Background:  Although men who have sex with men (MSM) still account for the majority of reported HIV infections, the incidence of HIV is increasing among women, injection drug users (IDU) and men who have sex with women (MSW). Several investigators have raised the possibility that men who have sex with men and women (MSM/W) may serve as a “bridge” for infection between these groups. 

Methods:  As part of our attempts to understand the role that MSM/W play in the spread of HIV on college campuses we reviewed state HIV surveillance records for all new diagnoses of HIV infection in males ≤ 30 years old living in 69 counties throughout North Carolina between January 1, 2000 and December 31, 2003. We determined the prevalence of MSM/W among a group of HIV-infected college students. We also examined characteristics associated with identifying as MSM/W compared with identifying as MSM.

Results:  Among all men newly diagnosed with HIV infection (n = 808), 11% (n = 89) were college students and 14% (n = 117) described themselves as MSM/W. Compared with HIV-infected men who were MSM (n = 410) or MSW (n = 214), MSM/W were younger and were more likely to be black. In multivariable analysis, compared to HIV-infected MSM, HIV-infected MSM/W were more likely to be college students (OR 1.96, 95% 1.02 to 3.76), to report > 10 sex partners in the year prior to their HIV diagnosis (OR 2.90, 95% CI 1.14 to 7.41) and to meet sex partners on college campuses (OR 4.19, 95% CI 1.06 to 16.58). At the time of their HIV diagnosis, 27% of MSM/W were attending college and were more likely to frequent bars or clubs (OR 2.38 95% CI 1.00 to 5.70) and to meet sex partners on college campuses (OR 24.79, 95% CI 2.91 to 211.50) than the MSM/W who were not college students. Nearly one-third of the college students who identified themselves as MSM/W reported only male partners.

Conclusions:  Among men in North Carolina aged 18 to 30 who were newly infected with HIV, college students were more likely to report both male and female sex partners than men not attending college. Young African American MSM/W may serve as a bridge for HIV transmission to African American women and are a population that deserves further scientific scrutiny.

Keywords: Men who have sex with Men; Bisexuality; College students