Sexual Risk Behaviors of HIV-Positive,HIV-Negative,and Serostatus-Unknown Black Men Who Have Sex with Men and Women

Black men who have sex with men and women (MSMW) are at high risk for HIV infection and transmission. This study compared the sexual risk behaviors of Black MSMW who self-reported being HIV-positive with those who reported being HIV-negative and those who did not know their HIV status. Respondent-driven sampling (RDS) was used to recruit 1,154 Black MSM in Philadelphia and New York who completed an audio computer-assisted self-interview (ACASI). Of these men, 212 had engaged in anal sex with male partners and vaginal or anal sex with female partners in the past 3 months. A quarter (23.6%; n = 50) of MSMW self-reported testing positive for HIV at their last test, 59.4% (n = 126) reported testing negative for HIV at their last test, and 17.0% (n = 36) reported never having an HIV test. Multivariate logistic regression analysis revealed that HIV-positive MSMW were much less likely than HIV-negative men and never-tested men to have engaged in unprotected intercourse with main male and main female partners perceived to be HIV-negative or of unknown serostatus. However, HIV-positive men were equally as likely as HIV-negative men to have unprotected intercourse with non-main male and non-main female partners perceived as HIV-negative or of unknown serostatus. Our findings indicate that some HIV-positive MSMW engage in unprotected sex that places female and male partners at risk for HIV infection. However, MSMW who have never taken an HIV test, or who have not been recently tested, may be a greater source of HIV transmission to their female and male partners.     

Unprotected sex among youth living with HIV before and after the advent of highly active antiretroviral therapy

CONTEXT: Since the advent of highly active antiretroviral therapy (HAART) in 1996, the incidence of HIV-especially among young men who have sex with men-and the prevalence of unprotected sex among HIV-positive persons have increased. The characteristics associated with unprotected sex among youth living with HIV since the advent of HAART have not been explored. METHODS: Samples of HIV-positive youth aged 13-24 were taken from two intervention studies that targeted the sexual behaviors of HIV-positive youth-one from 1994 to 1996 (pre-HAART) and the other from 1999 to 2000 (post-HAART). Generalized estimating equations were used to identify characteristics associated with unprotected sex in each sample. RESULTS: The prevalence of unprotected sex in the post-HAART sample was more than twice that in the pre-HAART sample (62% vs. 25%). Among the pre-HAART sample, being a man who has sex with men and having sex with a casual partner were negatively associated with the odds of unprotected intercourse (odds ratios, 0.5 and 0.2, respectively). Among the post-HAART sample, unprotected sex was negatively associated with knowing that a partner was HIV-negative (0.2) and positively associated with poorer mental health (1.02). In analyses among the post-HAART sample, poorer mental health was associated with increased odds of unprotected sex among youth living with HIV who were not receiving the treatment (1.02). CONCLUSIONS: Interventions for HIV-positive youth must be designed to address the complex needs of those youth who simultaneously suffer from HIV and poor mental health.     

Missouri toughens penalty for knowingly exposing others

The Missouri State Senate passed a law that makes it simpler to prosecute persons who knowingly transmit HIV to others through unprotected sex or needle sharing. The bill was sponsored in response to the case of Darnell "Boss Man" McGee, a man who had sex with more than 100 girls and women after he was diagnosed with HIV. Senate Bill 347 gives prosecutors more leeway when preparing cases against those who recklessly expose others to HIV through blood, semen, or vaginal fluid in the course of sex or needle sharing. The law also allows judges to order HIV tests for persistent prostitutes.     

Plea in exposure case

An HIV-positive Indianapolis man was sentenced to one year in a work-release program and one year on probation for having unprotected sex with two women. The man was jailed earlier this year for exposing a sex partner to HIV. In exchange for his guilty plea to two felonies of criminal recklessness, prosecutors dropped a misdemeanor charge of failure to warn. None of the women have tested HIV positive.     

Court upholds man's conviction for attempted murder

A three-judge panel of the Oregon Court of Appeals upheld the jury conviction of Timothy Alan Hinkhouse. Mr. Hinkhouse was found guilty of ten counts of attempted murder and attempted assault for engaging in unprotected sex with the knowledge that he is HIV-positive. The Appeals Court panel found that there was ample evidence to show that Hinkhouse knew about his HIV status, lied about his serostatus, disregarded warnings not to engage in unprotected sex, and threatened to spread the virus to others. Hinkhouse engaged in unprotected sex with an underage girl and a series of women, even after signing an agreement not to engage in sex without permission from his probation officer. The appeals court rejected the defense attorney's argument that Hinkhouse meant to satisfy his sexual urges and did not intend to cause harm or death.     

