Correlates of unprotected vaginal and/or anal sex with female partners among urban, drug-using, men who have sex with men and women: Results from project MIX

Background: The role of men who have sex with men and women (MSMW) in heterosexual HIV transmission is not well understood. Methods: We analyzed baseline data from 2,013 substance-using men who have sex with men (MSM) recruited for Project MIX, a multi-site HIV prevention intervention trial, conducted between 2005 and 2006 in Chicago, Los Angeles, New York, and San Francisco. Using regression techniques, we identified correlates of unprotected vaginal and/or anal intercourse with women (UVAI) among the MSMW sample. Results: Approximately 10% (N=194) of MSM reported vaginal/anal sex with a woman in the past 3 months; of these MSMW, 66% (N=129) reported UVAI. Of these 129 MSMW who reported UVAI, 36% (47) had been HIV-positive for at least six months prior to the baseline assessment. Multivariate analyses found MSMW who were unemployed (OR=2.28; CI 1.01, 5.17), had a primary female partner (OR=3.44; CI 1.4, 8.46), higher treatment optimism (OR=1.73; CI 1.18, 2.54) had increased odds of reporting UVAI in the past three months. Strong feelings of connection to a same-race gay community (OR=0.71; CI 0.56, 0.91) and erectile-dysfunction medication use (OR=0.31; CI 0.10, 0.95) decreased odds of reporting UVAI. Participant HIV status was not statistically significantly associated with UVAI. Conclusions: In this sample of MSMW, several critical factors, including female partner status and treatment optimism, emerged as associated with UVAI with female partners. Further research, recruiting MSMW specifically, is needed to inform HIV prevention interventions for high-risk MSMW to reduce transmission risk behaviors to female partners.