San Francisco saw 73% fewer new cases of HIV between 2012 and 2022 among men who have sex with men (MSM). As we approach zero HIV infections, MSM with multiple risk factors may be left behind. MSM who engage in sex work (MSMSW) are disproportionately effected by such risks. Unfortunately, data are sparse for this population.

Methods

We characterized MSMSW from National HIV Behavioral Surveillance in San Francisco from June-November, 2023. MSM were recruited using venue-based sampling, with MSMSW defined as engaging in sex for money or other resources. Ttest, ranksum, and Fisher’s exact tests were used to compare differences between MSMSW and other MSM.

Results

Of 545 participants, 31 (5.7%) were MSMSW. Compared to other MSM, more MSMSW were young (38.7% age 18-29, p=0.007), earned <$40,000 (56.7%, p=0.001), depended on Medicaid (53.6% p<0.001), and were incarcerated in the last year (16.1%, p<0.001). MSMSW had significantly higher HIV prevalence (38.7% vs 22.8%, p=0.042), median sex partners (20 vs. 6, p<0.001), condomless sex (93.6% vs 70.8%, p=0.006), and substance use (87.1% vs. 55.9%, p=0.001), particularly methamphetamine (59.3% vs. 19.2%, p<0.001), in the last year compared to other MSM. MSMSW were as likely to be tested for HIV (89.5%) and use PrEP (68.4%).

Conclusion

Our data show that MSMSW have a higher burden of HIV and risk factors linked to exposure compared to other MSM. If we are to achieve the goal of reaching zero HIV by 2030, providers must recognize the unique prevention and care needs of MSMSW.