Behaviorally Bisexual Men and their Risk Behaviors with Men and Women

Gay and bisexual men are often treated as a homogenous group; however, there may be important differences between them. In addition, behaviorally bisexual men are a potential source of HIV infection for heterosexual women. In this study, we compared 97 men who have sex with men only (MSM) to 175 men who have sex with men and women (MSMW). We also compared the 175 MSMW to 772 men who have sex with women only (MSW). Bivariate and multiple logistic regression analyses were performed to assess correlates of MSMW risk behaviors with men and with women as well as whether MSMW, compared with MSW, engaged in more risky behaviors with women. Compared with MSM, MSMW were less likely to be HIV-positive or to engage in unprotected receptive anal intercourse. In contrast, MSMW were more likely than MSW to be HIV-positive and to engage in anal intercourse with their female partners; however, rates of unprotected anal intercourse were similar. The study findings suggest that there may be important differences in HIV risk behaviors and HIV prevalence between MSM and MSMW as well as between MSMW and MSW.     

Behaviorally Bisexual Men and their Risk Behaviors with Men and Women

Gay and bisexual men are often treated as a homogenous group; however, there may be important differences between them. In addition, behaviorally bisexual men are a potential source of HIV infection for heterosexual women. In this study, we compared 97 men who have sex with men only (MSM) to 175 men who have sex with men and women (MSMW). We also compared the 175 MSMW to 772 men who have sex with women only (MSW). Bivariate and multiple logistic regression analyses were performed to assess correlates of MSMW risk behaviors with men and with women as well as whether MSMW, compared with MSW, engaged in more risky behaviors with women. Compared with MSM, MSMW were less likely to be HIV-positive or to engage in unprotected receptive anal intercourse. In contrast, MSMW were more likely than MSW to be HIV-positive and to engage in anal intercourse with their female partners; however, rates of unprotected anal intercourse were similar. The study findings suggest that there may be important differences in HIV risk behaviors and HIV prevalence between MSM and MSMW as well as between MSMW and MSW.     

Infected sex partner wins dismissal of assault charges

The California Court of Appeals ruled that a man who had unprotected intercourse with an underage female without disclosing his positive HIV status cannot be charged with aggravated assault. The court determined that prosecutors did not prove that the risk of HIV transmission from one act of unprotected heterosexual sex fell within California's definition of aggravated assault. The defendant, Dennis Guevara, will face trial on four counts of unlawful sexual intercourse, one count of failing to register as a sex offender, and two counts of assault with a deadly weapon. Guevara argued that because the sex was consensual he could not be convicted of aggravated assault; this argument was rejected. Guevara also argued that California's statutes violate his equal protection rights under the Constitution because they apply only to adult men who have sex with women and not the reverse. He also argued that the statutes discriminate against HIV carriers. The Supreme Court stated that the gender distinction protects women from becoming infected and passing the infection on to her infant in utero.     

Psychosocial Correlates of Unprotected Sex Without Disclosure of HIV-Positivity among African-American,Latino, and White Men Who Have Sex with Men and Women

African-American, Latino, and White men who have sex with men and women (MSMW) may be a bridge of HIV transmission from men to women. Very little research has directly compared culturally specific correlates of the likelihood of unprotected sex among MSMW. The present study examined psychosocial correlates of unprotected sex without disclosure of HIV status with male and female partners among 50 African American, 50 Latino, and 50 White HIV-positive MSMW recruited from AIDS service organizations in Los Angeles County. Multivariate logistic regressions were conducted to examine relationships of race/ethnicity and psychosocial variables (e.g., condom attitudes, self-efficacy for HIV disclosure, sexual identification) to unprotected sex without disclosure of HIV status, for male and female partners separately. For female partners, different effects emerged by race/ethnicity. Among African-Americans, less exclusively homosexual identification and low self-efficacy for disclosure of HIV status to female partners were associated with unprotected sex without disclosure; among Latinos, less exclusively homosexual identification and negative attitudes about condoms were significant. Participants who were more exclusively homosexually identified, who held less positive condom attitudes, and who had low self-efficacy for disclosure to female partners were more likely to have unprotected sex without disclosure of HIV status to male partners. Culturally tailored community-level interventions may help to raise awareness about HIV and bisexuality, and decrease HIV and sexual orientation stigma, thereby increasing African-American and Latino MSMW's comfort in communicating with their female partners about sexuality, HIV and condoms. Addressing norms for condom use and disclosure between male partners is recommended, especially for homosexually identified MSMW.     

