Which HIV-Infected Men Who Have Sex With Men in Care Are Engaging in Risky Sex and Acquiring Sexually Transmitted Infections: Findings From a Boston Community Health Center

In this study, the researchers set out to determine the prevalence of sexually transmitted infections in a cohort of HIV-positive men who have sex with men (MSM) and to identify the demographic and behavioral characteristics of those infected with STIs and the correlates of sexual transmission risk behavior.

The study involved 398 MSM in a primary care setting. At entry, the men were tested for STIs, and their medical charts were reviewed for STI results in the previous year. A computer-assisted self-assessment and medical record extraction were used to collect data on demographics, substance use, sexual behavior, and HIV disease characteristics. The characteristics of those with recent STI and recent transmission risk behavior were assessed through logistic regression analyses.

Among the men, 74.6 percent were white, and 51.7 percent were college-educated. The men were, on average, 41.5 years old (SD 8.4) and had been HIV-infected for 8.6 years (SD 6.7). Nine percent of the MSM had an STI: 6.4 percent tested positive for syphilis, 3.1 percent for gonorrhea, and 0.25 percent for chlamydia. Age and years since HIV diagnosis were found to be significantly associated with testing STI-positive, as was engaging in transmission risk behavior and using methamphetamine, ketamine and inhalants. In a multivariable model, use of substances -- particularly methamphetamine -- and being more recently diagnosed with HIV were each uniquely associated with transmission risk behavior.

"These results underscore the need to develop more effective secondary prevention interventions for HIV-infected MSM, tailored to more recently diagnosed patients, particularly those who are younger and substance users," the authors concluded.

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