Infectious Disease

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 relationships.

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 researchers wrote.

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 disclosures

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