AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #192 - Differences in health and health behaviors between HIV-positive and HIV-negative substance-using MSM
Authors: Presenting Author: Dr. Steven Kurtz - Nova Southeastern University
Additional Authors: Mr. Mance E. Buttram, Dr. Ron Stall, Dr. Hilary L. Surratt, Mr. Minxing Chen,
Aim: To examine differences between HIV-positive and HIV-negative MSM in drug use, sexual behavior, and serostatus disclosure, as well as syndemic theory predictors of health risk behaviors, including victimization history and mental distress.
Method / Issue: Participants were enrolled in a randomized clinical trial of two risk reduction interventions. Eligible participants were 18-55 year old MSM who reported recent (past 90 day) unprotected anal sex and frequent alcohol/drug use (N=517). The sample included nearly equal numbers of HIV-positive (N=241) and HIV-negative (N=276) MSM. Computer-assisted personal interviews at baseline included well-tested, comprehensive measures of substance use, sexual behaviors, mental health, and social environment.
Results / Comments: Compared to HIV-negative MSM, HIV-positive men reported greater frequency of stimulant drug use (p<.000), more severe mental health problems (p=.002) and lower levels of self-efficacy and coping skills (p=.006). HIV-positive MSM were more likely to report past sexual (p=.001) and physical abuse (p=.007) than their HIV-negative counterparts. Past 90 day unprotected insertive anal intercourse (UIAI) events were nearly equal for HIV-positive (M=11.91) and HIV-negative men (M=11.17), but unprotected receptive anal intercourse (URAI) events were higher for HIV-positive (M=13.99) compared to HIV-negative MSM (M=8.37). Excluding seroconcordant unprotected sex where both partners were HIV-positive, HIV-positive MSM reported fewer UIAI (M=5.26) and URAI (M=7.58) events involving HIV transmission risk to their partners than HIV-negative men. As such, HIV transmission risk events (UIAI and URAI combined), were much lower for HIV-positive MSM (M=12.84) than HIV-negative men (M=19.54). Taking responsibility for self-disclosure and asking one’s partner about HIV status was higher for HIV-negative compared to HIV-positive MSM (p<.001).
Discussion: Among high risk MSM in South Florida, HIV-positive men report more frequent stimulant drug use, more severe mental health problems, and more extensive victimization histories than HIV-negative men, in accordance with the syndemic model. Although HIV-positive MSM are less likely to disclose their serostatus to sex partners, they report much higher levels of protected sexual behavior with serodiscordant or sero-unknown partners than do HIV-negative men. This suggests that even high risk HIV-positive MSM often take personal responsibility to protect uninfected partners. Further, and given the very high numbers of MSM who are unaware of their HIV infection, it appears likely that the continuing rapid spread of HIV among this population is more often attributable to unprotected sex between HIV-negative men and men who are unaware of their HIV infection, than to unprotected sex between HIV-negative and known-positive MSM. Implications for HIV prevention and further research will be discussed. This research was supported by DHHS Grant DA024579 from the National Institute on Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.
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