More Than Half of MSM in US HIV Group Have Unprotected Anal Sex

Among 704 sexually active men who have sex with men (MSM) in the US HIV Outpatient Study (HOPS), 54% had unprotected (condom-free) anal intercourse. But only 15% of men reporting unprotected anal sex had a detectable viral load. To determine rates of unprotected anal sex among MSM in care in six US cities, HOPS investigators analyzed their medical records and performed a supplemental behavioral survey at some point between 2007 and 2010. The study included 902 MSM, 704 (78%) of whom had sex in the past 6 months.

Among sexually active men, 54% reported unprotected anal sex, including 37% who had insertive anal sex and 42% who had receptive anal sex. Four in 10 sexually active men reported unprotected anal sex with an HIV-negative male partner or a male partner of unknown HIV status, including 24% who had insertive anal sex and 31% who had receptive anal sex.

Multivariable regression analysis identified several predictors of unprotected anal sex with a male partner who was HIV-negative or had an unknown HIV status, at the following adjusted odds ratios (aOR) (and 95% confidence intervals):

• Age <29 vs >50: aOR 2.1 (0.9 to 4.8), P = 0.07

• Age 30 to 39 vs >50: aOR 2.1 (1.3 to 3.5), P = 0.002

• Age 40 to 49 vs >50: aOR 1.6 (1.1 to 2.4), P = 0.018

• Injection drug use: aOR 4.7 (1.3 to 17.0), = 0.020

• 2 vs 1 sex partner: aOR 2.4 (1.4 to 4.1), P = 0.001

• 3 or more vs 1 sex partner: aOR 5.5 (3.7 to 8.4), P < 0.001

• Disclosed HIV status to some vs all partners: aOR 1.6 (1.1 to 2.4), P = 0.008

Among MSM who had any unprotected anal intercourse, 15% had a detectable viral load. But frequency of unprotected anal sex did not differ significantly between MSM with a detectable versus undetectable viral load.

The HOPS team concludes that "the high frequency of unprotected anal sex with HIV-negative or unknown-status partners among HIV-infected MSM in care suggests the need for targeted prevention strategies for this population."

Source: Marcus D. Durham, Kate Buchacz, Jim Richardson, DerShung Yang, Kathy Wood, Bienvenido Yangco, John T. Brooks, the HOPS Investigators. Sexual risk behavior and viremia among men who have sex with men in the HIV Outpatient Study, United States, 2007–2010. JAIDS. 2013; 63: 372-378.

Written by Mark Mascolini on behalf of the International AIDS Society