risky behavior, in a sample of 42 seropositive MSM. Findings suggest that risky behavior occurs with some frequency, and that it is occasioned by informational, motivational, and behavioral skills-relevant deficits in the population at focus. Moreover, levels of risky behavior appear to differ with seropositive and seronegative primary partners. Implications for designing interventions for seropositive MSM are discussed.     

Evaluation of an HIV Prevention Intervention for Men Who Have Sex with Men at Cruising Areas in the Netherlands

This study collected data from 362 men who had sex with men at cruising areas in the Netherlands, and measured characteristics of respondents, sexual risk behavior, and risk perceptions. Furthermore, the study assessed whether outreach activities at cruising areas promote safe sex behavior. Almost one in five respondents reported having sex with both men and women, and 18.5% of respondents reported sexual risk behavior at cruising areas. Men who had a conversation about safe sex with a volunteer used condoms more consistently than men who had not spoken with a volunteer. Finally, it was found that behaviorally bisexual men used condoms less frequently at cruising areas. The relatively high levels of risk-taking sex stress the importance of HIV prevention at cruising areas. Furthermore, special attention could be given to cruising area visitors who have sex with both men and women, because they report higher levels of risk behavior and have less access to safer sex information regarding homosexual behavior.     

Partner Awareness of the Serostatus of HIV-Seropositive Men Who Have Sex With Men: Impact on Unprotected Sexual Behavior

Prior research has provided conflicting evidence about the association between partner awareness of an HIV-seropositive persons serostatus and HIV transmission behavior via unprotected intercourse. The current study examined partner awareness of participant HIV-seropositive status and sexual behavior in a multiethnic sample of HIV-seropositive men who have sex with men. Most HIV-seropositive men reported that their primary partners are aware, and most reported that at least some non-primary partners are aware the participant was HIV-seropositive before first having sex. Partner awareness of participant HIV-serostatus was related to unprotected sexual behavior during the past 3 months in a non-linear fashion, as men with partners who were inconsistently aware had higher rates of unprotected receptive anal intercourse than men with partners who were consistently aware or consistently unaware. Men with partners who were inconsistently aware also had higher rates of insertive oral intercourse than men with partners who were consistently aware. However, there were no differences in HIV transmission risk behavior between men with partners who were consistently aware and men with partners who were consistently unaware a participant was HIV-seropositive.     

Factors Associated with Recent HIV Testing among Men Who Have Sex with Men in Philadelphia: a Cross-Sectional Analysis of the National Behavioral Surveillance System Survey

The main objective of this study was to determine the demographic, geographic and socioeconomic characteristics of men who have sex with men (MSM) in Philadelphia that were associated with having a recent HIV test. We used data from the National HIV Behavioral Surveillance System (NHBS) surveys from 2011 and 2014 among MSM in Philadelphia, with the outcome of interest of having received an HIV test in the past twelve months. Of 1043 HIV-negative MSM, 70.2% had an HIV test. Multivariable analysis showed that seeing a medical provider (aOR: 1.73; p?=?.0039) or having heard of PrEP (aOR: 2.24; p?<?.0001) was associated with recent HIV testing. Those participants forty-five years of age or older (aOR 0.40, p?=?.0001) and those with Medicaid had lower rates of HIV testing (aOR 0.48, p?=?.002). Although over 80% of participants had seen a medical provider in the past year, only 50% had been offered an HIV test by a provider. Optimizing HIV testing through the expansion and increased awareness of PrEP, especially among older MSM, is critical. Further research is needed to delineate barriers that prevent MSM from utilizing medical providers for HIV testing and for those with Medicaid from receiving HIV testing.     

Challenges in Research on Drug and Sexual Risk Practices of Men Who Have Sex with Men: Applications of Ethnography in HIV Epidemiology and Prevention

Epidemiological studies of persons who engage in illicit or illegal activities suffer from methodological difficulties in population definition and specification. Additionally, particularly in the context of HIV research, studies often lack the specificity and validity needed to understand and intervene in the behavioral practices by which viral pathogens such as HIV are transmitted. These limitations are particularly complicated in research among populations of drug-involved, men who have sex with men (DU/MSM), a hidden but internally diverse population which varies in both sexual behavior and drug use patterns across a number of complex and interacting dimensions. The challenges become even more profound when we factor in complexities of sexual identity and identity formation, the debilitating effects of multiple sources of stigma, and the economic imperatives that underpin drug and sexual risk practices among some groups of DU/MSM. This paper describes some of the uses of ethnographic methods, particularly participant-observation, in specifying the nature and interrelationship between risk practices among DU/MSM. We also show how ethnography can contribute to the process of disentangling the independent effects of age, period, and cohort factors, a perennial problem in epidemiological research in out-of-treatment populations.     

