HIV Risk among Men who have Sex with Men and Women

Transcription

1 HIV Risk among Men who have Sex with Men and Women Damian J. Denson, PhD, MPH Behavioral Scientist Prevention Research Branch National Community Health Partners Webinar September 17, 2013 "The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

2 Overview of Presentation Epidemiological Profile of HIV among Gay, Bisexual and other Men who have Sex with Men (MSM) Context of HIV Risk among Men who have Sex with Men and Women (MSMW) What is CDC Doing? Discussion: What More Can We Do to Reach MSMW?

3 Epidemiological Profile of HIV among Gay, Bisexual and other MSM HIV Risk among MSM Estimated 4% of men in the US are gay, bisexual or other MSM (Purcell, 2012) Compared with other transmission groups, MSM accounted for the largest number of new infections in 2010 (CDC, 2013; HIV Surveillance Report, 2012) New infections among MSM increased by 12% from 2008 to 2010 (CDC, 2013) From 2008 to 2010, new HIV infections among young black MSM increased by 20% (CDC, 2013; CDC Vital Signs, 2012)

4 Epidemiological Profile of HIV among Gay, Bisexual and other MSM HIV Risk among Men who have Sex with Men and Women (MSMW) Of particular importance due to: Embody a multitude of identities Heterosexual Bisexual Closeted Discreet Down Low Sexual networks expand across heterosexual and MSM populations Could serve as a bridge for HIV transmission, but data inconclusive (Bond, 2009; Millett, 2005; Montgomery, 2003)

5 Epidemiological Profile of HIV among Gay, Bisexual and other MSM Few studies specifically focus on MSMW Usually pooled into MSM category during analyses (Maulsby, 2013) Differing measurement across studies in literature using either sexual identity or sexual behavior Studies on MSMW focus on subpopulations (Maulsby, 2013) Racial/ethnic minorities (Lauby, 2008; Wheeler, 2008) Youth (Flores, 2009; Valleroy, 2000) Low-income (Gorbach, 2009; Williams, 2009; Zule, 2009)

6 Epidemiological Profile of HIV among Gay, Bisexual and other MSM National HIV case surveillance data assessing MSMW (Campsmith and Hu, 2013) From , 115,994 men were diagnosed with HIV Of those, 19,285 (16.6%) reported sexual contact with both men and women Primarily black and Latino Percentage reporting MSMW increased with age across race/ethnicity groups National HIV behavioral surveillance data assessing MSMW (CDC, 2011) In 2008, HIV risk behavior was collected on 8,175 men who reported sex with another man in the past 12 months Of those, 1,109 (14%) reported female sex partners in the past 12 months as well 63% of vaginal or anal sex with female partners was unprotected

7 Epidemiological Profile of HIV among Gay, Bisexual and other MSM Other studies of MSMW indicate that: 14-20% of MSMW report unprotected sex with both men and women (Maulsby, 2013; Valleroy, 2000; Weatherburn, 1998) MSMW have fewer female partners than male partners (McKirnan, 1995; Siegel, 2008; Wold, 1998) MSMW with a main female partner report less unprotected anal intercourse with men (Maulsby, 2013)

8 Epidemiological Profile of HIV among Gay, Bisexual and other MSM MSMW are similar to MSM in terms of: Number of recent male partners (Knight, 2007; Maulsby, 2013) Estimates of unprotected insertive anal intercourse (Knight, 2007; Williams, 2009) Likelihood to use condoms (Williams, 2009) Rates of substance use (Maulsby, 2013)

9 Epidemiological Profile of HIV among Gay, Bisexual and other MSM MSMW are dissimilar to MSM in terms of: Lower rates of: HIV prevalence (Harawa, 2013; Montgomery, 2003; Wheeler 2008) Unprotected anal intercourse with male partners (Flores, 2009) Less likely to: Report unprotected receptive anal sex (Knight, 2007; Maulsby, 2013; Wheeler, 2008; Zule, 2009) Test for HIV (Flores, 2009; Jeffries, 2010) Be exposed to HIV Prevention (Flores, 2009) More likely to: Engage in sex work and IDU (Goldbaum, 1998; Maulsby, 2013; Wheeler, 2008) Report concurrent sex partners (Operario, 2011; Maulsby, 2013; Siegal, 2008) Have undiagnosed HIV (Young, 2009)

10 Context of HIV Risk among MSMW High prevalence of HIV (CDC, 2013) Particularly in racial/ethnic minority communities Increasing risk as one gets older Young MSM partnering with older MSM (higher prevalence) increases risk Lack of knowledge about HIV status (CDC, 2013) Unknowingly transmit virus False assumptions regarding partner s HIV status Misinformation regarding testing, frequency, results, viral loads

