Factors associated with unprotected anal intercourse among sexually active HIV-infected MSM – United States, 2007

Published: July 20, 2010

Factors associated with unprotected anal intercourse among sexually active HIV-infected men who have sex with men – United States, 2007

M. Freedman, J. Blair, C. Mattson, A. Edwards, E. Frazier, E. Valverde, A. McNaghten

Centers for Disease Control and Prevention, DHAP/BCSB/COT, Atlanta, United States

Background: HIV-infected men who have sex with men (MSM) who engage in high-risk sexual behavior, such as unprotected anal intercourse (UAI), risk exposing their partners to HIV. We assessed the prevalence of and factors associated with UAI in HIV-infected MSM. Understanding these factors can help inform prevention activities to avert new infections in this population.

Methods: We used interview data from patients in care in 2007 from the Medical Monitoring Project, a supplemental surveillance system conducted in 20 states and 6 cities that collects clinical and behavioral data on HIV-infected adults in care in the United States. We included MSM diagnosed with HIV ≥1 year who reported ≥1 male sex partner in the prior 12 months. We defined recent UAI as any UAI in the 12 months before interview and HIV viral load (VL) as the most recent self-reported VL measurement. Multiple logistic regression was used to describe the relationship between UAI and demographic factors, sex and drug-use behaviors, and clinical factors among HIV-infected MSM.

Results: Between July 2007-April 2008, 1259 MSM were interviewed; 55% were non-Hispanic white, 74% aged 35-54 years, and 67% reported undetectable VL. Forty-four percent reported recent UAI. Factors associated with recent UAI included number of anal intercourse partners (adjusted odds ratio [aOR]=1.3, 95% confidence interval [CI]=1.2-1.5) per person, non-injection drug use before or during sex (aOR=2.2, 95% CI=15-3.2), and using erectile dysfunction drugs (aOR=1.7, 95% CI=1.1-2.5), each in the past 12 months. Older age was associated with a lower risk of recent UAI (aOR=0.97 per 10 years older, 95% CI=0.95-0.99). VL was not associated with UAI.

Conclusions: Almost half of HIV-infected MSM in our study engaged in behaviors that can transmit HIV. Our participants are attending health care, representing a missed opportunity for HIV prevention and highlighting the need for continued and enhanced prevention efforts among HIV-infected people.

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