Continuing Increases in Sexual Risk Behavior and Sexually Transmitted Diseases Among Men Who Have Sex With Men: San Francisco, Calif., 1999-2001

Previously in the same journal, the authors reported on "worrisome increases" in sexual risk behavior, STDs and HIV incidence among men who have sex with men (MSM) during 1994-1999, a period of increasing use of highly active antiretroviral therapy (HAART). [Editor's note: "Impact of Highly Active Antiretroviral Treatment on HIV Seroincidence Among Men Who Have Sex With Men in San Francisco," published in AJPH (2002;92:388-394), was summarized in the PNU on 04.16.02.] Since then, the authors have obtained sexual risk behavior data for 2000 and 2001; added survey questions on whether unsafe sex occurred with partners of unknown HIV status; updated trends in male rectal gonorrhea; and provided data on primary and secondary syphilis among MSM.

Between 1999 and 2001, 10,568 MSM completed the survey. MSM reporting any anal sex in the previous six months increased from 67 percent in 1999 to 74 percent in 2001. Respondents reporting any unprotected anal sex increased from 32 percent to 38 percent; respondents reporting unprotected anal sex with two or more partners increased from 18 percent to 23 percent.

The proportion reporting unprotected anal sex with two or more partners of unknown HIV serostatus increased from 10 percent to 15 percent for self-reported HIV-negative respondents and from 19 percent to 25 percent for those who said they were HIV-positive.

Corroborating the continuing increases in sexual risk behavior are STD surveillance data. Reported cases of male rectal gonorrhea increased from 162 in 1999 (updated from 160 in the prior report, owing to reporting delays) to 237 in 2001. Primary and secondary syphilis cases among MSM increased from only six in 1998 to 115 in 2001.

The authors concluded "that the increases in unsafe sex seen from 1994 to 1999, in association with the availability of HAART, were not isolated but rather reflect an ongoing trend. Moreover, data on HIV serostatus of partners suggest that much of this unsafe sex is occurring among partners who are serodiscordant."

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