Do risk behaviors of HIV-positive MSM present a risk for hepatitis C transmission?
R. Stall1, W. Chongyi1, W. McFarland2, H.F. Raymond2, G. Colfax2, H.-H. Troung2
1University of Pittsburgh Graduate School of Public Health, Pittsburgh, United States, 2San Francisco Department of Public Health, San Francisco, United States
Background: HIV serosorting has reportedly been widely adopted by HIV-positive MSM and men in positive relationships may be less likely to use condoms. Meanwhile, reports of increasing Hepatitis C virus (HCV) sexual transmission among HIV-positive MSM in Europe and New York City have raised the possibility that HIV positive men are at high risk for HCV transmission. We examined sexual risk behaviors among HIV-positive MSM’s partnerships with other HIV-positive men to assess the potential for the spread of HCV.
Method: A cross-sectional survey was conducted among MSM (N=1104) in San Francisco using time-location sampling in 2008. Partnership-level data including partner’s HIV status, counts of anal sex acts (e.g., unprotected insertive vs. receptive), and substance use before sex with the 5 most recent partners were collected. Participants also self-reported their own HIV status.
Results: HIV-negative MSM (n=880) reported 1828 partnerships with other HIV-negative men while HIV-positive MSM (n=224) reported 387 partnerships with other HIV-positive men. HIV-positive MSM’s partnerships were more likely to involve unprotected anal intercourse (58.9%), unprotected insertive anal intercourse (36.4%), and unprotected receptive anal intercourse (43.7%) than were HIV-negative MSM’s partnerships (p < .01). However, mean numbers of acts of these sexual risk behaviors were higher among HIV-negative MSM. HIV-positive MSM’s partnerships were also more likely to involve illicit drug use before sex (e.g., stimulant drugs) than were HIV-negative MSM’s partnerships (p < .01).
Conclusions: While the exact behavioral practices for HCV transmission among HIV-positive MSM remain unclear, these findings suggest the potential for an outbreak of HCV infections among HIV-positive MSM in San Francisco. Epidemiologic studies specifically examining sexual transmission of HCV among HIV-positive MSM are needed.