Disproportionate social vulnerability and HIV-related sexual risk among men who have sex with men and women (MSMW) in the United States

Background: HIV remains a public health concern in the US, concentrated among men who have sex with men (MSM). Some MSM have had female partners (MSMW). Because MSMW may bridge HIV infection to women and men, research on social vulnerability and HIV-related sexual risk among MSMW is warranted. Methods: Data are from Wave IV (2007-2008) of the National Longitudinal Study of Adolescent Health. Using responses to past and current sexual activity, we classified men as having sex with women only (MSW), men only (MSMO), or MSMW. We also identified MSMW with current male partners, female partners, and both male and female partners (N= 6,945). We compared MSW, MSMO, and MSMW on social vulnerability, STI, multiple partners, concurrent partnerships and unprotected sex.

Results: Compared to MSW, MSMW with female partners had almost 3 times higher odds of an STI; MSMW with male and female partners had almost 4 times higher odds of reporting multiple partners. MSMW with male partners had almost 3 times higher odds of reporting multiple partners. MSMW with male partners and MSMW with male and female partners had approximately 3 times higher odds of concurrent partnerships. Compared to MSM, MSMW with female partners had almost 3 times higher odds of unprotected sex. MSMWs were more likely to report social vulnerabilities that are HIV risk factors including depression, substance use, and incarceration than MSWs and MSMOs. Conclusions: HIV risk is elevated among MSMW. Interventions to reduce HIV risk should address social vulnerability and varying sexual risk patterns of MSMW.