New CDC Reports Highlight HIV Risks for MSM, but Little Info on WSW

In July 2006, the Centers for Disease Control (CDC) published a report outlining the results of a study done with 10,030 Men Who Have Sex with Men (MSM) by the National HIV Behavioral Surveillance (NHBS) System. Risk behavior data was collected between November 2003 and April 2005 from MSM who were at least 18 years old in 17 major U.S. metropolitan areas, including Atlanta, Georgia. The term MSM includes not only men who identify as being gay or bisexual but also men who identify as heterosexual but have had sexual encounters with other men, or "on the DL."

Each of the men participated in an interview that lasted about 20 minutes, and were asked questions regarding their HIV testing history, sexual and drug-use behaviors and participation in HIV prevention service programs and STD testing, among other things. Some of the findings included the following:

• The majority of the MSM (over 90%) had been tested for HIV, and of those, 77% had been tested within the last year.

• In addition to their male sex partners, 14% of the participants also had at least one female partner within the last year.
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• A whopping 58% had reported having unprotected anal intercourse with a male partner who was a significant other (a boyfriend or life partner), and 34% with a casual male partner (someone who they had sex with, but not a significant other).

• The use of recreational drugs can facilitate sexual risk taking. Non-injection drugs were used by 42% of the participants, with the most commonly used drugs being marijuana (77%), cocaine (37%), ecstasy (29%), poppers (28%), and stimulants such as crystal meth (27%). Injection drugs, which can lead to direct HIV transmission, had been used by 6% of the participants.

• Most of the participants (80%) had received free condoms within the last year, but only 15% had participated in individual HIV prevention programs and only 8% in group HIV prevention programs.

• About 43% had also been tested for syphilis, gonorrhea, or some other STD during the last year.

According to the NHBS, MSM continue to be the largest population living with HIV in the United States. For the majority of MSM, unsafe sex is still the most likely route of HIV transmission. Approximately 11% of the HIV-negative study participants reported having unsafe sex with a partner whose status was unknown.

Another CDC study conducted in 2005 in five urban areas show that of the African-American MSM who were tested for HIV, 46% were HIV-positive and approximately two-thirds, or 67%, were unaware of their status. This indicates there is most likely a large number of Black MSM who are engaging in unsafe sex, believing they are HIV-negative when they are actually positive. For many of the white MSM, drug use is still associated with increased sexual risk behaviors, especially unprotected anal sex while high. Out of the 42% of NHBS participants that used non-injection drugs, three quarters of these users reported being under the influence while having sex.

The CDC report was clear that consistent and correct use of condoms during sexual intercourse is very effective in preventing HIV infection. They suggest a "multifaceted approach" be used by agencies to reduce HIV transmission, that should be designed to reduce risk behaviors, and increase knowledge of HIV status, especially among populations that are at high risk.

In stark contrast is the most recent CDC info from June 2006 regarding HIV among Women Who Have Sex with Women (WSW). To date, there are still no confirmed cases of woman-to-woman transmission of HIV in the U.S. database, although there are case reports of such transmission. The CDC refers to the well-documented risk of female-to-male transmission that indicates that vaginal secretions and menstrual blood are potentially infectious, and exposure to these fluids, especially via the mucous membrane, could possibly lead to HIV infection.

Joe Greenwood is an HIV Pre- and Post-Test Counselor in AIDS Survival Project's Prevention Department. jgreenwood@aidssurvivalproject.org.