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Unprotected Sex Rising Among Gay and Bi Men, Knowing HIV Status Reduces Risk

A majority of new HIV infection occurred among gay and bisexual men in all but 2 states, according to the latest data from the National HIV Behavioral Surveillance System, described in the November 29, 2013, Morbidity and Mortality Weekly Report. Although the number of gay men reporting unprotected anal sex rose significantly from 2005 to 2011, men who knew they were HIV positive were less likely to engage in risky sex than men who remained unaware of their status.

Researchers from the U.S. Centers for Disease Control and Prevention (CDC) analyzed data from the National HIV Behavioral Surveillance System to estimate the percentage of all new HIV diagnoses attributable to men who have sex with men ("MSM"), the likelihood of having unprotected anal sex, and HIV testing history. The 2011 analysis included data from men in 20 cities with high rates of HIV, and was compared to data from the 2005 and 2008 surveys.

Results

• 18% of men participating in the 2011 survey were HIV positive.
• Among men who tested positive in the study, the percentage who were previously aware of their status increased to 66% in 2011 from 56% in 2008.
• MSM accounted for at least half of people diagnosed with HIV in all states except Pennsylvania and South Dakota.
• 57% of gay and bi men reported having unprotected anal sex at least once during the past 12 months in 2011, a significant increase from 48% in 2005.
• While 33% of MSM who were HIV positive but did not know their status reported unprotected anal sex with a partner of opposite or unknown status, this fell to 13% among positive men who were aware of their own status.
• Two-thirds of men with negative or unknown status said they were tested for HIV within the past 12 months.
• More men were tested within the past 3 months (31%) than in the past 4-6 months (17%) or 7-12 months (19%).
• The percentage of men who tested positive but were previously unaware they were infected was 4% among those tested in the past 3 months, 5% among those tested in the past 4-6 months, and 7% among those tested in the past 7-12 months.

"CDC found that MSM who were HIV positive but unaware were more than two times more likely to engage in unprotected discordant anal sex, compared with HIV positive aware or HIV negative MSM," the report authors concluded.

"Expanded efforts are needed to reduce HIV risk behaviors and to promote at least annual HIV testing among MSM," they continued. "Persons aware of their infection are less likely to transmit the virus, and HIV testing is an essential first step in the care and treatment of those who are HIV positive. HIV treatment can lower viral load, improving health outcomes and reducing the likelihood of HIV transmission."

"While we remain concerned about potentially increasing levels of sexual risk, it is encouraging to see that risk is substantially lower in those who know they have HIV," CDC director Thomas Frieden said in an agency press release. "HIV testing remains one of our most powerful tools to reverse the epidemic. Everyone should know their HIV status."

"Getting an HIV test at least once a year is essential for gay and bisexual men," added Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "Only when a man knows his status can he make the best prevention choices for himself and his partners."

12/4/13

Reference

G Paz-Bailey, I Hall, RJ Wolitski, et al.HIV Testing and Risk Behaviors Among Gay, Bisexual, and Other Men Who Have Sex with Men -- United States. Morbidity and Mortality Weekly Report 62(47):958-962. November 29, 2013.

Other Source

Centers for Disease Control and Prevention. Sexual Risk Lower Among U.S. Gay and Bisexual Men Who Accurately Know Their HIV Status. Press release. November 27, 2013.