AIDS and Behavior

, Volume 21, Issue 10, pp 2874–2885 | Cite as

Unsafe Sexual Behavior Among Gay/Bisexual Men in the Era of Combination Antiretroviral Therapy (cART)

  • Pamela J. SurkanEmail author
  • Ying Li
  • Lisa P. Jacobson
  • Christopher Cox
  • Anthony Silvestre
  • Pamina Gorbach
  • Linda Teplin
  • Michael Plankey
Original Paper


The aim of this study was to determine the association between psychosocial determinants of unprotected receptive anal intercourse (URAI) and unprotected insertive anal intercourse (UIAI). Data from 417 HIV positive men who have sex with men (MSM) in the Multicenter AIDS Cohort Study from April 1999 to March 2012 were analyzed and adjusted odds were calculated. It was found that 66% (n = 277) and 72% (n = 299) reported any UIAI or URAI over follow-up, respectively. Cumulative cART-years (median = 5.30 years) was associated with 33 and 47% increases in UIAI and URAI, respectively. Not having reduced concern about HIV transmission (UIAI: OR 0.37, p-value = 0.0004; URAI: OR 0.57, p-value = 0.04), increased safe sex fatigue (UIAI: OR 2.32, 95% p-value = 0.0002; URAI: OR 1.94, p-value = 0.003), and sexual sensation seeking (UIAI: OR 1.76, p-value = 0.002; URAI: OR 1.56, p-value = 0.02) were associated with UIAI and URAI. Serosorting was associated with UIAI (OR 6.11, p-value < 0.0001) and URAI (OR 6.80, p-value < 0.0001). Findings suggest that negative attitudes about HIV transmission are sustained among older men who have sex with men.


Cohort study Homosexuality Male Anti-retroviral agents Sexual behavior HIV 


El objetivo del estudio fue evaluar la asociación entre determinantes psicosociales de sexo anal receptivo desprotegido (CARD) y sexo anal insertivo desprotegido (CAID). Datos de 417 participantes VIH positivos del Estudio Multicéntrico de Cohorte de SIDA (English: Multicenter AIDS Cohort Study, MACS) de abril del 1999 a marzo del 2012 fueron analizados y los odds ratios (OR) ajustados fueron calculados. Se encontró que 66% (n = 277) y 72% (n = 299) reportaron alguna actividad de CARD o CAID durante el tiempo del seguimiento, respectivamente. El tiempo cumulativo de tratamiento antiretroviral combinado en años (mediana  = 5.30 años) estuvo asociado con un incremento del 33% y 47% de la actividad de CARD y CAID respectivamente. No haber experimentado este tipo de actividades sexuales redujo el riesgo de transmisión de VIH (CARD: OR 0.37, p = 0.0004; CAID: OR 0.57, p = 0.04), aumento la fatiga sexual segura (CARD: OR 2.32, 95% p = 0.0002; CAID: OR 1.94, p = 0.003), e incremento la búsqueda de sensaciones sexuales (CARD: OR 1.76, p = 0.002; CAID: OR 1.56, p = 0.02). Serodiscriminación estuvo asociado con CARD (OR 6.11, p < 0.0001) y CAID (OR 6.80, p < 0.0001). Estos hallazgos sugieren que las actitudes negativas sobre la transmisión del VIH se mantienen entre los hombres de mayor edad que tienen relaciones sexuales con otros hombres.



Data in this manuscript were collected by the Multicenter AIDS Cohort Study (MACS) with centers at Baltimore (U01-AI35042): The Johns Hopkins University Bloomberg School of Public Health: Joseph B. Margolick (PI), Jay Bream, Todd Brown, Barbara Crain, Adrian Dobs, Michelle Estrella, W. David Hardy, Lisette Johnson-Hill, Sean Leng, Anne Monroe, Cynthia Munro, Michael W. Plankey, Wendy Post, Ned Sacktor, Jennifer Schrack, Chloe Thio; Chicago (U01-AI35039): Feinberg School of Medicine, Northwestern University, and Cook County Bureau of Health Services: Steven M. Wolinsky (PI), John P. Phair, Sheila Badri, Dana Gabuzda, Frank J. Palella, Jr., Sudhir Penugonda, Susheel Reddy, Matthew Stephens, Linda Teplin; Los Angeles (U01-AI35040): University of California, UCLA Schools of Public Health and Medicine: Roger Detels (PI), Otoniel Martínez-Maza (Co-P I), Aaron Aronow, Peter Anton, Robert Bolan, Elizabeth Breen, Anthony Butch, Shehnaz Hussain, Beth Jamieson, Eric N. Miller, John Oishi, Harry Vinters, Dorothy Wiley, Mallory Witt, Otto Yang, Stephen Young, Zuo Feng Zhang; Pittsburgh (U01-AI35041): University of Pittsburgh, Graduate School of Public Health: Charles R. Rinaldo (PI), Lawrence A. Kingsley (Co-PI), James T. Becker, Phalguni Gupta, Kenneth Ho, Susan Koletar, Jeremy J. Martinson, John W. Mellors, Anthony J. Silvestre, Ronald D. Stall; Data Coordinating Center (UM1-AI35043): The Johns Hopkins University Bloomberg School of Public Health: Lisa P. Jacobson (PI), Gypsyamber D’Souza (Co-PI), Alison Abraham, Keri Althoff, Jennifer Deal, Priya Duggal, Sabina Haberlen, Eithne Keelagan, Alvaro Muñoz, Derek Ng, Eric C. Seaberg, Sol Su, Pamela Surkan. Institute of Allergy and Infectious Diseases: Robin E. Huebner; National Cancer Institute: Geraldina Dominguez. The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH). Targeted supplemental funding for specific projects was also provided by the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute on Deafness and Communication Disorders (NIDCD). MACS data collection is also supported by UL1-TR001079 (JHU ICTR) from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH), Johns Hopkins ICTR, or NCATS. The MACS website is located at

Compliance with Ethical Standards

Conflict of interest

There are no financial conflicts of interest with the co-authors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees associated with the Multicenter AIDS Cohort Study sites and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Pamela J. Surkan
    • 1
    Email author
  • Ying Li
    • 2
  • Lisa P. Jacobson
    • 3
  • Christopher Cox
    • 3
  • Anthony Silvestre
    • 4
  • Pamina Gorbach
    • 5
  • Linda Teplin
    • 6
  • Michael Plankey
    • 2
  1. 1.Social and Behavioral Intervention Program, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Division of Infectious Diseases, Department of MedicineGeorgetown University Medical CenterWashingtonUSA
  3. 3.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Department of Infectious Diseases and Microbiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  5. 5.Division of Infectious Diseases, Department of Epidemiology, David Geffen School of MedicineUniversity of California at Los AngelesLos AngelesUSA
  6. 6.Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Feinberg School of MedicineNorthwestern UniversityChicagoUSA

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