Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting? (original) (raw)
Related papers
American Journal of Public Health, 2007
Objectives. We assessed differences in HIV prevalence and sexual risk behavior among men who have sex with men (MSM) between 1997 and 2002 in San Francisco. Methods. We used 2 population-based random-digit-dial telephone surveys of MSM households in San Francisco in 1997 (n=915) and 2002 (n=879). Results. Estimated HIV prevalence increased from 19.6% in 1997 to 26.8% in 2002. Measures of sexual risk also increased. Unprotected anal intercourse with a partner of different or unknown HIV serostatus increased from 9.3% to 14.6%. Mean number of male partners increased from 10.7 to 13.8. The largest reported increase was 18.9% to 26.8% for “serosorting,” or choosing unprotected anal intercourse partners believed to have the same HIV serostatus as oneself. Men aged 30 to 50 reported the largest increase in unprotected anal intercourse, whereas men aged 18 to 29 reported the largest increase in serosorting. Changes in the age distribution did not explain the increase in risky behavior. Con...
Aids Care-psychological and Socio-medical Aspects of Aids/hiv, 2011
“Seroadaptation” comprises sexual behaviors to reduce the risk of HIV acquisition and transmission based on knowing one's own and one's sexual partners' serostatus. We measured the prevalence of seroadaptive behaviors among men who have sex with men (MSM) recruited through time–location sampling (TLS) across three perspectives: by individuals (N=1207 MSM), among sexual dyads (N=3746 partnerships), and for sexual episodes (N=63,789 episodes) in the preceding six months. Seroadaptation was more common than 100% condom use when considering the consistent behavioral pattern of individuals (adopted by 39.1% vs. 25.0% of men, respectively). Among sexual dyads 100% condom use was more common than seroadaptation (33.1% vs. 26.4%, respectively). Considering episodes of sex, not having anal intercourse (65.0%) and condom use (16.0%) were the most common risk reduction behaviors. Sex of highest acquisition and transmission risks (unprotected anal intercourse with a HIV serodiscordant or unknown status partner in the riskier position) occurred in only 1.6% of sexual episodes. In aggregate, MSM achieve a high level of sexual harm reduction through multiple strategies. Detailed measures of seroadaptive behaviors are needed to effectively target HIV risk and gauge the potential of serosorting and related sexual harm reduction strategies on the HIV epidemic.
To determine infection patterns of STIs that facilitate HIV transmission among HIV-discordant couples. Methods: 112 initial respondents were recruited in an impoverished neighborhood of Brooklyn, NY. Their sexual (and injection) partners were recruited in up to 4 additional network sampling waves for a final sample of 465 persons 18 years or older. After separate informed consent, blood and urine were collected and tested for HIV (EIA/WB); type-specific (FOCUS) anti-HSV-2; syphilis (RPR and TPPA); chlamydia (BDProbeTec Amplified DNA assay) and gonorrhea (BDProbeTec Amplified DNA assay). Results: Of 30 HIV-discordant partnerships, 5 were same-sex male partnerships and 25 were opposite-sex partnerships. No subjects tested positive for syphilis or gonorrhea. Two couples were chlamydia-discordant. For HSV-2, 16 couples were double-positive, eight discordant, four double-negative, and two were comprised of a herpes-2-negative with a partner with missing herpes data. Conclusions: HSV-2 was present in 83% of the HIV-discordant couples; CT in 7%; and syphilis and gonorrhea in none. HSV-2 is probably more important for HIV transmission than bacterial STDs since it is more widespread. Even given the limited generalizability of this community-based sample, there seems to be an important HIV-prevention role for herpes detection and prevention activities in places where HIV-infected people are likely to be encountered, including STD clinics, HIV counseling and testing programs, jails and prisons, needle exchanges, and drug abuse treatment programs. The effects of HSVsuppressive therapy in highly-impacted groups should also be investigated.
Group Sex Events and HIV/STI Risk in an Urban Network
Jaids-journal of Acquired Immune Deficiency Syndromes, 2008
Objectives-To describe: a. the prevalence and individual and network characteristics of group sex events (GSE) and GSE attendees; and b. HIV/STI discordance among respondents who said they went to a GSE together.
Journal of acquired immune deficiency syndromes (1999), 2016
Serosorting among men who have sex with men (MSM) is common but recent data to describe trends in serosorting are limited. How serosorting affects population-level trends in HIV and other sexually transmitted infection (STI) risk is largely unknown. We collected data as part of routine care from MSM attending an STD clinic (2002-2013) and a community-based HIV/STD testing center (2004-2013) in Seattle, Washington. MSM were asked about condom use with HIV-positive, HIV-negative and unknown-status partners in the prior 12 months. We classified behaviors into four mutually exclusive categories: no anal intercourse (AI); consistent condom use (always used condoms for AI); serosorting (condomless anal intercourse [CAI] only with HIV-concordant partners); and non-concordant CAI (CAI with HIV-discordant/unknown-status partners; NCCAI). Behavioral data were complete for 49,912 clinic visits. Serosorting increased significantly among both HIV-positive and HIV-negative men over the study peri...
Sexuality and Culture, 2005
for understanding engagement in UAI with ejaculation. Men who engaged in such behaviors with casual partners were more likely to have negative attitudes towards condoms, report difficulty communicating desires for safer sex, disagree with the belief that AIDS is fatal, and be intoxicated during anal intercourse. Men who reported engaging in anal intercourse, but who never shared unprotected ejaculations, were most likely to be unknowingly infected with HIV, suggesting that many men may become infected while following what they believe to be "safer sex practices." In designing effective interventions, public health authorities need to take into account socially embedded risk-negotiating practices.
F1000 - Post-publication peer review of the biomedical literature, 2016
Aim-Unprotected anal intercourse is often used as a single indicator of risky behavior among men who have sex with men (MSM), yet MSM engage in a variety of behaviors which have unknown associations with sexually transmitted infection (STI) and HIV. We assessed the prevalence of a wide range of sexual behaviors as well as their associations with prevalent STI and HIV. Methods-We used a standardized, self-administered survey to collect behavioral data for this cross-sectional study of 235 MSM seeking care in a public STD clinic. Using modified Poisson regression, we generated unadjusted and adjusted prevalence ratios (PRs) to characterize associations between recent participation in each behavior and prevalent STI and HIV. Results-Participants' median age was 26 years. One-third (35%) were STI-positive. STI prevalence was significantly associated with using sex slings (adjusted prevalence ratio (aPR): 2.35), felching (aPR: 2.22), group sex (aPR: 1.86), fisting (aPR: 1.78), anonymous sex (aPR: 1.51), and sex toys (aPR: 1.46). HIV prevalence was 17% and was significantly associated with fisting (aPR: 4.75), felching (aPR: 4.22), enemas (aPR: 3.65), and group sex (aPR: 1.92). Conclusions-Multiple behaviors were significantly associated with prevalent STI and HIV in adjusted analyses. To provide a more comprehensive understanding of sexual risk among MSM, prospective studies are needed to examine whether these behaviors are causally associated with HIV/STI acquisition.