Reasons for Not Taking an HIV-Test Among Untested Men Who Have Sex with Men: An Internet Study

The present paper focuses on reasons for not taking an HIV-test among untested men who have sex with men (MSM). From an MSM web-based survey, 1627 MSM who had never tested for HIV were selected for the reported analyses. Results show that fear of a positive test result and the perceived consequences thereof, are reported as the most important reasons for not taking an HIV-test among at-risk respondents. The most important reasons for not taking an HIV-test among no-risk respondents are related to perception of low risk for HIV-infection. Implications for future interventions to promote HIV-testing are discussed.     

Recruitment Source and Behavioral Risk Patterns of HIV-Positive Men Who Have Sex with Men

To effectively target HIV prevention activities, community outreach workers need to know how to locate persons at greatest risk for acquiring or transmitting HIV. This study compared the behavioral characteristics of HIV-positive men who have sex with men recruited from different sources: AIDS service organizations, mainstream gay environments, public/private sex environments, and friend referrals. Men recruited from sex environments exhibited the riskiest behavior: more male partners, more likely to have casual sex, more likely to have had unprotected insertive sex with men of HIV-negative or unknown status, less likely to have disclosed serostatus to primary partners, less comfortable discussing serostatus with others, and less feeling of personal responsibility for disclosure. A distinctive group of men, the referral group, did not identify with the gay community and reported sex with men and women. Future efforts should continue to assess the types of people that are recruited from different sources so that program and research efforts can be appropriately targeted.The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.An erratum to this article can be found at     

High HIV Risk but Inadequate Prevention Services for Men in China Who Have Sex with Men: An Ethnographic Study

China is facing an emerging HIV epidemic among men who have sex with men (MSM). However, the HIV risk and prevention needs of these men are not well understood. We conducted in-depth qualitative interviews between August and October 2000 with 38 persons who identified as being MSM or knowledgeable about the MSM population in Beijing. Our ethnographic study identified 20 different segments of the population of MSM in Beijing and 14 distinct types of venues where these men congregate. Despite high levels of sexual risk taking, few men perceived themselves to be at risk for HIV. The main reasons cited for engaging in unsafe sex were economic survival, misconceptions about HIV, inaccurate assessment of a partner's risk, trusting a partner or needing to prove a partner trustworthy, meeting an attractive partner, and cruising in public sex environments. The HIV prevention services currently available in Beijing include mass media education, hotline information and counseling services, venue-based outreach, hospital-based services, and Internet sites, but few of these programs specifically targeted the MSM population. The major barriers to utilizing exiting services were lack of perceived risk, lack of privacy and anonymity, uninteresting program content, and distrust and questionable credibility of providers. Programs need to address issues broader than AIDS, be peer-designed and peer-led, be entertaining, and receive more government support. Our data suggest that many MSM are at high risk for HIV, but receive inadequate services. More effective and sustainable programs must be developed and implemented to prevent the further spread of HIV in this population.     

Prevalence of Sexually Transmitted Infections Among Men Who Have Sex with Men in Zagreb, Croatia

We used respondent-driven sampling among men who have sex with men (MSM) in Zagreb, Croatia in 2006 to investigate the prevalence of HIV, other sexually transmitted infections and sexual behaviours. We recruited 360 MSM. HIV infection was diagnosed in 4.5%. The seroprevalence of antibodies to viral pathogens was: herpes simplex virus type-2, 9.4%; hepatitis A, 14.2%; hepatitis C, 3.0%. Eighty percent of participants were susceptible to HBV infection (HBs antigen negative, and no antibodies to HBs and HBc antigen). Syphilis seroprevalence was 10.6%. Prevalence of Chlamydia and gonorrhoea was 9.0%, and 13.2%, respectively. Results indicate the need for interventions to diagnose, treat and prevent sexually transmitted infections among this population.     

