At-risk men failing to change behavior
CDC studies prove problem continuing to grow
New research shows that HIV-infected gay and bisexual men increasingly are having unprotected anal intercourse. Also, not enough young gay men who are at risk for HIV infection are being tested. Together, those trends highlight the continual need for HIV prevention and education messages aimed at men who have sex with men, an AIDS activist says.
"We have a plethora of information on HIV prevention, but is it really speaking to young people in a language they understand?" said Julio Abreu, deputy director of government affairs for AIDS Action in Washington, DC. "That’s why it needs to continue to be an evolving message that we give about prevention. Think of it as an ad campaign: Coca Cola wouldn’t dream of just saying one jingle time and time over."
Concerned about recent outbreaks of sexually transmitted diseases (STDs) among HIV-infected gay and bisexual men, researchers from the Centers for Disease Control and Prevention (CDC) in Atlanta conducted an extensive, three-year survey to assess their sexual behavior. The survey began in January 1995, just before the advent of highly active antiretroviral therapy, and ended in December 1998.
The CDC presented the results of the study at the XIII International AIDS Conference held in Durban, South Africa.
CDC research into risk behaviors of HIV-positive men who have sex with men (MSM) shows that gay and bisexual men were increasing their sexual risk behaviors even before protease inhibitors and antiretroviral regimens changed the face of AIDS in this country, reported Paul Denning, MD, medical epidemiologist with the CDC’s Division of HIV/AIDS Prevention.
"A lot of people are attributing all of this risk behavior just to the protease inhibitors and HAART and new treatment regimens," Denning said. "But these trends go back quite a while."
At-risk population no longer careful
Denning said AIDS is no longer as frighten-ing to people as it was in the early 1980s, when it meant rapid death. By the 1990s, HIV-infected people were living longer, taking AZT and other treatments.
"As early as 1990," he said, "there were reports of a resurgence of unsafe sex in the United States and the Netherlands," Denning said. "Throughout the 1990s, there have been sporadic outbreaks of STDs, so there probably has been a gradual decline in safe sexual behavior."
Denning’s research found that HIV-infected MSM, interviewed by CDC investigators in 1997 and 1998, were significantly more likely to have anal intercourse and unprotected anal intercourse than were MSM interviewed in 1995-96. In the earlier group, 29% reported having had unprotected anal intercourse, vs. 38% in the 1997-1998 group.1 Risk factors for MSM having anal intercourse included men who injected drugs, had fewer than 12 years of education, had a steady sex partner of unknown status, and had "$5 sex partners."1
Investigators interviewed 5,094 MSM in 12 cities and states who were newly reported with HIV or AIDS. Of the 1,942 men who met the inclusion criteria, 27% of those who were sexually active had at least one episode of unprotected anal intercourse in the year before they were interviewed. If they had at least one episode of anal intercourse without condoms, it was considered unprotected anal intercourse. The men who were having sex with one HIV-positive partner were excluded. The increases in unprotected anal intercourse were noted in both MSM participants, Denning said.
This study highlights the importance of focusing HIV prevention messages on members of the HIV-infected MSM population, Denning said. "The HIV-infected population is a group we’ve often ignored in our prevention work," he added. "So for clinicians, this is an optimum time to intervene, at the time of diagnosis and at the first intake of the patient."
Gay, bisexual men failing to get tested
However, even this strategy only works when at-risk MSM get tested for HIV. Research by another CDC investigator showed that a large number of young gay and bisexual men have never been tested for HIV.
"I think this reflects a trend that has been seen in a variety of surveillance studies of men who have sex with men," said Esther Sumartojo, PhD, team leader for the Community Intervention Research Team in the CDC Division of HIV/AIDS Prevention.
Sumartojo’s study showed that among young MSM, 22% reported they had never been tested for HIV. Of those who had been tested, 1.5% were HIV-positive, 95% were HIV-negative, and 3% didn’t know their test results.2
CDC investigators interviewed 2,621 MSM, ages 15 to 25, in 10 cities. They chose venues known to be frequented by young MSM, including gay bars, dance clubs, coffee houses, parks, and bookstores. Investigators conducted 20 minute on-the-site interviews with the eligible men.
They found that African-American men were more likely to report being tested than any other race, and men with less education were less likely to report being tested.2
"We asked the men if they could name a comfortable place to be tested," Sumartojo explained. "To me, that was one of the interesting things about this study, because whether or not they could name a comfortable place had a strong association to whether they had ever been tested."
Sumartojo and other researchers are continuing to analyze the data and will publish a study later that looks what kinds of settings MSM consider "comfortable" for HIV testing.
For HIV prevention to succeed in the future, the nation will need to continue providing highly targeted HIV prevention programs directed toward high-risk people and people who have already become infected, said Helene D. Gayle, MD, MPH, director of the CDC’s National Center for HIV, STD, and TB Prevention.
"We must increase the number of people who know their HIV status and link HIV-infected individuals not only to the treatment they need, but also to prevention services, including substance abuse treatment and mental health services, to support them in establishing and maintaining safer behaviors over a lifetime," Gayle said.
References
1. Denning P, Nakashima AK, Wortley P. Increasing rates of unprotected anal intercourse among HIV-infected men who have sex with men in the United States. Abstract ThOrC714. Presented at the XIII International AIDS Conference. Durban, South Africa; July 2000.
2. Sumartojo E, Lyles C, Guenther-Gray C, et al. Prevalence and predictors of HIV testing in a multi-site sample of young men who have sex with men. Abstract ThPeD5804. Presented at the XIII International AIDS Conference. Durban, South Africa; July 2000.
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