W. L. H. Whitington*, T. Collis, D. Dithmer-Schreck, H. H. Handsfield, R.-W. Wood, K. K. Holmes, and C. Celum.
Univ. of Washington and Public Hlth.—Seattle & King County, Seattle.
Background:In Seattle and elsewhere, bacterial STD incidence has increased among both HIV-positive (HIV+) and HIV-negative (HIV-) men who have sex with men (MSM). Sexual and drug use behaviors, STD prevalence, and sexual mixing between HIV+and HIV-MSM were studied to assess potential for HIV transmission.
Methods:Cross-sectional study at 5 Seattle clinical facilities (STD and HIV-testing clinics, AIDS clinic, private practice, and anal dysplasia study). Behaviors during the prior 2 mo were ascertained by self-administered anonymous questionnaires. Syphilis, gonorrhea and chlamydia testing was offered; HIV testing was optional.
Results:Among 959 MSM enrolled, median age was 36 yr and median number of sex partners (SP) in the prior 2 mo was 3. Of men reporting HIV status, 337 (37%) were HIV+and 564 (63%) were HIV-. HIV+men were more likely than HIV-men to have had receptive anal sex (72% vs 64%, p < 0.05). Of men reporting anal sex, 43% acknowledged inconsistent condom use (never or sometimes). About 40% usually did not discuss HIV serostatus prior to sex. Of HIV+men, 150 (45%) reported having sex with known HIV-SPs and 147 (43%) had sex with SPs of unknown serostatus, and men <36 yr (ORADJ1.5, 95% CI 1.0—2.5) were more likely to have an HIV-SP. Of HIV-men, 79 (14%) reported sex with HIV+SPs and 308 (56%) had sex with SPs of unknown serostatus. HIV-men with HIV+SPs were more likely to be >36 yr (ORADJ2.0, CI951.2—3.3), to have >5 SP during 2 mo (ORADJ2.2, CI951.1—4.2), and to use methamphetamines (ORADJ2.3, CI951.3—2.5). Regardless of subject's serostatus, MSM with SP of unknown serostatus were more likely to recruit SP at bathhouses (ORADJ>5) or parks (ORADJ>2). Gonorrhea, chlamydia or syphilis was diagnosed in 12% of HIV+and 13% of HIV-men; STD prevalence was similar in men with serodiscordant and serodiscordant SP.
Conclusions:Among these MSM with high STD prevalence, mixing between HIV+and HIV-men occurred frequently and condoms were often used inconsistently or not at all. Interventions in HIV+as well as HIV-MSM must facilitate serostatus discussion, reduce the number of anonymous SP, and increase condom use with anal sex.© 8th Conference on Retroviruses and Opportunistic Infections