Abstract
We estimated the prevalence of conscious risk, specifically defined as unprotected anal intercourse with an HIV-serodiscordant partner, and identified individual-level and partnership-level predictors of this behavior. Conscious risk was estimated to be practiced by 4.8% of HIV-negative MSM and 15.7% of HIV-positive MSM over a six-month period (p < 0.01). Among HIV-negative MSM, episodes of conscious risk were estimated to be more frequent among individuals between the ages of 18 and 24 (compared to those 55 years of age or older), among African Americans and Whites (compared to Latinos and Asians), individuals earning less than 10,000 dollars per year (compared to those earning 50,000 and 70,000 dollars per year), and among users of methamphetamine, downers, pain killers, and amyl nitrate (poppers). Among HIV-positive MSM, episodes of conscious risk were more frequent among Whites and Asians (compared to those of “other” races, i.e., those of mixed race, or those who did not exclusively self-report as White, Black, Latino, or Asian), those with full-time employment (as opposed to those with part-time employment), those earning between 30,000 and 50,000 dollars per year or 70,000 dollars per year or greater (compared to those earning under 10,000 dollars per year), and recent users of poppers. Conscious risk was more frequently reported in partnerships with large age gaps and in main partnerships (as opposed to casual or exchange partnerships). Individuals at high risk for conscious risk may be ideal candidates for pre-exposure prophylaxis (PrEP).
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References
Centers for Disease Control and Prevention. Consultation on serosorting practices. http://www.cdc.gov/hiv/topics/research/resources/other/serosorting.htm. Accessed 5 Nov 2010.
Mao L, Crawford JM, Hospers HJ, Prestage GP, Grulich AE, Kippax SC. “Serosorting” in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia. AIDS. 2006;20:1204–6.
Eaton LA, Kalichman SC, O’Connell DA, Karchner WD. A strategy for selecting sexual partners believed to pose little/no risks for HIV: serosorting and its implications for HIV transmission. AIDS Care. 2009;21:1279–88.
Parsons JT, Schrimshaw EW, Wolitski RJ, Halkitis PN, Purcell DW, Hoff CC, Gómez CA. Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation. AIDS. 2005;19(Suppl. 1):S13–25.
Elford J, Bolding G, Sherr L, Hart G. No evidence of an increase in serosorting with casual partners among HIV-negative gay men in London, 1998–2005. AIDS. 2007;21:243–5.
Golden MR, Stekler J, Hughes JP, Wood RW. HIV serosorting in men who have sex with men: is it safe? J Acquir Immune Defic Syndr. 2008;49:212–8.
Zablotska IB, Imrie J, Prestage G, Crawford J, Rawstorne P, Grulich A, Jin F, Kippax S. Gay men’s current practice of HIV seroconcordant unprotected anal intercourse: serosorting or seroguessing? AIDS Care. 2009;21:501–10.
McFarland W, Chen YH, Nguyen B, Grasso M, Levine D, Stall R, Colfax G, Robertson T, Truong HHM, Raymond HF. Behavior, intention or chance? A longitudinal study of seroadaptive behavior, abstinence and condom use. AIDS Behav. 2011 [Epub ahead of print].
McFarland W, Chen Y-H, Raymond HF, Nguyen B, Colfax G, Mehrtens J, Robertson T, Stall R, Levine D, Truong H-HM. HIV seroadaptation among individuals, within sexual dyads, and by sexual episodes, men who have sex with men, San Francisco, 2008. AIDS Care. 2011;23(3):261–8.
Muhib FB, Lin LS, Stueve A, Miller RL, Ford WL, Johnson WD, Smith PJ. A venue-based method for sampling hard-to-reach populations. Public Health Rep. 2001;116:216–22.
Ferreira LO, Sabino de Oliveira E, Raymond HF, Chen SY, McFarland W. Use of time-location sampling for systematic behavioral surveillance of truck drivers in Brazil. AIDS Behav. 2008;12(4):S32–8.
Rao JNK, Scott AJ. On Chi-squared tests for multiway contingency tables with proportions estimated from survey data. Ann Stat. 1984;12:46–60.
Lumley T. Analysis of complex survey samples. J Stat Softw. 2004;9(1):1–19.
Centers for Disease Control and Prevention. HIV prevalence estimates—United States, 2006. MMWR Morb Mortal Wkly Rep. 2008;57:1073–6.
Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health. 2006;96:1007–19.
Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS. 2007;21(15):2083–91.
Buchacz K, McFarland W, Kellogg T, Loeb L, Holmberg SD, Dilley J, Klausner J. Amphetamine use is associated with increased HIV incidence among men who have sex with men (MSM) in San Francisco. AIDS. 2005;19:1423–4.
Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, Goicochea P, Casapía M, Guanira-Carranza JV, Ramirez-Cardich ME, Montoya-Herrera O, Fernández T, Veloso VG, Buchbinder SP, Chariyalertsak S, Schechter M, Bekker LG, Mayer KH, Kallás EG, Amico KR, Mulligan K, Bushman LR, Hance RJ, Ganoza C, Defechereux P, Postle B, Wang F, McConnell JJ, Zheng JH, Lee J, Rooney JF, Jaffe HS, Martinez AI, Burns DN, Glidden DV, iPrEx Study Team. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010 363(27):2587–99 [Epub 2010 Nov 23].
Padian NS, McCoy SI, Karim SS, Hasen N, Kim J, Bartos M, Katabira E, Bertozzi SM, Schwartländer B, Cohen MS. HIV prevention transformed: the new prevention research agenda. Lancet. 2011;378(9787):269–78.
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Chen, YH., Raymond, H.F., Grasso, M. et al. Prevalence and Predictors of Conscious Risk Behavior Among San Franciscan Men who have Sex with Men. AIDS Behav 17, 1338–1343 (2013). https://doi.org/10.1007/s10461-012-0169-2
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DOI: https://doi.org/10.1007/s10461-012-0169-2