Background:
Recent research suggests that unprotected anal intercourse (UAI) by partner
serostatus is a stronger and more useful predictor of HIV acquisition risk
in men who have sex with men (MSM) than UAI not stratified by partner
serostatus.
Objectives:
To estimate the proportion of MSM at high risk for HIV acquisition or
transmission and examine factors associated with potential exposure to and
transmission of HIV.
Methods:
In 2003, 311 MSM participated in a random digit dial telephone survey of MSM
in three Seattle zip codes with high prevalences of MSM.
Results:
Ten percent (25/241, 95%CI:7%-15%) of HIV-negative MSM were potentially
exposed to HIV, based on reported UAI with a man who was HIV-positive or of
unknown HIV status in the last 12 months. Thirty-one percent (14/45,
95%CI:20%-46%) of HIV-positive MSM were potential HIV transmitters, based on
reported UAI with a man of negative or unknown status in the last 12 months.
The strongest correlates of potential exposure were having sex at a
bathhouse (OR=9.1, 95%CI:3.7-22.3), use of methamphetamine (OR=8.0,
95%CI:2.0-32.3), amyl nitrite (OR=6.2, 95% CI:2.6-14.8), or sildenafil
(Viagra) (OR=4.4, 95% CI:1.7-11.3), and recent STD diagnosis (OR=4.4, 95%
CI:1.2-15.5). Potential transmitters had more male sex partners (r=.41,
95%CI:.13-.63) and were more likely to have had recent concurrent anal sex
partners (OR=6.9, 95%CI:1.7-28.9) than other HIV-positive MSM. Based on
STD/HIV testing history and stated preferences for healthcare sites, few
potentially exposed MSM (36%) or potential transmitters (38%) have attended
or would likely attend public health STD/HIV clinical sites.
Conclusions:
MSM potentially exposed to HIV and potential HIV transmitters are fairly
well-defined subsets of MSM. Most do not attend public health STD/HIV
facilities.
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