Running in Place: Implications of HIV Incidence Estimates among Urban Men Who Have Sex with Men in the United States and Other Industrialized Countries

Attempts to document changing HIV incidence rates among MSM are compromised by issues of generalizability and statistical power. To address these issues, this paper reports annualized mean HIV incidence rates from the entire published incidence literature on MSM from Europe, North America and Australia for the period 1995–2005. Publications that met the entry criteria were coded for region of the world, sampling method and year of study. From these reports, we calculated a mean incidence rate with confidence intervals for these variables. Although no differences in mean incidence rates were found for MSM from 1995 to 2005, HIV incidence rates are lower in Australia than either North America or Europe. We calculated a mean incidence rate of 2.39% for MSM in the United States, which if sustained within a cohort of MSM, would yield HIV prevalence rate of approximately 40% at age 40. These extrapolations overlap published HIV prevalence rates for MSM younger than age 40 in the United States. HIV incidence rates in the 2–3% range will adversely affect the health of gay male communities for decades to come. This analysis suggests that greater attention should be devoted to the question of how best to design prevention interventions that will lower HIV incidence rates among gay men.     

Intertwining Epidemics: A Review of Research on Substance Use Among Men Who Have Sex with Men and Its Connection to the AIDS Epidemic

This paper reviews the (1) literature on substance use among men who have sex with men (MSM), (2) data that test whether connections between substance use and abuse and high-risk sexual behavior exist among MSM, and (3) ways that HIV interventions might address the effects of substance use on high-risk sexual behavior. We conclude that while alcohol use patterns are not substantially different between gay and heterosexual men, gay men do use more kinds of other drugs. Although there is considerable evidence to support the view that substance use patterns have declined among gay men since the mid-1980s, substance use should still be regarded as a health risk in this population. Although the associations between substance use and sexual risk-taking for HIV are complex, the inclusion of interventions to disentangle substance use and high-risk sexual practices may increase the efficacy of AIDS prevention efforts among gay men.     

HIV-related Sexual Risk Taking Among HIV-negative Men Who Have Sex with Men in Zagreb,Croatia

Croatia has a low-level HIV epidemic and, as in a number of other Central and Southeastern European countries, sex between men accounts for most HIV infections. This study examines sexual behavior and the correlates of condom use in a snowball sample of 342 HIV non-infected men who have sex with men (MSM) in Zagreb. The median age of participants in the sample was 27 years. The majority of participants (81%) reported using condom at last anal sex with casual partner and 56% claimed to have used condoms consistently at anal sex with casual partners in the last 12 months. HIV risk self-assessment and number of sexual partners were significantly correlated with condom use at last anal sex with casual partner. Self-assessed HIV-risk and heterosexual activity were found associated with consistent condom use at anal sex with casual partners. To sustain a low-level HIV epidemic, targeted intervention among young MSM is needed in Croatia.     

Why HIV Infections Have Increased Among Men Who Have Sex with Men and What to Do About It: Findings from California Focus Groups

A resurgence of sexual risk taking, STDs, and HIV incidence has been reported among men who have sex with men (MSM) in several countries. We asked 113 MSM in 12 focus groups conducted in five California cities to identify factors leading to increased risk taking and assess prevention messages to reduce risk in this population. Participants perceived that HIV risk taking has increased because (1) HIV is not the threat it once was due to more effective therapies, (2) MSM communicate less about HIV, and social support for being safe has decreased, and (3) community norms have shifted such that unsafe sex is more acceptable. The prevention messages ranked most likely to motivate risk reduction encouraged individuals to seek social support from friends. Themes ranked least likely to succeed were those that described the negative consequences of HIV or reinforced existing safer sex messages.     

Rising HIV Prevalence Among Married and Unmarried Among Men Who Have Sex with Men: Jinan, China

We report on two waves of bio-behavioral surveillance of MSM in Jinan, Shandong Province, China. HIV prevalence rose from 0.05% in 2007 to 3.1% in 2008. Differences in the two waves of surveys were noted, particularly with respect to marital status, requiring stratified analysis. In multivariable analysis, unmarried, homosexually identified MSM who do not have female sex partners have a greater than sixfold greater chance of being infected with HIV compared to married, non-homosexually identified MSM who do have female partners. Carefully targeted and population-specific messages will be needed for homosexually identified and non-identified MSM in China.     