11 Context of HIV Risk among MSMW Complacency about risk (CDC, 2013) Sexual risks still account for most HIV infections in MSM Poor maintenance of safer sex behaviors over time Underestimation of personal risks Very few behavioral interventions targeting MSMW Men of African American Legacy Empowering Self (MAALES) (Harawa, 2013; Williams, 2009) Social discrimination and cultural issues Poverty and lack of access to health care Gender role conflict (Bingham, 2013; Operario, 2011) Minority Stress Model (Meyer, 1995) Homophobia/biphobia (internalized and experienced) Stigma (internalized and experienced) Racism

12 Context of Risk among MSMW How do societal and structural approaches impact HIV risk? Recent Supreme Court decisions? Anti-bullying efforts, i.e. It Gets Better? Mainstream media (Internet, TV, Film, Music)? NOH8 marriage equality campaign in response to California Proposition 8 Human Rights Campaign marriage equality efforts Logo Network, i.e. Noah s Arc Frank Ocean, hip hop/r&b artist Modern Family, Glee Macklemore and Ryan Lewis, Same Love

13 What is CDC doing? Division of HIV/AIDS Prevention s (DHAP) High-Impact HIV Prevention approach prioritizes interventions that are Cost-effective at reducing overall HIV infections Practical to implement at full-scale Target highest-risk populations Combined for specific populations Expanded HIV Testing Initiatives target: MSM African Americans Latinos

14 What is CDC doing? Development and Testing of HIV Prevention Interventions Targeting Black Bisexually Active Men (PS ) Funded 3 researchers to develop and test efficacy of novel HIV behavioral interventions Data collection complete and efficacy analyses ongoing Modified chain referral sampling was effective at recruitment (Joseph, 2012) HIV Prevention Projects for Young Men of Color Who Have Sex with Men and for their Partners (PS ) Funded 34 community-based organizations in 19 states and Puerto Rico in 2011 Prioritized most disproportionately affected populations Included partners regardless of gender or race/ethnicity

15 What is CDC doing? Evaluated recruitment approaches for HIV testing among black MSM Alternate Venue Testing HIV testing at venues frequented by MSM (Baytop Abt Poster; Ellen, 2013; Halkitis, 2011) NYC: 6.3% seropositivity (n=400) Baltimore: 10.9% seropositivity (n=218) DC: seropositivity not reported by strategy (n=175) Social Networking Strategies HIV-positive or high-risk negative black MSM recruit their peers (Baytop Abt Poster; Ellen, 2013; Halkitis, 2011) NYC: 19.3% seropositivity (n=109) Baltimore: 0% seropositivity (n=22) DC: 11% seropositivity (n=149) Partner Counseling and Referral Services (Halkitis, 2011) NYC: 14.3% seropositivity (n=49) Baltimore: 0% seropositivity (n=2) DC: seropositivity not reported by strategy (n=152)

16 What is CDC doing? Act Against AIDS: Targeted health communication campaigns for African Americans and Latinos

17 What more can we do to reach MSMW? [Discussion]

18 Works Cited Bingham, T. A., Harawa, N. T., & Williams, J. K. (2013). Gender role conflict among African American men who have sex with men and women: associations with mental health and sexual risk and disclosure behaviors. American journal of public health, 103(1), Bond, L., Wheeler, D. P., Millett, G. A., LaPollo, A. B., Carson, L. F., & Liau, A. (2009). Black men who have sex with men and the association of down-low identity with HIV risk behavior. American Journal of Public Health, 99(S1), S92-S95. Campsmith & Hu. (2013) Men Diagnosed with HIV who Reported Sex with both Men and Women Analysis of HIV Case Surveillance Data in the United States. Poster. CDC. HIV and AIDS among Gay Bisexual Men Fact Sheet Published 2013 CDC. HIV Surveillance Report, 2011; vol Published February CDC. Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths United States Published November Ellen, J. M., McCree, D. H., Muvva, R., Chung, S. E., Miazad, R. M., Arrington-Sanders, R.,... & Fichtenberg, C. (2013). Recruitment approaches to identifying newly diagnosed HIV infection among African American men who have sex with men. International journal of STD & AIDS. German D, Sifakis F, Maulsby C, et al. Persistently high prevalence and unrecognized HIV infection among men who have sex with men in Baltimore: the BESURE Study. J Acquir Immune Defic Syndr. 2011;57: Halkitis, P. N., Kupprat, S. A., Simons, S. M., Hampton, M. C., & Gillen, S. (2011). Evaluation of the relative effectiveness of three HIV testing strategies targeting African American men who have sex with men (MSM) in New York City. Annals of behavioral medicine, 42(3), Harawa, N. T., McCuller, W. J., Chavers, C., & Janson, M. (2012). HIV Risk Behaviors Among Black/African American and Hispanic/Latina Female Partners of Men Who Have Sex With Men and Women. AIDS and Behavior, 1-8.

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