AIDS Trends and Risk Behaviors Among Men Who Have Sex With Men

A study in a recent issue of Morbidity and Mortality Weekly Report (MMWR), published by the U.S. Centers for Disease Control and Prevention (CDC), examines AIDS incidences and risk behaviors among men who report both sexual contact with other men and injection drug use.

This report presents demographic characteristics of men who have sex with men (MSM) and are injection drug users (IDU) diagnosed with AIDS, trends in AIDS incidence among MSM/IDU diagnosed with AIDS from 1996 to 1998, and information on selected risk behaviors.

Findings

Demographics

Demographic characteristics were obtained from CDC AIDS surveillance in the 50 states and the District of Columbia as well as medical records.

• Among MSM/IDU diagnosed with AIDS in 1998, 0.2% were between the ages of 13 and 19, 12% were between the ages of 20 and 29, 47% were between the ages of 30 and 39, 32% were between the ages of 40 and 49, 8% were between the ages.



• Among MSM/IDU diagnosed with AIDS in 1998, 41% were Non-Hispanic blacks, 41% were non-Hispanic whites, 16% were Hispanics, less than 1% were Asian/Pacific Islanders, and less than 1% were American Indians/Alaskan Natives.



• Among MSM/IDU diagnosed with AIDS in 1998, 44% lived in the South, 26% lived in the West, 17% lived in the Northeast, 10% lived in the Midwest, and 3% lived in a U.S. territory.

Trends

• The proportion of all AIDS cases among MSM/IDU decreased from 8% in 1990 to 5% in 1998.
  
  
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• AIDS incidence among MSM/IDU peaked during 1992 and 1993 and declined 37% between 1996 and 1998.

Sexual Risk Behaviors

Researchers interviewed 513 MSM/IDU who were diagnosed with AIDS during 1996-1998. Information on selected risk behaviors of MSM/IDU with AIDS were obtained from the Supplement to HIV/AIDS Surveillance (SHAS) project, a cross-sectional interview study aimed at extending information routinely collected in AIDS surveillance.

• 76% of respondents reported having had sexual contact with a man during the five years preceding the study.



• 43% of respondents reported having had sexual contact with a woman during the five years preceding the study.



• 25% of respondents reported having had vaginal-penile intercourse during the five years preceding the study. Of those respondents, 53% reported always using a condom.



• 36% of respondents reported having had receptive anal intercourse with men during the five years preceding the study. Of those respondents, 45% reported always using a condom.



• 9% of respondents reported having had insertive anal intercourse with men during the five years preceding the study. Of those respondents, 52% reported always using a condom.



• 18% of respondents reported receiving money for "sex" during the five years preceding the study. Of those respondents, 47% reported always using a condom.



• 20% of respondents reported receiving drugs for "sex" during the five years preceding the study. Of those respondents, 27% reported always using a condom.

Drug Use

• 82% of respondents reported having used non-injecting drugs during the five years preceding the study.



• 61% of respondents reported having ever used crack cocaine with 30% reporting having used crack cocaine during the five years preceding the study.



• 34% of respondents reported having injected drugs during the five years preceding the study. Of those respondents, 45% reported sharing needles.

The findings show that because MSM/IDU engage in multiple behaviors that put them at higher risk, they are particularly vulnerable to HIV infection and can transmit HIV across multiple populations, including, MSM, IDU, and heterosexual women.

The authors recommend that prevention strategies must provide the information, skills, and support necessary to reduce both sexual and drug-related risk behaviors among MSM/IDU. Programs must also include access to drug treatment and prevention case management.

Additionally, the authors note that behavioral risk information for HIV prevention is important to assure that state and local prevention programs are directed to appropriate populations. If providers do not elicit this information or are reluctant to question patients about their sexual behavior and drug use, information in medical records may under-represent true risks for HIV in the population.

Finally, the authors point out that additional research is needed to determine whether risk reduction strategies that have been effective for groups with single risk also are effective for groups with multiple risk. HIV/AIDS disease surveillance supplemented with behavioral surveys will help in planning prevention, treatment, and other services needed to reduce transmission and to improve survival and quality of life for MSM/IDU living with HIV/AIDS.

For more information:

"HIV/AIDS Among Men Who Have Sex with Men and Inject Drugs-United States, January 1985-December 1998"

Morbidity and Mortality Weekly Report, June 2, 2000, vol. 49, no. 21, pp. 465-70.