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


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.

  • Source
    • "Specifically, research demonstrates that YMSM are more likely to engage in condomless sex with a perceived main partner[26]. Moreover, most new HIV infections among YMSM occur within the context of a relationship with a main partner[27]. On the other hand, YMSM may have a greater number of different sexual partners than their heterosexual peers, and increased frequency of sex with different partners may be associated with increased risk for HIV/STIs. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Among young men who have sex with men (YMSM) few studies have examined the relationship between intimate partner violence (IPV) perpetration versus victimization and sexual behaviors. Methods: Using data from n = 528 urban YMSM, multinomial logistic regression models were built to examine the distinct relationships between any IPV, victimization, and perpetration with condomless sex in the previous 30 days, controlling for key sociodemographic characteristics. Results: In this sample of YMSM, lifetime experience of any IPV was associated with increased odds of recent condomless oral (adjusted odds ratio [AOR] = 1.81, 95% confidence interval [CI] = 1.21-2.72) and anal receptive sex (AOR= 2.29, 95% CI = 1.22-4.31). IPV victimization was associated with a greater likelihood of condomless receptive anal sex (AOR= 2.12, 95% CI = 1.15-3.93) whereas IPV perpetration was associated with increased odds of condomless receptive (AOR= 2.11, 95% CI = 1.14-3.91) and insertive (AOR= 2.21, 95% CI = 1.06-4.59) anal sex. Conclusions: Among YMSM, reports of both IPV perpetration and victimization were associated with increased odds of recent condomless sex. These findings indicate that the need for IPV prevention and intervention programs for this new generation of YMSM is highly warranted.
    Full-text · Article · Feb 2016 · Journal of Adolescent Health
  • 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.
    Full-text · Article · May 2015 · Sexuality Research and Social Policy: Journal of NSRC
  • 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.
    Full-text · Article · Sep 2014 · PLoS ONE
Show more