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HIV Infection and Associated Risks Among Young Men Who Have Sex With Men in a Florida Resort Community

June 23, 2003

Several recent studies have reported high rates of sexual risk-taking and HIV infection among young men who have sex with men. Research led to warnings that a new generation was at risk for HIV infection, especially young MSM of color. In 1996, Miami-Dade County, Fla., had one of the highest AIDS rates among U.S. metropolitan areas. South Beach, situated at the southern end of Miami Beach, was among the top three ZIP-code areas for Miami-Dade County in the number of reported AIDS cases. Almost all studies of the prevalence of HIV infection and associated risk behaviors among young MSM have used samples of convenience, greatly limiting the generalizability of the findings. The current study was designed to obtain population-based estimates of HIV prevalence among young MSM living in South Beach.

A household probability sample was drawn to survey unmarried 18- to 29-year-old MSM resident in South Beach for at least 30 days. Subjects were interviewed, completed self-administered questionnaires, and provided oral specimens for HIV antibody testing.

Between January 20 and December 19, 1996, individuals at 2,622 residential units were screened, yielding 108 18- to 29-year-old eligible MSM; 100 (92.6 of eligible participants) consented and completed study procedures. Of the 100 MSM interviewed, 48 identified as white, 44 as "Hispanic, Latino, Spanish heritage," five as African American, and three as "other." Median age was 28 years. Sixty-one MSM reported having a four-year college degree. Seventeen percent were currently in school part- or full-time. More than half (55 percent) reported having resided in South Beach for less than two years. Forty-one (41 percent) reported a current relationship with a primary partner. By self-identification, 84 percent identified as gay or homosexual; 12 percent as bisexual; and 4 percent as heterosexual.

Many respondents (27 percent) reported attendance at local gay bars and nightclubs more than once a week in the prior year and an additional 29 percent reported weekly attendance. Approximately one half reported using ecstasy (MDMA; 51 percent), or cocaine (48 percent) within the previous year. Forty-five percent had used three or more recreational drugs within the past year; 34 percent reported at least weekly use of some drug. More than half (56 percent) reported having had anal sex while high on alcohol and/or drugs during the previous year; 24 percent reported that at least one half of their anal sex was under the influence of alcohol and/or drugs.

All 100 men who completed the interview and questionnaire provided a specimen for OraSure HIV testing, and 93 percent reported a prior HIV test. Fifteen respondents (15 percent) tested positive for HIV antibodies. All 15 reported a history of HIV testing; one-third (n=5) reported that their previous HIV test was negative. Using the date of their most recent HIV test for the five MSM who reported a negative result for this test, researchers estimate the incidence to be 6.3 percent.

Recent migrants to South Beach were more likely to test HIV positive than were longer-term residents. There was a trend for MSM who did not have a primary partner to be more likely to test HIV positive. Orasure test positivity was associated with higher reported number of anal intercourse partners and "cruising" in public areas for sex partners in the prior year, but was not associated with UAI in the prior year or unprotected anal intercourse (UAI) with a nonprimary partner. Neither age nor race/ethnicity was associated with HIV antibody status.

Within the past year, 81 percent of respondents reported anal intercourse; 45 percent of the sample reported engaging in UAI. UAI was not associated with age, race, educational background or length of residency. MSM having a primary partner were significantly more likely to report engaging in UAI in the last year than were MSM not having a primary partner. Men "cruising" in public places were significantly less likely to report UAI than were those who did not report "cruising." MSM who reported engaging in unprotected receptive oral intercourse with ejaculation tended to report engaging in UAI. Having a primary partner, "cruising," and fellatio with ejaculation were significant predictors of UAI in the past year in the logistic regression model.

"The high prevalence of UAI and HIV infection in South Beach attest to a previously undocumented public health concern," the study authors concluded. "The extremely high estimated incidence for young MSM in South Beach highlights the urgent need for more effective risk-reduction interventions and further epidemiological research on resort areas."

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Excerpted from:
Journal of Acquired Immune Deficiency Syndromes
06.01.03; Vol. 33, No. 2, P. 223-231; Robert D. Webster; William W. Darrow; Jay P. Paul; Randall A. Roark; William J. Woods; Robert R. Stempel

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