Sexual Risk Behavior Among Virologically Detectable Human Immunodeficiency Virus-Infected Young Men Who Have Sex With Men.

TitleSexual Risk Behavior Among Virologically Detectable Human Immunodeficiency Virus-Infected Young Men Who Have Sex With Men.
Publication TypePublication
Year of Publication2016
AuthorsWilson PA, Kahana SY, Fernandez MIsabel, Harper GW, Mayer K, Wilson CM, Hightow-Weidman LB
JournalJAMA Pediatr
Volume170
Issue2
Pagination125-31
Date Published2016 Feb
ISSN2168-6211
KeywordsAdolescent, Adult, Cross-Sectional Studies, HIV Infections, HIV-1, Homosexuality, Male, Humans, Male, Risk, Risk-Taking, Sexual Behavior, Sexually Transmitted Diseases, United States, Viral Load, Young Adult
Abstract

<p><b>IMPORTANCE: </b>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.</p><p><b>OBJECTIVES: </b>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.</p><p><b>DESIGN, SETTING, AND PARTICIPANTS: </b>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.</p><p><b>MAIN OUTCOMES AND MEASURES: </b>Demographic, behavioral, and psychosocial assessments obtained using audio computer-assisted self-interviews. Viral load information was obtained via blood draw or medical record abstraction.</p><p><b>RESULTS: </b>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).</p><p><b>CONCLUSIONS AND RELEVANCE: </b>Targeted multilevel interventions are needed to reduce HIV transmission risk behaviors among YMSM living with HIV, particularly among those who are VL+.</p>

DOI10.1001/jamapediatrics.2015.3333
Alternate JournalJAMA Pediatr
PubMed ID26641367
PubMed Central IDPMC4821589
Grant ListU01 HD 040533 / HD / NICHD NIH HHS / United States
U01 HD040533 / HD / NICHD NIH HHS / United States
P30 MH043520 / MH / NIMH NIH HHS / United States
U01 HD068040 / HD / NICHD NIH HHS / United States
U01 D 040474 / / PHS HHS / United States