Sullivan PS, Salazar L, Buchbinder S, et al.. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities

Emory University Rollins School of Public Health, Atlanta, Georgia 30322, USA.
AIDS (London, England) (Impact Factor: 6.56). 07/2009; 23(9):1153-62. DOI: 10.1097/QAD.0b013e32832baa34
Source: PubMed

ABSTRACT HIV incidence in the United States among men who have sex with men (MSM) has been increasing since 2000, and MSM remain the most heavily impacted risk group in the US HIV epidemic.
We modeled HIV transmissions, using data from MSM in five US cities from the National HIV Behavioral Surveillance System, the HIVNET Vaccine Preparedness Study, and other published data. Annual HIV transmissions were estimated by partner type (main or casual) and by sex type (receptive anal intercourse, insertive anal intercourse, or oral sex).
Sixty-eight percent [95% confidence interval (CI) 58-78) of HIV transmissions were from main sex partners because of a higher number of sex acts with main partners, more frequent receptive roles in anal sex with main partners, and lower condom use during anal sex with main partners. By sex type, 69% (95% CI 59-79) of infections were from receptive anal intercourse, 28% (95% CI 19-38) were from insertive anal intercourse, and 2% (95% CI 0-5) were from oral sex. The model-based estimated HIV incidence rate was 2.2% (95% CI 1.7-2.7) per year. Sensitivity analyses demonstrated estimates of transmission from main sex partners as low as 52% (95% CI 41-62) and as high as 74% (95% CI 68-80).
According to our model, most HIV transmissions among MSM in five US cities are from main sex partners. HIV prevention efforts should take into account the risks of HIV transmissions in male partnerships, and couples-based HIV prevention interventions for MSM should be given high priority in the US HIV prevention research portfolio.

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Available from: Patrick Sullivan, Aug 22, 2015
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    • "Questions regarding CAS were limited to non-main partners. Since these data were collected, researchers have highlighted that a significant number of new HIV infections are via main partners and thus sexual behavior with main partners remains an important area for future investigations (Sullivan et al. 2009). In addition, this study did not ask about men's beliefs regarding racial stereotypes among gay and bisexual men or if they themselves held such stereotypes. "
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    ABSTRACT: Racial prejudice and stereotyping in gay and bisexual communities may be important contextual factors that contribute to racial disparities in HIV. In an effort to challenge race-based stereotypes regarding gay and bisexual men’s sexuality, we sought to determine the extent to which race and ethnicity were associated with (1) racial homophily (i.e., same-race partnerships), (2) sexual behavior (e.g., number of partners, condomless anal sex (CAS), sexual position (top/versatile/bottom)), and (3) perceived penis size and size satisfaction. Data were taken from a survey of 1,009 gay and bisexual men recruited using a street-intercept method at gay, lesbian, and bisexual community events in NYC in 2006—15 % Black, 61 % White, 18 % Latino, and 6 % Asian/Pacific Islander (mean age, 35.7). There was strong evidence of racial homophily (i.e., having a partner of the same race) among men who were in relationships, particularly for White and Black men. Race and ethnicity was largely unassociated with multiple dimensions of sexual behavior (e.g., number of partners, CAS, sexual positioning). Although we observed some racial and ethnic differences in perceived penis size that were consistent with stereotypes, the magnitudes of the differences were insufficient to justify the stereotype. As well, there were no significant differences with regard to satisfaction with penis size or lying to others about penis size. The disproportionate HIV prevalence among Black and Latino men does not appear to be as a result of differences in sexual behavior (e.g., CAS, number of partners) and race-based sexual stereotypes were largely unsupported by empirical data.
    Sexuality Research and Social Policy: Journal of NSRC 05/2015; 12(3). DOI:10.1007/s13178-015-0190-0 · 0.72 Impact Factor
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    • "While Goodreau et al. (2012) suggested that the number may be somewhat more modest (32–39 %), they echoed assertions that main partnerships are an important vector of transmission and that approaches to HIV prevention appropriate for MSM in stable relationships are lacking and warrant development. Sullivan et al. (2009) attributed the increased risk of main partner HIV infection to a higher number of sex acts, a higher number of receptive anal sex acts (which are most likely to result in transmission), and a lower likelihood of condom use between main partners. Consistent with these hypotheses, Mustanski, Newcomb, and Clerkin (2011) studied predictors of main partner transmission risk among young men who have sex with men. "
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    ABSTRACT: Previous research has found secure adult attachment to be associated positively with dimensions of main partner relationship quality and negatively with sexual risk taking and sex with casual partners among heterosexuals in primary relationships. Potential associations between adult attachment and aspects of relationship functioning have received limited attention among gay men. Data were collected from both members of 344 gay male couples as part of a community survey (M age = 38.6, SD = 9.4). Participants completed a shortened version of the Adult Attachment Inventory (Collins & Read, 1990) and the Dyadic Sexual Communication Scale (Catania, 1998). They reported the frequency of sex with main partners and the number of casual male unprotected sex partners. Data were analyzed using the Actor-Partner Interdependence Model. Securely attached individuals reported the highest levels of sexual communication and men with securely attached partners were the most likely to report having sex with their partners as least once per week. Avoidantly attached men reported significantly more casual unprotected anal intercourse (UAI) partners compared to other attachment styles. Having an avoidantly attached partner was also associated with an increase in the number of UAI partners reported. Attachment style is relevant to the sexual relationship quality and sexual safety of partnered gay men. Cognitive-interpersonal intervention approaches developed to target attachment-related cognitions and behaviors may be relevant to HIV prevention efforts in this population.
    Archives of Sexual Behavior 12/2013; 43(1). DOI:10.1007/s10508-013-0224-8 · 3.53 Impact Factor
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    • "CVCT messaging may need to be tailored based upon age in order to increase appeal across the lifespan. Such efforts may be useful given that younger men may be partnered with older men and that risk of main partner transmission also increases with relationship duration (which is correlated with age) (Sullivan et al., 2009). This may also suggest developmental differences, whereby younger individuals may view CVCT as a ritual that signifies the seriousness of or commitment within their relationships and acts as an important step in their relationship development that may be viewed as unnecessary or insignificant for older men in relationships. "
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    ABSTRACT: Main partnerships represent one context in which HIV transmission may occur that has been insufficiently addressed to date for gay and bisexual men, but few studies have focused on the acceptability of couples-based voluntary HIV counseling and testing (CVCT) for male couples in the U.S. Our aim in this study was to explore the acceptability of CVCT among a national U.S. sample of 1,532 gay and bisexual men surveyed online using a sexual networking site. We examined the role of demographic (i.e., geographic region, age, relationship status, sexual orientation, race/ethnicity) and HIV risk (i.e., substance use, number of sexual partners, unprotected anal intercourse, sexual role identity, and sexual compulsivity) factors that may be associated with CVCT among the full sample and among partnered men separately. We found that single men expressed higher interest in CVCT than partnered men and that greater age was more strongly associated with lower interest in CVCT for partnered men than for single men. The intersection of sexual orientation and race/ethnicity was also significantly associated with CVCT interest, with a higher proportion of Black bisexual men being interested than White bisexual men. These findings suggest that the uptake of CVCT may be less impacted by HIV risk factors than by demographic factors and that young gay and bisexual men of color-for whom rates of HIV continue to rise-may be the group with the highest levels of interest in CVCT.
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