141st APHA Annual Meeting and Exposition

In This section

290244
HIV infection among men who have sex with men and women (MSMW): A systematic review and comprehensive meta-analysis

Wednesday, November 6, 2013 : 12:30 PM - 12:45 PM

Mackey Friedman, PhD, MPH , Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA
Chongyi Wei, DrPH , Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA
Mary Lou Klem, PhD , Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA
Anthony Silvestre, PhD , Dept. of Infectious Diseases and Microbiology, Graduate School of Public Health, Pittsburgh, PA
Nina Markovic, PhD , Graduate School of Public Health, Dept. of Epidemiology, University of Pittsburgh, Pittsburgh, PA
Ron Stall, PhD , Department of Community and Behavioral Health, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA
INTRODUCTION: Some public health researchers have suggested that men who have sex with men and women (MSMW) are responsible for significant HIV transmission or "bridging." However, few studies have estimated MSMW-specific HIV risks. We conducted a systematic review and comprehensive meta-analysis to assess a) differences in HIV prevalence and risk behavior between MSMW and men who have sex with men only (MSMO); and b) population sizes of MSMW and HIV-positive MSMW. METHODS: We conducted systematic searches of PubMed and PsycINFO. Articles were included if they were peer-reviewed, published in English, and presented HIV prevalence data for U.S. MSMW. Meta-analyses were conducted with NIH-supported software using random-effects models. RESULTS: 3474 articles were identified; 31 met inclusion criteria. MSMW were less likely than MSMO to be HIV-positive (OR=0.4, 95% CI: 0.3, 0.5) and to report URAI (OR=0.4, 95% CI: 0.3, 0.5). Among MSM, 33.8% (95% CI: 23.7%, 45.6%) were past-year MSMW. Among confirmed HIV-positive MSM, 21.0% (95% CI: 14.7%, 28.9%) were past-year MSMW. We estimate that 1,204,204 U.S. males are past-year MSMW, of whom 121,800 are HIV-positive. DISCUSSION: This represents the first meta-analysis of HIV prevalence between MSMW and MSMO in the U.S. Lower URAI engagement among MSMW may explain commensurately reduced HIV prevalence. Our HIV-positive MSMW estimate aligns with CDC estimates for HIV-positive male heterosexuals and IDU; thus, we propose that MSMW risk to female partners has been relatively overstated. MSMW-specific data collection, research, and HIV prevention and care delivery are necessary to better quantify and ameliorate this population's HIV burden.

Learning Areas:
Diversity and culture
Epidemiology
Social and behavioral sciences

Learning Objectives:
Assess differences in HIV prevalence between men who have sex with men only (MSMO) and men who have sex with men and women (MSMW).

Keywords: Bisexual, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I joined the HIV Prevention and Care Project in the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh in 2005.† As Director of Project Silk, my work focuses on designing, implementing, and evaluating HIV prevention demonstration project with the local House and Ball Community.† I have worked in HIV prevention for the last 18 years, working primarily with injection drug users, sex workers, MSM, and homeless and runaway youth.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.