Background:  Black men who have sex with men (MSM) are disproportionately affected with HIV in the United States, yet behavioral risk factors do not fully explain the high rates of HIV infection in this group. One hypothesis is the high HIV prevalence among black MSM sexual partners. Limited event-specific data have been reported in black MSM to help understand factors associated with increased risk of infection.

Methods:  Cross-sectional data from 503 MSM who attended public venues in New York City as part of the 2004 to 2005 National HIV Behavioral Surveillance were analyzed. Men ≥18 years old who reported ≥1 male sexual partner in the past year were included. Event-specific information, including alcohol and drug use during sex and partner race/ethnicity, age (older age as a proxy for higher HIV prevalence), and HIV status, was collected. A case-crossover approach for which each individual served as his own control compared last protected and last unprotected anal intercourse event using conditional logistic regression.

Results:  Among 503 MSM, median age was 29 years; 117 (23%) were black, 138 (27%) Hispanic, 199 (40%) white, and 49 (10%) other. Among 349 tested for HIV, 18% were positive. Black MSM were more likely to test HIV⁺ (OR 3.7, p <0.01) and not know their HIV⁺ status (OR 2.5, p = 0.07) than non-black MSM. Black MSM were less likely to self-identify as MSM (OR 0.3, p <0.01) and to be college educated (OR 0.4, p <0.01), and more likely to be recently incarcerated (OR 1.9, p = 0.047). Case-crossover analysis of 208 MSM showed men were less likely to engage in protected anal intercourse with a first time partner (OR 0.4, p <0.01) and with a partner of unknown HIV status (OR 0.3, p <0.01). Alcohol and drug use during sex, same race/ethnicity, age of partner >40 years, and sexual position were not associated with having unprotected anal intercourse. Although black MSM were more likely to have black male partners (OR 9.9, p <0.01), they were not more likely to have unprotected anal intercourse with those partners (p = 0.76) or to have a partner age >40 years (p = 0.71).

Conclusions:  HIV prevalence was high among black MSM in New York City, as was unawareness of HIV⁺ status. Having a sexual partner of same race/ethnicity and >40 years of age was not associated with having unprotected anal intercourse among black MSM. More research is needed to explore the relationship of sexual networks to risk behavior among black MSM to guide HIV prevention endeavors.