No Turning Back

HIV-Positive MSM

As a result of treatment advances, more MSM are living with HIV in the United States than at any other time in the epidemic.

Identifying HIV-positive MSM through voluntary testing is essential -- to ensure that more men have access to quality prevention, care, and treatment services. In addition, evidence suggests that there is a need for increased counseling and prevention services for MSM who test positive.

In one study, 22 percent of HIV-positive MSM said they had engaged in unprotected anal intercourse in the previous three months with a partner who was HIV-negative or whose HIV status was unknown.⁽⁵²⁾ In another study of older HIV-positive gay men in Seattle (median age 36), 45 percent reported having sex with partners they knew were HIV-negative and 43 percent reported having sex with partners whose status they did not know. Of men reporting anal sex, 43 percent acknowledged inconsistent condom use.⁽⁵³⁾ In addition, many MSM diagnosed with syphilis and reporting high-risk behavior in recent outbreaks in multiple cities were co-infected with HIV -- for example, 60 percent of men were co-infected with HIV in a syphilis outbreak in southern California in 2000.⁽¹⁵⁾

It has become increasingly apparent that HIV-positive men require prevention services that take into account various complex factors:

Viral Load. Some men on HAART may believe they pose no risk to others if their viral load has been substantially lowered. Studies have shown that some HIV-positive MSM whose viral load becomes undetectable erroneously believe that they are not infectious and engage in unprotected anal intercourse.⁽⁵⁴⁾ Because HIV transmission can take place even when viral load is undetectable, prevention programs should continue to encourage HIV-infected men to consistently practice safer sex.

Drug Resistance. While antiretroviral therapy has prolonged lives, many people on HAART develop resistance to different drugs over time. These resistant strains of HIV can then be passed on to others, complicating treatment for those newly infected with these strains. Maximum adherence to drug regimens will reduce the development of resistance, but ongoing prevention services for HIV-positive people on HAART is essential to minimize the spread of drug-resistant HIV.

Risks for Individuals Living with HIV. Unprotected sex between two HIV-positive men may pose a risk of infection with other STDs that could compromise their health. For example, infection with the herpes virus hhv-8 has been associated with the development of the AIDS-associated malignancy Kaposi's sarcoma.^(55,56)