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Behavior Change Among HIV-Negative Men Who Have Sex with Men Not Using PrEP in the United States

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Abstract

This study measures changes in condomless anal sex (CAS) among HIV-negative men who have sex with men (MSM) who are not taking pre-exposure prophylaxis (PrEP). It considers the 2014–2019 cycles of the American Men’s Internet Survey, a serial, cross-sectional web-based survey of US cisgender MSM aged ≥ 15 years, in which ~ 10% of each year’s sample is drawn from the previous year. Among those surveyed for 2 years who remained HIV-negative and off PrEP, reports of having any CAS and of CAS partner number were compared across years. We disaggregated by partner HIV status, and considered demographic predictors. The overall population saw a significant 2.2 percentage-point (pp) increase in reports of any CAS year-over-year. Sub-populations with the largest year-on-year increases were 15–24-year-olds (5.0-pp) and Hispanic respondents (5.1-pp), with interaction (young Hispanic respondents = 12.8-pp). On the relative scale, these numbers correspond to 3.2%, 7.2%, 7.3% and 18.7%, respectively. Absolute increases were concentrated among partners reported as HIV-negative. Multivariable analyses for CAS initiation found effects concentrated among Hispanic and White youth and residents of fringe counties of large metropolitan areas. CAS partner number increases were similarly predicted by Hispanic identity and young age. Although condom use remains more common than PrEP use, increasing CAS among MSM not on PrEP suggests potential new HIV transmission pathways. Concentration of increases among 18–24-year-old MSM portends future increases in the proportion of newly diagnosed HIV that occur among youth. Concentration among young Hispanic MSM will likely expand existing disparities. Although reducing barriers to PrEP remains vital, condom promotion for MSM remains a key public health practice and appears to be missing key audiences. LGBTQ+-inclusive sex education is one avenue for enhancing these efforts.

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Acknowledgements

The authors thank the members of the Coalition for Applied Modeling for Prevention (www.emorycamp.org), especially Monica Trigg and Abby Tighe. We also thank the members of our Public Health Advisory Group, especially those who provided feedback on this work: Drs. Thomas Bertrand, Daniel Driffin, Gregory “Grey” Felzien, Jane Kelly, and Ron Valdiserri. Our gratitude to all of our CDC partners, including Taiwo Abimbola, Terrika Barham, and Ranell Myles. Thank you to the entire AMIS team and to Dr. Jane Lee.

Funding

This study was supported by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (Grant No. U38-PS004646), National Institute of Allergy and Infectious Diseases (Grant Nos. R01-AI138783, P30-AI027757), National Institute of Child Health and Human Development (Grant No. P2C-HD042828).

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Authors and Affiliations

  1. Department of Anthropology, University of Washington, Campus Box 353100, Seattle, WA, 98122, USA

    Steven M. Goodreau

  2. Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA

    Steven M. Goodreau & Deven T. Hamilton

  3. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Michael P. Barry

  4. Center for AIDS & STD, University of Washington, Seattle, WA, USA

    Michael P. Barry

  5. Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Austin M. Williams

  6. Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Li Yan Wang

  7. Department of Epidemiology, Emory University, Atlanta, GA, USA

    Travis H. Sanchez

  8. Department of Global Health, University of Washington, Seattle, WA, USA

    David A. Katz

  9. Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Kevin P. Delaney

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  1. Steven M. Goodreau
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Correspondence to Steven M. Goodreau.

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The original online version of this article was revised: In the sentence beginning “Meanwhile, there is a paucity of quantitative research...” in this article, the text “An Australian study found no significant changes in the proportion of HNM-NP having condomless anal sex (CAS) with casual partners from 2013 (30%) to 2017 (29)% [13].” should have read “An Australian study found that the proportion of HNM-NP having condomless anal sex (CAS) with casual partners increased from 30% in 2013 to 41% in 2017 [13], further increasing to 45% in 2019 and in the sentence beginning “To our knowledge” the text “this study is the first since the onset of PrEP and U = U to document CAS increases specifically among MSM who are HIV-negative and off PrEP” should have read “this study is the first since the onset of PrEP and U = U to document CAS increases specifically among MSM who are HIV-negative and off PrEP in the United States.”

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Goodreau, S.M., Barry, M.P., Hamilton, D.T. et al. Behavior Change Among HIV-Negative Men Who Have Sex with Men Not Using PrEP in the United States. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04281-7

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