In recent years, annual increases have been observed in the number of HIV infections among men who have sex with men (MSM). Understanding trends in sexual risk behaviors among MSM may help shed light on why these increases are occurring and help clinicians develop interventions to address the issue.

Analyzing the Data on Sexual Risk Behaviors

To gain a better understanding of the trends in sexual risk behaviors among MSM, Gabriela Paz-Bailey, MD, PhD, and colleagues analyzed 2005, 2008, and 2011 data from nearly 30,000 MSM from 20 major cities in the United States. “One-third of HIV-positive MSM who did not know they were infected reported having sex without a condom with someone they perceived to be HIV negative or whose HIV status was unknown,” says Dr. Paz-Bailey. “However, we found that this rate was 60% lower for men who knew they were HIV positive.”

The percent of men who did not know their current HIV status increased with longer periods since they were last tested. “Only 4% of those who were tested within the past 3 months were HIV-positive but unaware of their infection, compared with 5% and 7% of those tested in the past 4 to 6 months or 7 to 12 months, respectively,” says Dr. Paz-Bailey.

Sex-Risk-Men-Callout

Over the study period, the percent of MSM who reported having sex without a condom at least once in the previous 12 months increased from 48% in 2005 to 57% in 2011. “It could be that with effective treatment now available, HIV is not seen as big a threat as it once was,” says. Dr. Paz-Bailey. “Research indicates that people who are complacent about HIV are more likely than others to practice risky sex. Some MSM may not think they are at risk for HIV. There may also be social and cultural issues—like homophobia, stigma, and discrimination—that could increase risk behaviors and contribute to barriers to effective testing and treatment. Furthermore, it could be that more men are using other, newly available prevention strategies, such as treatment as prevention and pre-exposure prophylaxis.”

Implementing the Findings to Prevent HIV Transmission

According to Dr. Paz-Bailey, her study team’s findings underscore the need for healthcare providers to create a trusting and confidential environment for discussing sex, particularly among MSM. “Providers should ask their MSM patients directly about their behaviors and recommend ways to reduce the risk of getting and transmitting HIV,” she says. “It’s important to test sexually active, HIV-negative men for HIV at least once a year and to ensure that those who have sex without a condom have access to risk-reduction strategies, such as pre-exposure prophylaxis. Providers should also ensure that HIV-positive MSM have access to care, receive antiretroviral therapy, and have access to other prevention services.”

References

CDC. HIV testing and risk behaviors among gay, bisexual, and other men who have sex with men — United States. MMWR. 2013;62:958-962. Available at www.cdc.gov/mmwr/preview/mmwrhtml/mm6247a4.htm?s_cid=mm6247a4_w.

CDC. Diagnoses of HIV infection in the United States and dependent areas, 2011.. Available at www.cdc.gov/hiv/library/reports/surveillance/2011/surveillance_report_vol_23.html.

CDC. Gay and bisexual men’s health: HIV/AIDS: serosorting among MSM. Available at www.cdc.gov/msmhealth/serosorting.htm.

Hart G, Elford J. Sexual risk behaviour of men who have sex with men: emerging patterns and new challenges. Curr Opin Infect Dis. 2010;23:39-44.