Certain subgroups of men who have sex with men show a tendency for more risky behavior.
Human immunodeficiency virus (HIV) continues to affect men who have sex with men (MSM) more than other populations in the US.
Recent data from the US Centers for Disease Control and Prevention (CDC) suggests that the HIV epidemic is growing among MSM, while remaining relatively stable in heterosexual populations.
Young MSM, or YMSM, aged 13-29 years, are particularly vulnerable to HIV, accounting for more than 25% of new infections in the US, and more than 70% of all new HIV infections among youths.
Black YMSM are disproportionately affected, accounting for 61% of all new HIV infections in the US in 2009. Young transgender women are also at risk, with more than 20% of new HIV cases reported in this subgroup.
Methods and aims of HIV treatment
HIV testing, antiretroviral treatment, adherence and viral suppression among YMSM with HIV play a key role in preventing new infections.
Treatment for HIV aims to decrease the level of virus in the blood to an undetectable viral load. If a person has a detectable viral load, this means the amount of virus in the blood is high enough to be reliably detected; a cut-off point is fixed, below which the virus is said to be undetectable.
It is thought that behavioral approaches, together with interventions to reduce risky sexual behaviors, could help improve rates of engagement in care and adherence to medication. Risky sexual behavior includes condomless anal intercourse (CAI).
Patrick A. Wilson, PhD, of the Columbia University Mailman School of Public Health in New York, and coauthors examined differences in demographic and psychosocial factors between YMSM with and without a detectable viral load for HIV.
The team also looked at psychosocial factors associated with CAI and CAI among YMSM with detectable viral load.
The authors studied 991 YMSM with a detectable viral load, aged 15-26, at 20 adolescent HIV clinics in the US from 2009-12.
Higher CAI activity among those with detectable HIV
Among these participants, 69.4% had a detectable HIV viral load; 46.2% reported CAI in the past 3 months, and 31.3% reported CAI with someone of a different HIV status.
More than half (54.7%) of YMSM with detectable HIV reported CAI, compared with 44.4% of those who were virologically suppressed, or without detectable HIV.
Likewise, 34.9% of YMSM with detectable HIV reported CAI with a partner who was HIV-negative, while 25% of YMSM without HIV reported CAI with a different HIV status.
Fast facts about HIV
- About 50,000 HIV infections occur each year in the US
- 1.2 million people in the US were estimated to have HIV at the end of 2012
- 12.8% of these do not know they have HIV.
Analyses suggest that among YMSM with HIV, those with problematic substance use are more likely to report CAI or CAI with someone of a different HIV status.
Black YMSM with HIV were less likely to report CAI or CAI with someone of a different HIV status, as were transgender participants. The authors suggest that more research is needed into these subgroups, for whom relatively high rates of infection do not appear to be matched by risky behavior.
YMSM with detectable HIV who told their sex partners about their HIV status were more likely to report CAI compared with YMSM who did not tell their partner about their status.
Employed YMSM with detectable HIV were less likely to report CAI with a partner without HIV than those who were unemployed.
The authors conclude:
"Combination HIV prevention and treatment interventions, which include behavioral, biomedical and structural strategies to increase viral suppression and reduce HIV transmission risk behaviors, that target HIV-infected YMSM are needed. To truly curb HIV incidence among YMSM, we cannot solely rely on one strategy to prevent and treat HIV."
The team points out that the study does not prove a cause, only a link; they also caution that results could be affected by the fact that all the YMSM with HIV who were involved in the study were receiving care.
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