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Introduction:  Individuals with primary HIV may be highly infectious; risky sexual behavior soon after infection increases likelihood of HIV transmission to others. Longitudinal data are needed on timing and type of behavior change following HIV diagnosis to prevent further transmission of HIV.

Methods:  We studies 152 recently HIV-infected men who have sex with men (MSM) in Southern California who completed a computer-assisted behavioral interview about 6 weeks after diagnosis; 113 completed a follow-up interview about 15 weeks later. Differences in behaviors were compared from baseline to follow up using paired t-tests and within follow up using χ² analysis to assess statistical significance. Multivariate logistic regression was applied to predict behavior change at follow up.

Results:  At follow up 92% reported sexual activity since their HIV diagnosis. Sexually active MSM reported fewer partners in the 3 months after follow up than in the 3 months prior to baseline (7.9 vs 5.2 partners, p = 0.01). MSM reported significantly lower mean numbers of risky types of partners: one-time (1.9 vs 0.8, p = 0.04); unknown (3.7 vs 2.6, p = 0.05); and acquaintance (1.1 vs 0.5, p = 0.001). Numbers of friend, regular, main, and trade partners were not different. There was no difference in the percentage reporting unprotected anal intercourse (UAI) with their last partner from baseline to follow up (59%). At follow up, more MSM reported UAI with sero-concordant than sero-discordant or sero-status unknown partners (87%, 60%, and 31%, respectively), and more reported sex with a sero-concordant partner (87% vs 63%). In multivariate analysis the following were significantly associated with reporting more than 1 partner at follow up:  not having a main partner at baseline or follow up (odds ratio (OR) 2.65); number of male partners last 12 months (OR 1.02); UAI with last partner (OR 0.32); and ever non-consensual sex (OR 2.57). Age and ethnicity were not associated with behavior change.

Conclusions:  MSM report less risky sexual behavior in the first 3 months following a HIV diagnosis than before diagnosis. MSM also report harm reduction behaviors such as sero-status mixing and less unprotected anal intercourse. Yet many risky behaviors persist that allow for continued transmission of HIV from these highly infectious individuals. Targeted counseling support is needed to assist these MSM in initiating and maintaining rapid behavior change.

Keywords: Primary HIV; Sexual behavior; Men who have sex with Men