Stall R. Sex Transm Infect. 2011;doi:10.1136/sti.2010.048223.
HIV-positive men who have sex with other HIV-positive men are more
likely to engage in unprotected anal intercourse and combine sex and drug use
than are HIV-negative men who have sex with other HIV-negative men, according
to researchers from the University of Pittsburgh and the San Francisco
Department of Public Health.
“While a precise list of the sexual behaviors and co-occurring
conditions implicated in hepatitis C transmission among MSM has yet to be
codified, the rapid rise of hepatitis C infection over the past decade raises
the possibility that unprotected anal intercourse may be a behavioral risk
factor for hepatitis C transmission, particularly among HIV-positive MSM,”
the researchers wrote.
The researchers used time-location sampling to perform a cross-sectional
survey of MSM between November 2007 and October 2008. The men were all aged 18
years or older, a resident of one of the San Francisco Bay Area counties and
were consecutively approached by the staff to participate in the study.
Information on the participants’ race/ethnicity, age, education,
employment status, sexual orientation and HIV status were self-reported. The
participants assessed the HIV status of up to five of their most recent sexual
partners. The researchers analyzed the rates of unprotected anal intercourse
among MSM in HIV-positive, HIV-negative and serodiscordant sexual
They found that men in positive-positive relationships were
significantly more likely to engage in unprotected anal intercourse, both
insertive and receptive, compared with men in negative-negative relationships
and men in serodiscordant relationships. Men in positive-positive relationships
were also more likely to combine sex and drug use.
“If the sexual networks of men overlap with MSM who are especially
likely to combine sex and drugs overlap with MSM who use drugs in ways that
might transmit hepatitis C, a transmission bridge of hepatitis C virus from
drug injectors to a larger population of MSM would then be created,” the
The increasing trends in HIV and other STIs, and evolving risk
behaviors, among MSM are cause for concern in many Western, industrialized
countries, including the US. Although the substantial outbreaks of hepatitis C
among MSM currently being seen in some European countries have not been
observed to the same degree in the United States, we must remain vigilant.
Every effort must be made to promote and scale up hepatitis C screening of
HIV-positive MSM; promote education, awareness and screening for all MSM and
their providers; and strengthen local surveillance capacity to ensure our
ability to detect and respond quickly and effectively.
–Kevin Fenton, MD, PhD, FFPH
Infectious Disease News Editorial Board member
Disclosure: Dr. Fenton reports no relevant financial