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Original Investigation |

Sexual Risk Behavior Among Virologically Detectable Human Immunodeficiency Virus–Infected Young Men Who Have Sex With Men

Patrick A. Wilson, PhD1; Shoshana Y. Kahana, PhD2; Maria Isabel Fernandez, PhD3; Gary W. Harper, PhD, MPH4; Kenneth Mayer, MD5; Craig M. Wilson, MD6; Lisa B. Hightow-Weidman, MD, MPH7
[+] Author Affiliations
1Mailman School of Public Health, Columbia University, New York, New York
2Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
3College of Osteopathic Medicine, Nova Southeastern University, Ft Lauderdale, Florida
4School of Public Health, University of Michigan, Ann Arbor
5The Fenway Institute, Harvard Medical School, Boston, Massachusetts
6School of Public Health, University of Alabama at Birmingham, Birmingham
7Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill
JAMA Pediatr. 2016;170(2):125-131. doi:10.1001/jamapediatrics.2015.3333.
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Importance  Human immunodeficiency virus (HIV) diagnoses continue to increase among young men who have sex with men (YMSM). Many YMSM living with HIV engage in sexual risk behaviors, and those who have a detectable viral load can transmit HIV to sex partners. Understanding factors that are related to sexual risk taking among virologically detectable (VL+) YMSM can inform prevention and treatment efforts.

Objectives  To describe differences between virologically suppressed (VL−) and VL+ YMSM living with HIV and to identify correlates of condomless anal intercourse (CAI) and serodiscordant CAI among VL+ YMSM.

Design, Setting, and Participants  In this cross-sectional survey conducted from December 1, 2009, through June 30, 2012, we studied 991 HIV-infected YMSM 15 to 26 years of age at 20 adolescent HIV clinics in the United States. Data analysis was conducted December 1, 2013, through July 31, 2015.

Main Outcomes and Measures  Demographic, behavioral, and psychosocial assessments obtained using audio computer-assisted self-interviews. Viral load information was obtained via blood draw or medical record abstraction.

Results  Of the 991 participants, 688 (69.4%) were VL+ and 458 (46.2%) reported CAI, with 310 (31.3%) reporting serodiscordant CAI in the past 3 months. The VL+ YMSM were more likely than the VL− YMSM to report CAI (detectable, 266 [54.7%]; suppressed, 91 [44.4%]; P = .01) and serodiscordant CAI (detectable, 187 [34.9%]; suppressed, 57 [25.0%]; P < .01). Multivariable analyses indicated that among VL+ YMSM, those reporting problematic substance use were more likely to report CAI (adjusted odds ratio [AOR], 1.46; 95% CI, 1.02-2.10) and serodiscordant CAI (AOR, 1.45; 95% CI, 1.06-1.99). Black VL+ YMSM were less likely to report CAI (AOR, 0.63; 95% CI, 0.44-0.90) or serodiscordant CAI (AOR, 0.66; 95% CI, 0.46-0.94) compared with other VL+ YMSM. In addition, VL+ YMSM who disclosed their HIV status to sex partners were more likely to report CAI compared with nondisclosing YMSM (AOR, 1.35; 95% CI, 1.01-1.81). Transgender participants were less likely to report CAI than cisgender participants (AOR, 0.35; 95% CI, 0.14-0.85). Last, VL+ YMSM who reported currently being employed were less likely to report serodiscordant CAI than those who were unemployed (AOR, 0.74; 95% CI, 0.55-0.99).

Conclusions and Relevance  Targeted multilevel interventions are needed to reduce HIV transmission risk behaviors among YMSM living with HIV, particularly among those who are VL+.

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Participant Flow Diagram

Blue shaded boxes represent subsamples examined in the current study. HIV indicates human immunodeficiency virus.

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