Patrick A Wilson1, Shoshana Y Kahana2, Maria Isabel Fernandez3, Gary W Harper4, Kenneth Mayer5, Craig M Wilson6, Lisa B Hightow-Weidman7. 1. Mailman School of Public Health, Columbia University, New York, New York. 2. Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland. 3. College of Osteopathic Medicine, Nova Southeastern University, Ft Lauderdale, Florida. 4. School of Public Health, University of Michigan, Ann Arbor. 5. The Fenway Institute, Harvard Medical School, Boston, Massachusetts. 6. School of Public Health, University of Alabama at Birmingham, Birmingham. 7. Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill.
Abstract
IMPORTANCE: Human immunodeficiency virus (HIV) diagnoses continue to increase among young men who have sex with men (YMSM). Many YMSM living with HIV engage in sexual risk behaviors, and those who have a detectable viral load can transmit HIV to sex partners. Understanding factors that are related to sexual risk taking among virologically detectable (VL+) YMSM can inform prevention and treatment efforts. OBJECTIVES: To describe differences between virologically suppressed (VL-) and VL+ YMSM living with HIV and to identify correlates of condomless anal intercourse (CAI) and serodiscordant CAI among VL+ YMSM. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional survey conducted from December 1, 2009, through June 30, 2012, we studied 991 HIV-infected YMSM 15 to 26 years of age at 20 adolescent HIV clinics in the United States. Data analysis was conducted December 1, 2013, through July 31, 2015. MAIN OUTCOMES AND MEASURES: Demographic, behavioral, and psychosocial assessments obtained using audio computer-assisted self-interviews. Viral load information was obtained via blood draw or medical record abstraction. RESULTS: Of the 991 participants, 688 (69.4%) were VL+ and 458 (46.2%) reported CAI, with 310 (31.3%) reporting serodiscordant CAI in the past 3 months. The VL+ YMSM were more likely than the VL- YMSM to report CAI (detectable, 266 [54.7%]; suppressed, 91 [44.4%]; P = .01) and serodiscordant CAI (detectable, 187 [34.9%]; suppressed, 57 [25.0%]; P < .01). Multivariable analyses indicated that among VL+ YMSM, those reporting problematic substance use were more likely to report CAI (adjusted odds ratio [AOR], 1.46; 95% CI, 1.02-2.10) and serodiscordant CAI (AOR, 1.45; 95% CI, 1.06-1.99). Black VL+ YMSM were less likely to report CAI (AOR, 0.63; 95% CI, 0.44-0.90) or serodiscordant CAI (AOR, 0.66; 95% CI, 0.46-0.94) compared with other VL+ YMSM. In addition, VL+ YMSM who disclosed their HIV status to sex partners were more likely to report CAI compared with nondisclosing YMSM (AOR, 1.35; 95% CI, 1.01-1.81). Transgender participants were less likely to report CAI than cisgender participants (AOR, 0.35; 95% CI, 0.14-0.85). Last, VL+ YMSM who reported currently being employed were less likely to report serodiscordant CAI than those who were unemployed (AOR, 0.74; 95% CI, 0.55-0.99). CONCLUSIONS AND RELEVANCE: Targeted multilevel interventions are needed to reduce HIV transmission risk behaviors among YMSM living with HIV, particularly among those who are VL+.
IMPORTANCE: Human immunodeficiency virus (HIV) diagnoses continue to increase among young men who have sex with men (YMSM). Many YMSM living with HIV engage in sexual risk behaviors, and those who have a detectable viral load can transmit HIV to sex partners. Understanding factors that are related to sexual risk taking among virologically detectable (VL+) YMSM can inform prevention and treatment efforts. OBJECTIVES: To describe differences between virologically suppressed (VL-) and VL+ YMSM living with HIV and to identify correlates of condomless anal intercourse (CAI) and serodiscordant CAI among VL+ YMSM. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional survey conducted from December 1, 2009, through June 30, 2012, we studied 991 HIV-infected YMSM 15 to 26 years of age at 20 adolescent HIV clinics in the United States. Data analysis was conducted December 1, 2013, through July 31, 2015. MAIN OUTCOMES AND MEASURES: Demographic, behavioral, and psychosocial assessments obtained using audio computer-assisted self-interviews. Viral load information was obtained via blood draw or medical record abstraction. RESULTS: Of the 991 participants, 688 (69.4%) were VL+ and 458 (46.2%) reported CAI, with 310 (31.3%) reporting serodiscordant CAI in the past 3 months. The VL+ YMSM were more likely than the VL- YMSM to report CAI (detectable, 266 [54.7%]; suppressed, 91 [44.4%]; P = .01) and serodiscordant CAI (detectable, 187 [34.9%]; suppressed, 57 [25.0%]; P < .01). Multivariable analyses indicated that among VL+ YMSM, those reporting problematic substance use were more likely to report CAI (adjusted odds ratio [AOR], 1.46; 95% CI, 1.02-2.10) and serodiscordant CAI (AOR, 1.45; 95% CI, 1.06-1.99). Black VL+ YMSM were less likely to report CAI (AOR, 0.63; 95% CI, 0.44-0.90) or serodiscordant CAI (AOR, 0.66; 95% CI, 0.46-0.94) compared with other VL+ YMSM. In addition, VL+ YMSM who disclosed their HIV status to sex partners were more likely to report CAI compared with nondisclosing YMSM (AOR, 1.35; 95% CI, 1.01-1.81). Transgender participants were less likely to report CAI than cisgender participants (AOR, 0.35; 95% CI, 0.14-0.85). Last, VL+ YMSM who reported currently being employed were less likely to report serodiscordant CAI than those who were unemployed (AOR, 0.74; 95% CI, 0.55-0.99). CONCLUSIONS AND RELEVANCE: Targeted multilevel interventions are needed to reduce HIV transmission risk behaviors among YMSM living with HIV, particularly among those who are VL+.