Sexual Risk Behavior of HIV-Positive Methamphetamine-Using Men Who Have Sex with Men: The Role of Partner Serostatus and Partner Type

This study examined the role of partner serostatus and partner type in relation to the sexual risk behaviors and disclosure practices of HIV-positive methamphetamine (meth)-using men who have sex with men (MSM). The sample consisted of 132 HIV-positive meth-using MSM who reported having both serodiscordant (i.e., HIV-negative and unknown serostatus) and seroconcordant (i.e., HIV-positive) partners. HIV-positive meth-using MSM engaged in significantly fewer acts of anal sex with serodiscordant partners as compared to seroconcordant partners. However, mean levels of unprotected anal and oral sex were high, and mean levels of protected sex were low for both seroconcordant and serodiscordant partners. Oral sex was practiced twice as often as anal sex; however, both types of sex were primarily unprotected. This pattern of risky sexual behavior was reported for steady, casual, and anonymous partners, regardless of partner serostatus. Despite high rates of unprotected sex, rates of HIV serostatus disclosure were consistently high for HIV-positive and HIV-negative steady, casual, and anonymous partners. However, rates of disclosure to unknown serostatus partners were low, particularly in relation to anonymous partners. Future research should address the reasons why HIV-positive meth-using MSM engage in risky sexual activity with serodiscordant partners, and HIV prevention programs for this population should emphasize the risks associated with unprotected sex with seroconcordant partners.     

Risk for HIV and Unprotected Sexual Behavior in Male Primary Partners of Transgender Women

Men who have sex with transgender women are a potentially high-risk population for HIV and other sexually transmitted infections (STIs). We administered structured quantitative surveys to 174 men whose primary partner was a transgender woman. We assessed men’s demographic characteristics, sexual behaviors, substance use, and social-psychological factors, including condom use self-efficacy and depression. Overall, 19% reported being HIV-positive (8% had been diagnosed with AIDS), 11% had at least one other STI during the past year, and 16% reported being in a HIV serodiscordant relationship with their primary partner. In the past 3 months, 40% had unprotected anal or vaginal sex with any partner. In multivariate analysis, significant correlates of having unprotected sex included younger age, concurrent partnerships, alcohol intoxication, and low condom use self-efficacy; depression was marginally associated with having unprotected sex. Interventions are needed to reduce risk for HIV and other STIs among men who have sex with transgender women. Prevention programs for these men should build condom use self-efficacy and address the contributions of alcohol intoxication, concurrent sex partnerships, and depression to sexual risk behavior.     

Sex without disclosure of positive HIV serostatus in a US probability sample of persons receiving medical care for HIV infection

OBJECTIVES: We estimated the proportion of HIV-positive adults who have any sexual contact without disclosure and the proportion of their sexual partnerships that involve unprotected sex without disclosure. METHODS: We drew participants from the HIV Cost and Services Utilization Study (n = 1421). Interviews assessed disclosure and sexual activities with up to 5 recent partners. RESULTS: Overall, 42% of the gay or bisexual men, 19% of the heterosexual men, and 17% of all the women reported any sex without disclosure, predominately within nonexclusive partnerships (P <.001). Across all groups, 13% of serodiscordant partnerships involved unprotected anal or vaginal sex without disclosure, with no significant difference between groups. CONCLUSIONS: Risky sex without disclosure of serostatus is not uncommon among people with HIV.     

