Unawareness of HIV infection among men who have sex with men in Puerto Rico: Data from the National HIV Behavioral Surveillance System 2008-2011

Background: Puerto Rico (PR) has the second highest HIV incidence in the US. Understanding unawareness of HIV infection has been recognized as public health challenge that needs to be addressed, particularly among MSM living in PR, since recent data reports increasing rates in this group.

Objective: To evaluate the magnitude and distribution of HIV infection unawareness over time among Puerto Rican MSMs.

Methods: Data from the PR National HIV Behavioral Surveillance-MSM from the 2008 and 2011 cycles was used. Participants who reported a prior negative HIV test and tested positive, were considered to be unaware of their status. Poisson regression model were used to determine changes in HIV unawareness across cycles.

Results: A high unawareness of HIV was reported (72.2% in 2008; 76.7% in 2011), however, no statistical changes were observed over time (p>0.10). Regression models shows that as age increases, a marginal significant decrease on unawareness was observed (OR:0.98;CI95%0.96-1.00). The model also suggests that as the number of male sexual partners increase, a 1% increase in unawareness was observed (OR:1.01;CI95%:1.00-1.01). Those who reported their sexual preferences to their health care provider (HCP) were 36% more likely to be unaware (OR:1.36;CI:1.07-1.73).

Conclusions: The increase in HIV incidence might be explained due to the high proportion of unaware HIV positive MSMs. Therefore, targeted prevention efforts -specifically among young MSM- should be delineated in order to decrease HIV unawareness among this population. Those efforts must address better targeted educational intervention among HCP in order to promote HIV prevention and awareness.