Psychosocial Problems Linked to Higher HIV Risk in Men Who Have Sex With Men

New data indicate that high rates of HIV infection are continuing among gay men; that most young gay and bisexual men with HIV are unaware they are infected; and that psychosocial problems and age of partners are tied to HIV risk.

In a household-based CDC study of 2,881 MSM in four US cities, the rate of HIV infection and high-risk sex were much higher when psychosocial problems were present. The percentage of men reporting high-risk sex increased steadily from 7.1 percent among men with no health problems to 33.3 percent of those with psychosocial problems, according Ron Stall, Ph.D., M.P.H., chief of the behavioral interventions and research branch at the CDC.

The most common psychosocial problems were multiple drug use, partner violence, a history of childhood sexual abuse, and depression. In men who reported no psychosocial health problems, 13 percent indicated they were HIV-infected compared to 25 percent of those with all four health problems.

"The correlation between risk behavior, HIV infection, and these psychosocial health problems were consistent and striking," said Stall. "The more of these other problems [that] gay and bisexual men reported, the more likely they were to have high-risk sex or to be infected already.

"These findings help point us toward the kind of sophisticated prevention programs that are needed -- ones that incorporate a more comprehensive approach to gay men's health, addressing the multiple health and social issues influencing HIV risk," said Stall.

In a related study, gay and bisexual men are more likely to engage in high-risk sexual behavior with younger partners, according to CDC behavioral scientist Gordon Mansergh, PhD. He and colleagues examined the sexual patterns of 376 sexually active MSM in San Francisco among four age groups -- men in their 20s, 30s, 40s, or 50 and older. Fifty-two percent of the men overall reported having high-risk sex during their most recent encounter, with 56 percent of men with younger partners engaging in high-risk sex compared to 43 percent with partners in a similar age group.

In a report last month in AIDScience, Mansergh described a paradigm shift from an AIDS epidemic when effective treatment was rare to today's HIV epidemic where the emphasis is upon life-long health promotion, with more opportunities for further transmission of the virus. Ron Valdiserri, MD, MPH, deputy director of the CDC's Center for HIV, STD, and TB Prevention, added three more elements of today's AIDS epidemic:

• High levels of infection in communities already plagued by many social inequities and other health problems;
• Gay men of all races and levels of sexual identification have unique prevention needs; and
• A wide spectrum of individuals are at risk, from those who have grown tired of prevention to those who don't fully understand or appreciate their risk.

Back to other CDC news for August 12, 2002

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