Navy acted properly in seizing civilian's HIV test report

The U.S. Navy's seizure of a civilian's HIV lab report was upheld by the 9th U.S. Circuit Court of Appeals. The Navy's actions were ruled to be key elements of a criminal investigation of an HIV-positive naval officer who engaged in unprotected sex. The civilian Roger Roe, and the officer, Petty Officer Michael J. Healy, engaged in unprotected sexual acts on a number of occasions after Healy assured Roe he was HIV-negative. When Roe learned that Healy was HIV-positive, he reported Healy to his commanding officer. Healy was under orders not to engage in sex without a condom. If Roe's claims were correct, Healy could face court martial and discharge from the Navy. The Navy obtained a search warrant for Roe's apartment and discovered a lab report showing Roe tested positive for HIV antibodies. The report was seized as evidence against Healy. Roe sued the Navy investigators claiming violation of his Fourth Amendment protection. A U.S. District Judge and the 9th Circuit Court found in favor of the defendants. The Navy's interest in collecting evidence of a serious crime outweighed Roe's interest in protecting the confidentiality of his HIV status.     

Supreme Court to review case arising from HIV exposure

The U.S. Supreme Court is reviewing whether the military may dismiss an Air Force officer who had unprotected sex with two women without telling them his HIV status. Major James T. Goldsmith tested positive in 1988 and was ordered to avoid sexual intercourse unless he informed his partners of his HIV status. Goldsmith was also ordered to use condoms every time he had intercourse. He disobeyed both orders by having unprotected sex with one woman in 1988 and another in 1993. Both women have tested negative. Goldsmith was convicted of willful disobedience of orders, assault with a means likely to inflict death or grievous bodily harm, and assault consummated by battery. He was sentenced to 6 years in confinement and ordered to forfeit his pay for 72 months.     

Psychosocial Predictors of Sexual HIV Transmission Risk Behavior among HIV-Positive Adults with a Sexual Abuse History in Childhood

Childhood sexual abuse (CSA) is associated with HIV sexual risk behavior. Although many psychosocial correlates of sexual risk among HIV-positive persons have been identified, studies predicting continued risk among HIV-positive adults with histories of CSA are limited. This cross-sectional study identified variables predictive of sexual transmission risk behavior among an ethnically diverse sample of 256 HIV-positive adults (women and men who have sex with men; MSM) with CSA histories. Participants were assessed for trauma symptoms, shame related to HIV and sexual trauma, substance use, coping style, and sexual risk behavior. Logistic regression analyses were conducted to identify variables predictive of unprotected sexual behavior in the past 4 months. Unprotected sex was significantly associated with substance use and trauma-related behavioral difficulties among women and men, and less spiritual coping among men. Unprotected sex with HIV negative or serostatus unknown partners was significantly associated with greater trauma-related behavioral difficulties, more HIV-related shame, and fewer active coping strategies. Thus, trauma symptoms, shame, coping style, and substance use were significantly associated with sexual risk behavior among HIV-positive adults with histories of CSA, with models of prediction differing by gender and partner serostatus. HIV prevention intervention for persons with HIV and CSA histories should address trauma-related behavioral difficulties and enhance coping skills to reduce sexual transmission risk behavior.     

High-risk behaviors in women who use crack: knowledge of HIV serostatus and risk behavior

PURPOSE: To determine whether crack cocaine-using women who are aware of their HIV serostatus have made modifications in risk behaviors, we compared known HIV-positive (HIV+) and HIV-negative (HIV-) users with respect to sexual risk behaviors, prevalence of sexually transmitted infections (STIs) and vaginitis, and correlates of unprotected sex. METHODS: We used a cross-sectional design with street outreach, recruitment, and interviews of sexually active crack cocaine using women. Women received testing for HIV, STIs, and vaginitis. RESULTS: Sixty-one HIV+ and 117 HIV- women were enrolled. HIV+ women were significantly more likely to be African-American. There were no significant differences in drug use, types of sexual partners, number of paying partners, attitudes regarding condoms, or STI diagnoses. HIV+ women were less likely to engage in unprotected sex compared with HIV- women (56% vs. 75%, adjusted odds ratio [AOR], 0.36; 95% confidence interval [CI], 0.13-0.99). Among HIV+ women, unprotected sex was negatively associated with stronger beliefs regarding the protective value of condoms (AOR, 0.07; 95% CI, 0.01-0.67) and concurrent injection-drug use (AOR, 0.19; 95% CI, 0.04-0.99). CONCLUSIONS: Although the majority of crack using HIV+ crack using women in this sample continued to engage in high-risk sexual activities, they were less likely to do so than HIV- women. Interventions targeting this population are needed.     

