Behaviors of Recently HIV-Infected Men Who Have Sex With Men in the Year Postdiagnosis: Effects of Drug Use and Partner Types

Abstract

Objectives Assess behaviors of recently HIV-infected men who have sex with men (MSM). Methods From 2002–2006 193 recently HIV-infected MSM in the Southern California Acute Infection and Early Disease Research Program were interviewed every 3 months. Changes in HIV status of partners, recent unprotected anal intercourse (UAI), drug use, use of antiretroviral therapy (ART), detectable viral load and partnership dynamics over one year were used to predict recent UAI in a random effect logistic regression. Results Over a year significantly fewer partners in the past month were reported (mean 8.81 to 5.84; p<.0001). Percentage of recent UAI with HIV-status unknown last partners decreased from enrollment to 9 months (49% to 27%) and rebounded at 12 months to 71%. In multivariable models controlling for ART use, recent UAI was significantly associated with: baseline methamphetamine use (AOR 7.65, 95% CI 1.87, 31.30), methamphetamine use at follow-up (AOR 14.4, 95% CI 2.02, 103.0), HIV-uninfected partner at follow-up (AOR 0.14, 95% CI 0.06, 0.33) and partners with unknown HIV status at follow-up (AOR 0.33, 95% CI 0.11, 0.94). HIV viral load did not influence rate of UAI. Conclusions Transmission behaviors of these recently HIV-infected MSM decreased and serosorting increased after diagnosis; recent UAI with serostatus unknown or negative partners rebounded after nine months, identifying critical timepoints for interventions targeting recently HIV-infected individuals. There was no evidence in this cohort that the viral load of these recently infected men guided their decisions about protected or unprotected anal intercourse.

HIV treatment as prevention among men who have sex with men in the UK: is transmission controlled by universal access to HIV treatment and care?

“…In addition to being infectious, the undiagnosed population is also more likely to have unprotected sex compared with their diagnosed counterparts [27] and to contain those MSM who are experiencing primary infection (characterized by elevated viraemia [28]). In the UK, while the coverage of HIV testing is 82% among MSM attending sexual health clinics [11], only 55% of HIV-negative MSM reported an HIV test in the last year [29].…”

“…In 2010, only 5% of the infectious population met treatment guidelines but were not receiving ART and most of these men went on to start treatment within the next 6 months. While more substantial gains could be achieved through expanding ART to MSM with CD4 counts < 500 cells/mL, an even greater impact could be achieved by halving the undiagnosed population and extending ART to all MSM with a CD4 count < 500 cells/mL.In addition to being infectious, the undiagnosed population is also more likely to have unprotected sex compared with their diagnosed counterparts [27] and to contain those MSM who are experiencing primary infection (characterized by elevated viraemia [28]). In the UK, while the coverage of HIV testing is 82% among MSM attending sexual health clinics [11], only 55% of HIV-negative MSM reported an HIV test in the last year [29].…”

Barriers to HIV Care and Treatment Among Participants in a Public Health HIV Care Relinkage Program

“…Studies of medication-assisted therapy to reduce methamphetamine use have, to date, mostly been negative, apart from one study of mirtazapine. 23 The proportionately greater methamphetamine use among referred participants, who were identified primarily through the STD Clinic and STD partner services, likely reflects the higher HIV/STD transmission risk among methamphetamine-using MSM 24,25 and further highlights the public health challenge of addressing methamphetamine as a barrier to HIV care and treatment and as a facilitator of HIV transmission. Many substance users did not identify their substance use as an important barrier to care.…”

Crystal Methamphetamine Use and HIV Transmission Among Gay and Bisexual Men

“…In another study, one-third of HIV-positive MSM reported methamphetamine use and unprotected anal intercourse, a pattern that remained consistent over time [24]. In a sample of racially diverse HIV-positive MSM in medical care in San Francisco, methamphetamine users reported an increased rate of unprotected sex among [19•].…”