AIDS and Behavior

, Volume 17, Issue 4, pp 1338–1343

Prevalence and Predictors of Conscious Risk Behavior Among San Franciscan Men who have Sex with Men

  • Yea-Hung Chen
  • H. Fisher Raymond
  • Michael Grasso
  • Binh Nguyen
  • Tyler Robertson
  • Willi McFarland
Original Paper


We estimated the prevalence of conscious risk, specifically defined as unprotected anal intercourse with an HIV-serodiscordant partner, and identified individual-level and partnership-level predictors of this behavior. Conscious risk was estimated to be practiced by 4.8% of HIV-negative MSM and 15.7% of HIV-positive MSM over a six-month period (p < 0.01). Among HIV-negative MSM, episodes of conscious risk were estimated to be more frequent among individuals between the ages of 18 and 24 (compared to those 55 years of age or older), among African Americans and Whites (compared to Latinos and Asians), individuals earning less than 10,000 dollars per year (compared to those earning 50,000 and 70,000 dollars per year), and among users of methamphetamine, downers, pain killers, and amyl nitrate (poppers). Among HIV-positive MSM, episodes of conscious risk were more frequent among Whites and Asians (compared to those of “other” races, i.e., those of mixed race, or those who did not exclusively self-report as White, Black, Latino, or Asian), those with full-time employment (as opposed to those with part-time employment), those earning between 30,000 and 50,000 dollars per year or 70,000 dollars per year or greater (compared to those earning under 10,000 dollars per year), and recent users of poppers. Conscious risk was more frequently reported in partnerships with large age gaps and in main partnerships (as opposed to casual or exchange partnerships). Individuals at high risk for conscious risk may be ideal candidates for pre-exposure prophylaxis (PrEP).


Men who have sex with men San Francisco Risk behavior Unprotected intercourse 


  1. 1.
    Centers for Disease Control and Prevention. Consultation on serosorting practices. Accessed 5 Nov 2010.
  2. 2.
    Mao L, Crawford JM, Hospers HJ, Prestage GP, Grulich AE, Kippax SC. “Serosorting” in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia. AIDS. 2006;20:1204–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Eaton LA, Kalichman SC, O’Connell DA, Karchner WD. A strategy for selecting sexual partners believed to pose little/no risks for HIV: serosorting and its implications for HIV transmission. AIDS Care. 2009;21:1279–88.PubMedCrossRefGoogle Scholar
  4. 4.
    Parsons JT, Schrimshaw EW, Wolitski RJ, Halkitis PN, Purcell DW, Hoff CC, Gómez CA. Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation. AIDS. 2005;19(Suppl. 1):S13–25.PubMedCrossRefGoogle Scholar
  5. 5.
    Elford J, Bolding G, Sherr L, Hart G. No evidence of an increase in serosorting with casual partners among HIV-negative gay men in London, 1998–2005. AIDS. 2007;21:243–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Golden MR, Stekler J, Hughes JP, Wood RW. HIV serosorting in men who have sex with men: is it safe? J Acquir Immune Defic Syndr. 2008;49:212–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Zablotska IB, Imrie J, Prestage G, Crawford J, Rawstorne P, Grulich A, Jin F, Kippax S. Gay men’s current practice of HIV seroconcordant unprotected anal intercourse: serosorting or seroguessing? AIDS Care. 2009;21:501–10.PubMedCrossRefGoogle Scholar
  8. 8.
    McFarland W, Chen YH, Nguyen B, Grasso M, Levine D, Stall R, Colfax G, Robertson T, Truong HHM, Raymond HF. Behavior, intention or chance? A longitudinal study of seroadaptive behavior, abstinence and condom use. AIDS Behav. 2011 [Epub ahead of print].Google Scholar
  9. 9.
    McFarland W, Chen Y-H, Raymond HF, Nguyen B, Colfax G, Mehrtens J, Robertson T, Stall R, Levine D, Truong H-HM. HIV seroadaptation among individuals, within sexual dyads, and by sexual episodes, men who have sex with men, San Francisco, 2008. AIDS Care. 2011;23(3):261–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Muhib FB, Lin LS, Stueve A, Miller RL, Ford WL, Johnson WD, Smith PJ. A venue-based method for sampling hard-to-reach populations. Public Health Rep. 2001;116:216–22.PubMedCrossRefGoogle Scholar
  11. 11.
    Ferreira LO, Sabino de Oliveira E, Raymond HF, Chen SY, McFarland W. Use of time-location sampling for systematic behavioral surveillance of truck drivers in Brazil. AIDS Behav. 2008;12(4):S32–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Rao JNK, Scott AJ. On Chi-squared tests for multiway contingency tables with proportions estimated from survey data. Ann Stat. 1984;12:46–60.CrossRefGoogle Scholar
  13. 13.
    Lumley T. Analysis of complex survey samples. J Stat Softw. 2004;9(1):1–19.Google Scholar
  14. 14.
    Centers for Disease Control and Prevention. HIV prevalence estimates—United States, 2006. MMWR Morb Mortal Wkly Rep. 2008;57:1073–6.Google Scholar
  15. 15.
    Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health. 2006;96:1007–19.PubMedCrossRefGoogle Scholar
  16. 16.
    Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS. 2007;21(15):2083–91.PubMedCrossRefGoogle Scholar
  17. 17.
    Buchacz K, McFarland W, Kellogg T, Loeb L, Holmberg SD, Dilley J, Klausner J. Amphetamine use is associated with increased HIV incidence among men who have sex with men (MSM) in San Francisco. AIDS. 2005;19:1423–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, Goicochea P, Casapía M, Guanira-Carranza JV, Ramirez-Cardich ME, Montoya-Herrera O, Fernández T, Veloso VG, Buchbinder SP, Chariyalertsak S, Schechter M, Bekker LG, Mayer KH, Kallás EG, Amico KR, Mulligan K, Bushman LR, Hance RJ, Ganoza C, Defechereux P, Postle B, Wang F, McConnell JJ, Zheng JH, Lee J, Rooney JF, Jaffe HS, Martinez AI, Burns DN, Glidden DV, iPrEx Study Team. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010 363(27):2587–99 [Epub 2010 Nov 23].Google Scholar
  19. 19.
    Padian NS, McCoy SI, Karim SS, Hasen N, Kim J, Bartos M, Katabira E, Bertozzi SM, Schwartländer B, Cohen MS. HIV prevention transformed: the new prevention research agenda. Lancet. 2011;378(9787):269–78.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Yea-Hung Chen
    • 1
  • H. Fisher Raymond
    • 1
  • Michael Grasso
    • 1
  • Binh Nguyen
    • 1
  • Tyler Robertson
    • 1
  • Willi McFarland
    • 1
  1. 1.AIDS OfficeSan Francisco Department of Public HealthSan FranciscoUSA

Personalised recommendations