Authors: Gregorio A Millett; John L Peterson; Stephen A Flores; Trevor A Hart; William L Jeffries; Patrick A Wilson; Sean B Rourke; Charles M Heilig; Jonathan Elford; Kevin A Fenton; Robert S Remis Journal: Lancet Date: 2012-07-20 Impact factor: 79.321
Authors: Charles H Hinkin; Terry R Barclay; Steven A Castellon; Andrew J Levine; Ramani S Durvasula; Sarah D Marion; Hector F Myers; Douglas Longshore Journal: AIDS Behav Date: 2007-03
Authors: Eli S Rosenberg; Gregorio A Millett; Patrick S Sullivan; Carlos Del Rio; James W Curran Journal: Lancet HIV Date: 2014-12 Impact factor: 12.767
Authors: Shoshana Y Kahana; Maria Isabel Fernandez; Patrick A Wilson; Jose A Bauermeister; Sonia Lee; Craig M Wilson; Lisa B Hightow-Weidman Journal: J Acquir Immune Defic Syndr Date: 2015-02-01 Impact factor: 3.731
Authors: Mary R Tanney; Sylvie Naar-King; Debra A Murphy; Jeffrey T Parsons; Heather Janisse Journal: J Adolesc Health Date: 2009-08-18 Impact factor: 5.012
Authors: Kathryn E Muessig; Sara LeGrand; Keith J Horvath; José A Bauermeister; Lisa B Hightow-Weidman Journal: Curr Opin HIV AIDS Date: 2017-09 Impact factor: 4.283
Authors: Lisa Hightow-Weidman; Kate Muessig; Joseph R Egger; Sara LeGrand; Alyssa Platt Journal: J Adolesc Health Date: 2020-01-25 Impact factor: 5.012
Authors: Irene S Yoon; Martin J Downing; Richard Teran; Mary Ann Chiasson; Steven T Houang; Jeffrey T Parsons; Sabina Hirshfield Journal: AIDS Care Date: 2017-12-19
Authors: Michael J Stirratt; Gary Marks; Christine O'Daniels; Edward R Cachay; Meg Sullivan; Michael J Mugavero; Shireesha Dhanireddy; Allan E Rodriguez; Thomas P Giordano Journal: Sex Transm Infect Date: 2017-11-02 Impact factor: 3.519
Authors: Timothy W Menza; Stephen A Berry; Julie Dombrowski; Edward Cachay; Jodie Dionne-Odom; Katerina Christopoulos; Heidi M Crane; Mari M Kitahata; Kenneth H Mayer Journal: Clin Infect Dis Date: 2022-08-31 Impact factor: 20.999
Authors: Heather L Armstrong; Julian Gitelman; Zishan Cui; Nicanor Bacani; Paul Sereda; Nathan J Lachowsky; Kiffer G Card; Jordan M Sang; Henry F Raymond; Julio Montaner; David Hall; Terry Howard; Mark Hull; Robert S Hogg; Eric A Roth; David M Moore Journal: PLoS One Date: 2022-10-21 Impact factor: 3.752
Authors: Cynthia L Gay; Sarah J Willis; Anna B Cope; JoAnn D Kuruc; Kara S McGee; Joe Sebastian; Amanda M Crooks; Mehri S McKellar; David M Margolis; Susan A Fiscus; Charles B Hicks; Guido Ferrari; Joseph J Eron Journal: AIDS Date: 2016-11-28 Impact factor: 4.177