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: 5.55). 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.

Download full-text


Available from: Patrick Sullivan, Sep 26, 2015
205 Reads
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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
  • Source
    • "Data on sexual behaviors were derived both from a literature review and from the Lambda study carried out in Toronto and Ottawa in Ontario in 2007 [18]. Values for frequency of sexual episodes in particular were guided by data from published studies [4]–[8], [19]–[21]. In the final model, the values for number of episodes of anal and oral sex were adjusted within the ranges of the values indicated in these sources such that the model generated the number of incident HIV infections from our estimates (i.e. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Despite preventive efforts, HIV incidence remains high among men who have sex with men (MSM) in industrialized countries. Condoms are an important element in prevention but, given the high frequency of condom use and their imperfect effectiveness, a substantial number and proportion of HIV transmissions may occur despite condoms. We developed a model to examine this hypothesis. Methods We used estimates of annual prevalent and incident HIV infections for MSM in Ontario. For HIV-negative men, we applied frequencies of sexual episodes and per-contact HIV transmission risks of receptive and insertive anal sex with and without a condom and oral sex without a condom. We factored in the proportion of HIV-infected partners receiving antiretroviral therapy and its impact in reducing transmissibility. We used Monte-Carlo simulation to determine the plausible range for the proportion of HIV transmissions for each sexual practice. Results Among Ontario MSM in 2009, an estimated 92,963 HIV-negative men had 1,184,343 episodes of anal sex with a condom and 117,133 anal sex acts without a condom with an HIV-positive partner. Of the 693 new HIV infections, 51% were through anal sex with a condom, 33% anal sex without a condom and 16% oral sex. For anal sex with a condom, the 95% confidence limits were 17% and 77%. Conclusions The proportion of HIV infections related to condom failure appears substantial and higher than previously thought. That 51% of transmissions occur despite condom use may be conservative (i.e. low) since we used a relatively high estimate (87.1%) for condom effectiveness. If condom effectiveness were closer to 70%, a value estimated from a recent CDC study, the number and proportion of HIV transmissions occurring despite condom use would be much higher. Therefore, while condom use should continue to be promoted and enhanced, this alone is unlikely to stem the tide of HIV infection among MSM.
    PLoS ONE 09/2014; 9(9):e107540. DOI:10.1371/journal.pone.0107540 · 3.23 Impact Factor
  • Source
    • "In this context, previous research has shown that the prevalence of unprotected anal intercourse (UAI) with male regular sex partners (RP) is significantly higher than that with male non-regular sex partners (NRP) among MSM [7]. UAI with RP among MSM contributes to the majority of the new HIV infections in the United States and in Lebanon [8,9]. Among the 61.4% of the MSM in China having RP, 78.6% also have had sexual intercourse with other male sex partners [10,11]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The HIV prevalence and incidence among men who have sex with men (MSM) are high. Unprotected anal intercourse (UAI) with male regular partners (RP) is an important but under-emphasized risk behavior. The current study aimed to describe the prevalence of UAI with regular partner and the associated multi-dimensional factors with UAI among MSM in Hong Kong, China. Respondent Driven Sampling method was used to recruit participants. A total of 285 participants were recruited, of whom 211 (75.1%) had had anal sex with RP in the last six months and their data were analyzed in this report. Weighed data were presented and logistic regression methods were fit. Participants' high risk behaviors in the last six months included high prevalence of having had UAI with RP (45.8%), having had non-regular male sex partners (NRP: 27.3%) and UAI with such partners (18.9%). Adjusted for socio-demographic variables, factors associated with UAI with RP included: 1) substances use prior to having anal sex (65.7% versus 43.8%; AOR =2.36; 95% CI =1.07-5.18), 2) worry that condom use symbolizes mistrust (67.9% versus 44.3% ; AOR = 2.91; 95% CI =1.19-7.10), 3) a lower perceived degree of the RP's acceptance of condom use (91.7% versus 38.3%; AOR = 22.70; 95% CI =6.20-83.10), and 4) a higher level of impulsivity (61.1% versus 35.0%; AOR =4.02; 95% C I = 1.62-9.97). Two of these four variables, substances use (ORm = 2.28, 95% CI = 1.01-5.16) and perceived lower level of RP's acceptance of condom use (ORm = 17.22; 95% CI = 5.06-58.62) were selected by the forward stepwise logistic regression model. MSM with RP in Hong Kong is subjected to high risk of HIV transmission. Risk factors of UAI are multi-dimensional and interventions need to take into account factors of structural, interpersonal and individual levels.
    BMC Infectious Diseases 04/2014; 14(1):205. DOI:10.1186/1471-2334-14-205 · 2.61 Impact Factor
Show more