The amount of unprotected anal sex gay men in San Francisco had with men whose HIV status was unknown to them increased between 1999 and 2001, according to a study published in the June 1st edition of the Journal of Acquired Immune Deficiency Syndromes.
The study, conducted by the STOP AIDS Project, recruited 10,579 gay men in venues such as bars and in gay neighbourhoods in 1999 and 2001. The men were asked to give details of their HIV status (positive, negative or unknown) and to say how many times they had had unprotected anal sex with different partners in the last six months. Study participants were not specifically asked if they had had unprotected anal sex with men of different or unknown HIV status. Rather, the investigators asked the men to count the number of men they had had unprotected sex with whose HIV status they knew, and this figure was subtracted to give the number of serodiscordant partners.
Men were classified as having serodiscordant unprotected sex if they reported two partners of unknown status.
Basic demographic information was also collected, including age and race. Men were classified as young if they were under 30 years of age, and older if they were over 30.
The investigators found that the overwhelming majority of men (90.5%) had been tested for HIV. Nearly two thirds (64.2%) were white and a little under 60% were aged over 30.
In total 12.7% of men reported unprotected anal sex with at least two partners of unknown status in the past six month. The number reporting unprotected sex increased over the study period from 11% in 1999 to 16.2% in 2001.
Potentially serodiscordant sex was reported most frequently by HIV-positive men (20.8%) compared to 12.1% of HIV-negative respondents, and 13.4% of men who did not know their HIV status.
When the investigators analysed these data further they found that HIV-positive men having potentially serodiscordant unprotected anal sex tended to be white (OR 1.8 95% CI 1.3-2.5 p<.001 an="" anal="" and="" are="" be="" below="" both="" ci="" conducted="" early="" echoes="" engaging="" finding="" francisco="" gay="" having="" hiv-negative="" in="" likely="" link="" men="" more="" non-white="" of="" older="" or="" p="" potentially="" san="" serodiscordant="" sex="" status="" study="" tended="" that="" the="" to="" under="" unknown="" unprotected="" untested="" were="" whilst="" white="" with="" younger="">
”Recent increases in u(nprotected) a(nal) s(ex) previously reported among MSM in San Francisco are not only the result of increases in UAI between MSM who are known to be of the same HIV status” note the investigators.
The attitude towards safer sex amongst older HIV-positive men may have changed since the advent of HAART suggest the investigators, as they may regard HIV to be less serious and themselves to be less infectious.
High rates of unprotected sex amongst non-white men who did not know their HIV status highlighted to the authors “the need to identify barriers to HIV testing for these communities.”
A potential limitation of the study could be the under-reporting of potentially serodiscordant sex by HIV-positive men, as the investigators note the legal sanctions against it and possible social stigma.
The investigators conclude “our data point to the urgent need for prevention messages promoting condom use and the disclosure of HIV status to partners.” However, they note that “disclosure...is neither necessary nor sufficient to ensure safer sex” rather, a “potentially valuable and under explored part of HIV prevention.”
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ReferenceChen SY et al. Unprotected anal intercourse between potentially HIV-serodiscordant men who have sex with men, in San Francsico. JAIDS 33: 166 - 170, 2003.