Behavioral intention to take up different types of HIV testing among men who have sex with men who were never-testers in Hong Kong

Human immunodeficiency virus (HIV) testing is an important global prevention strategy but underutilized by local men who have sex with men (MSM). This study investigated the prevalence of behavioral intention to take up HIV testing (specific or any type), in the next six months among MSM who had not been tested for HIV in the last three years (never-testers) in Hong Kong. The data was based on 141 never-testers of 430 MSM who completed the anonymous baseline telephone survey of an ongoing randomized controlled trial from January 2015 to August 2015. Only 17.7% of them showed strong intention to take up any type of HIV testing in the next six months. Adjusted analysis showed that perceived benefit of HIV testing (adjusted odds ratio [AOR]: 1.29, 95% confidence interval [CI]: 1.01, 1.66), perceived psychological barriers of HIV testing (AOR: 0.85, 95%CI: 0.73, 1.00), and perceived self-efficacy in taking up HIV testing (AOR: 1.28, 95%CI: 1.07, 1.52) were significantly associated with behavioral intention to take up any HIV testing. Perceived cue to action from non-governmental organization staff was positively associated with a marginal p-value of 0.077 (AOR: 2.37, 95%CI: 0.97, 5.77). It is warranted to strengthen perceived benefit, remove psychological barriers, and increase perceived self-efficacy related to HIV testing. Innovative and effective health promotions are greatly needed to increase HIV testing coverage among never-testers.     

Inconsistent Condom Use with Steady and Casual Partners and Associated Factors among Sexually-Active Men who Have Sex with Men in Bangkok, Thailand

HIV/STD risk behavior has not been examined in community samples of men who have sex with men (MSM) in Thailand. The sexually-active sample (n=927) was recruited from bars, saunas, and parks; 20% identified as bisexual and 17% tested HIV-positive. Inconsistent (<100%) condom use was reported by 45% of those with steady partners and 21% of those with casual partners in the prior three months. 21% had heard of effective HIV treatments (n=194), among whom 44% believed HIV was less serious and 36% said their risk behavior had increased after hearing about the treatments. In multivariate analysis, HIV-positive status, gay-identification, getting most HIV information from the radio, believing HIV can be transmitted by mosquito bite, and concern about acquiring an STD were associated with inconsistent condom use during anal sex; slightly older age (25–29 vs. 18–24 years) was associated with more consistent condom use. HIV/STD risk-reduction strategies for MSM in Bangkok should clearly state sexual risk to individuals in this population.     

Risk Factors for Syphilis and Prevalence of HIV, Hepatitis B and C among Men Who Have Sex with Men in Beijing, China: Implications for HIV Prevention

To examine the correlates for syphilis and the prevalence for HIV, hepatitis B, hepatitis C among men-who-have-sex-with-men (MSM) in Beijing, China. A total of 541 MSM was recruited using peer-referral, community outreach, and Internet. Questionnaire-based interviews provided information including, demographics, sexual and other risk behaviors. HIV prevalence was 4.8%, syphilis 19.8%, HCV 0.4% and HBsAg 6.5%. The median number of lifetime male sex partners was ten. In the past 3 months, 20.7% drank alcohol ≥1 times per week. In the past month, 21.3 and 14.6% had unprotected anal intercourse with regular and casual male sex partners, respectively. Syphilis infection was associated with less education, alcohol use, finding male sex partners through bathhouses/public washrooms/parks, and diagnoses of sexual transmitted diseases (STDs). Syphilis is now epidemic among Beijing’s MSM. Prevention efforts are urgent as HIV prevalence is already near 5%. Education, condom promotion, STD control, and alcohol-related intervention are needed urgently.     

The Role of Human Papillomavirus in Human Immunodeficiency Virus Acquisition in Men who have Sex with Men: A Review of the Literature

Human Papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide. Incidence rates of HPV infection among human immunodeficiency virus (HIV)-infected individuals are well documented and are several-fold higher than among HIV-uninfected individuals. Few studies have demonstrated an increased risk for acquiring HIV infection in those with HPV infection, and this risk seems to be higher when HPV strains are of high-risk oncogenic potential. The estimated prevalence of high-risk oncogenic HPV infection is highest in men who have sex with men (MSM), a particularly vulnerable group with high prevalence rates of HIV infection and other STIs. In this paper, we provide a comprehensive review of the available literature on the role of HPV infection in HIV acquisition. Our review includes data from cross-sectional and longitudinal studies.