HIV prevalence and risk behaviors among men who have sex with men and inject drugs in San Francisco

The dual risks of male-to-male sex and drug injection have put men who have sex with men and inject drugs (MSM-IDU) at the forefront of the HIV epidemic, with the highest rates of infection among any risk group in the United States. This study analyzes data collected from 357 MSM-IDU in San Francisco between 1998 and 2002 to examine how risk behaviors differ by HIV serostatus and self-identified sexual orientation and to assess medical and social service utilization among HIV-positive MSM-IDU. Twenty-eight percent of the sample tested HIV antibody positive. There was little difference in risk behaviors between HIV-negative and HIV-positive MSM-IDU. Thirty percent of HIV-positive MSM-IDU reported distributive syringe sharing, compared to 40% of HIV negatives. Among MSM-IDU who reported anal intercourse in past 6 months, 70% of positives and 66% of HIV negatives reported unprotected anal intercourse. HIV status varied greatly by self-identified sexual orientation: 46% among gay, 24% among bisexual, and 14% among heterosexual MSM-IDU. Heterosexual MSM-IDU were more likely than other MSM-IDU to be homeless and to trade sex for money or drugs. Gay MSM-IDU were more likely to have anal intercourse. Bisexual MSM-IDU were as likely as heterosexual MSM-IDU to have sex with women and as likely as gay-identified MSM-IDU to have anal intercourse. Among MSM-IDU who were HIV positive, 15% were currently on antiretroviral therapy and 18% were currently in drug treatment, and 87% reported using a syringe exchange program in the past 6 months. These findings have implications for the development of HIV interventions that target the diverse MSM-IDU population.     

Criminal exposure

Luis Diaz, director of the Nevada Association of Latin Americans' HIV/AIDS program, was sentenced to 2 to 6 years in prison for exposing two women to HIV through unprotected sex. Diaz, who pleaded guilty to attempted intentional transmission of HIV, asked for leniency because of his medical condition; but district court Judge Sally Loehrer called Diaz a "danger to society" and rejected his request. So far, both women have tested negative for HIV.     

Thoughts, attitudes, and feelings of HIV-positive MSM associated with high transmission-risk sex

This study presents survey data collected from a sample of HIV-positive men (N = 182) who had high transmission-risk sex, defined as unprotected anal intercourse with a man whose HIV-status was negative or unknown, in the previous 6 months. Despite the tremendous changes in HIV treatment and their impact on people living with HIV, little recent research has examined current trends in their thoughts toward unprotected anal intercourse. Here, the authors describe the self-justifications reported by HIV-positive men who have sex with men (MSM) in their current study conducted between 2006 and 2009 and explore key differences between the those of the HIV-positive MSM and those collected from a previous cohort of HIV-negative men (n = 124), who previously reported engaging in high transmission-risk sex. Whereas HIV-negative men focused on themes related to the impulsivity of and gratification from unprotected intercourse, HIV-positive men focused on themes regarding the deferral of responsibility/assumption the partner is positive (i.e., "If he's doing X, he must be positive . . ."), or the role of condomless sex fulfilling emotional needs. The findings highlight unique aspects of how HIV-positive men approach decision making regarding the use of condoms, as well as how they perceive issues of responsibility for initiating safer sex practices.     

Latino Men’s Sexual Behavior with Transgender Persons

Male-to-female transgender persons are thought to be “vectors” for HIV/STI transmission, yet little quantitative information exists about the risk behavior of their male sexual partners who may serve as a “bridge” for HIV transmission into the general population. As part of an online survey examining the sexual risk behavior of Latino men who have sex with men (N = 1,026), we identified 44 (4%) participants who reported having had sex with a transgender partner. Compared with a randomly selected sub-sample of 200 men who did not report sex with a transgender person, sexual partners of transgender persons were almost three times more likely to have had unprotected sexual intercourse in the last three months. In addition, men who had sex with transgender persons were more likely to be HIV-positive; married, separated, or divorced; identify as bisexual or straight; have sex with women; and live in rural or small town communities. Regression analysis revealed that community size, sexual compulsivity, and having had a transgender partner were independent predictors of unprotected sex. Among Latino men who have sex with men, men with a history of sex with a transgender person appear more likely to be sexually compulsive and at greater risk for HIV and other sexually transmitted infections. These men may, therefore, also serve as a “bridge” for HIV transmission to (as opposed to from) the transgender population.