Serodiscordant unprotected anal intercourse among HIV-positive men who have sex with men recruited from a sexual networking website, United States

Background: The changing landscape of HIV prevention in the U.S. underscores the need to improve our ability to efficiently reach HIV-positive MSM who engage in behaviors that could transmit HIV. This analysis examines serodiscordant unprotected anal sex among a cohort of MSM recruited over the internet.

Methods: An email was sent to approximately 675,000 members of a gay-oriented sexual networking website inviting men to participate in an anonymous behavioral survey. 11,721 men initiated the survey, and 8,472 provided sufficient information to assess their HIV status. Sexual behaviors and substance use were measured over a 60-day reporting period. Logistic regression was used to identify correlates of serodiscordant unprotected anal (receptive or insertive) intercourse (UAI).

Results: 1,319 (16%) participants were HIV-positive and more than half (57.2%) had been diagnosed ≥3 years ago. Three-quarters (74%) were on antiretroviral therapy. Most men (median age=44) were white (82%) and college educated (52%). Nearly one-third reported cocaine (30%) or crystal methamphetamine use (29%), and approximately half (46%) used PDE5 inhibitors (e.g., Viagra®). Overall, 32% of men engaged in UAI with HIV-negative/unknown serostatus partners (11% receptive UAI, 11% insertive UAI, and 10% both). Multivariable logistic regression identified several predictors of serodiscordant UAI, including sex with ≥2 male partners (p≤.001), substance use in conjunction with sex (p≤.01), and use of PDE5 inhibitors (p≤.01).

Conclusions: High levels of sexual risk were found among these MSM. Increased internet-based HIV prevention marketing efforts and prevention strategies should be considered to efficiently reach HIV-positive MSM who engage in serodiscordant unprotected anal intercourse.