Register for CDC studies report factors underlying high HIV rates among gay, bisexual men
AIDS ConferenceAugust 19, 2002
New research from the U.S. Centers for Disease Control and Prevention (CDC) presented at the XIV International AIDS Conference provides further evidence of high rates of new HIV infection among gay and bisexual men in the United States and sheds light on factors underlying high-risk behavior among these men.
The new data also offer insight into steps needed to tailor HIV prevention to the challenges currently facing gay and bisexual men in the United States and other industrialized nations.
In one of the largest studies on HIV incidence in the U.S., CDC epidemiologist Laurie Linley and colleagues estimated that 4.8% of men who have sex with men (MSM) treated at sexually transmitted disease (STD) clinics in four U.S. cities were infected annually, compared with 0.4% of heterosexual men and 0.5% of women treated at those same clinics. The researchers based their estimates on an analysis of anonymous blood samples from more than 40,000 high-risk patients of all ages at STD clinics in Los Angeles, Denver, Miami, and Newark.
More than three-fourths of young gay and bisexual men infected with HIV in a six-city CDC study - including 91% of African Americans in the study - were unaware of their status, and may have unknowingly transmitted the virus to their partners.
Led by CDC's Duncan MacKellar, researchers surveyed MSM between the ages of 15 and 29, and found that 60% of infected white MSM and 70% of infected Hispanic MSM also did not know they were infected. Of the men who were unaware of their infection, 59% perceived themselves to be at low or very low risk, even though more than half had unprotected anal intercourse with other men in the previous 6 months and nearly half had three or more male sex partners during that time period.
Psychosocial health factors increase HIV risk. Psychosocial health problems - including multiple drug use, partner violence, history of childhood sexual abuse, and depression - interact to increase sexual risk behavior and HIV infection rates among gay and bisexual men in the United States, according to research led by CDC's Ron Stall, PhD.
In a household-based survey of MSM in New York City, Chicago, Los Angeles, and San Francisco, the percentage of men reporting high-risk sex increased steadily from 7.1% among those with none of the four problems, to 33.3% for those suffering from all four. Similarly, of those with none of the psychosocial health problems, 13% indicated they are HIV infected, compared with 25% of those with all four health problems
New CDC research indicates that gay and bisexual men are more likely to engage in high-risk sexual behavior if their partners are younger. The study, by CDC behavioral scientist Gordon Mansergh, PhD, and colleagues, defined "high-risk" behavior as unprotected anal intercourse with partners of unknown or different HIV status.
The San Francisco study examined sexual patterns among a diverse sample of MSM in four age categories: 20s, 30s, 40s, and 50 and older. Of the 376 sexually active MSM surveyed, 52% reported having high-risk sex during their most recent encounter. Analysis by age of partners found that 56% of men with younger partners engaged in high-risk sex, compared with 43% of those with partners in a similar or older age group.
Use of nonoxynol-9 continues despite potentially increased HIV risk. Following the discovery that the spermicide, nonoxynol-9 (N-9), may increase risk of HIV transmission, CDC recommended, in 2000, that N-9 not be used for protection against HIV during intercourse. However, a 2001 CDC survey of MSM in San Francisco found that 41% of those who had used N-9 during anal sex in the past year did so without a condom because they thought, or hoped, it would be protective against HIV, underscoring the need for better education on the risks of N-9 use. This article was prepared by AIDS Weekly editors from staff and other reports.
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