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An Event-Level Analysis of Condomless Anal Intercourse with a HIV-Discordant or HIV Status-Unknown Partner Among Black Men Who Have Sex with Men from a Multi-site Study

AIDS and Behavior volume 22, pages 2224–2234 (2018)Cite this article

Abstract

Despite the high HIV incidence and prevalence among black men who have sex with men (BMSM), little research has examined partner characteristics, partner seeking venue, sexual position, substance use, and sexual risk behavior at the sex event-level among BMSM. Using the baseline data from a multi-site study of 807 BMSM stratified by their HIV status, the goal of this study was to conduct a detailed event-level analysis of 1577 male anal sex events to assess the factors associated with condomless anal intercourse (CLAI) with a HIV-discordant or HIV status-unknown partner. We found CLAI with an HIV-discordant or unknown HIV status partner among HIV-negative BMSM was negatively associated with having sex with a main partner, and was positively associated with taking both receptive and insertive sexual positions during sex. As compared to a sex partner met at bar, night club or dance club, HIV-positive BMSM were less likely to engage in CLAI with HIV-discordant and unknown HIV status partner met at party or friend’s house or at community organizations. HIV-positive BMSM had lower odds of engaging in CLAI with HIV-discordant and unknown HIV status partner if they had insertive sexual position or both receptive and insertive sexual positions. These results underscore the importance of delineating unique sex event-level factors associated with sexual risk behavior depending on individuals’ HIV status. Our findings suggest event-level partner characteristics, sexual position, and partner seeking venues may contribute to disparities in HIV incidence.

Resumen

A pesar de la alta incidencia y prevalencia del VIH entre morenos que tienen sexo con hombres (MSH), pocas investigaciones han examinado las características de la pareja, lugar de encuentro de parejas, posición sexual, uso de sustancias, y comportamientos sexuales de riesgo al nivel de evento sexual entre MSH. Utilizando los puntos de referencia de 807 MSH estratificados por su estado del VIH de un estudio de sitios múltiples, el objetivo de este estudio fue realizar un análisis de nivel de evento detallado de 1577 eventos masculinos del sexo anal para evaluar los factores asociados con el coito anal sin condón (CASC) con una pareja que es VIH-discordante o desconocida de su estado del VIH. Entre los MSH, los que tuvieron CASC con una pareja que es VIH-discordante o desconocida de su estado del VIH, encontramos que los MSH que son VIH-negativo fueron asociados negativamente con teniendo relaciones sexuales con una pareja principal, y ellos eran asociados positivamente con tomando posiciones sexuales tanto receptivas como de inserción durante el sexo. En comparación a los que conocieron una pareja sexual en un bar, club nocturno, o discoteca, los MSH que son VIH-positivos eran menos probable a participar en el CASC con una pareja VIH-discordante y de estado desconocido del VIH que fue conocida en una fiesta, en casa de un amigo o en organizaciones comunitarias. Los MSH con VIH también tenían menos probabilidades de participar en el CASC con una pareja con VIH y VIH-discordante si hacían una posición sexual de inserción o ambas posiciones sexuales receptivas y de inserción. Estos resultados subrayan la importancia de delinear factores de nivel de eventos sexuales únicos asociados con el comportamiento sexual de riesgo según el estado de VIH de las personas. Nuestros resultados sugieren que las características de la pareja al nivel de evento, la posición sexual, y los lugares de encuentro de parejas pueden contribuir a las disparidades en la incidencia del VIH.

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References

  1. Center for Disease Control and Prevention (CDC). Half of black gay men and a quarter of Latino gay men projected to be diagnosed within their lifetime. 2016. http://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html. Accessed 1 Apr 2017.

  2. Crosby R, Holtgrave DR, Stall R, Peterson JL, Shouse L. Differences in HIV risk behaviors among black and white men who have sex with men. Sex Transm Dis. 2007;34:744–8.

    PubMed  Google Scholar 

  3. Harawa NT, Greenland S, Bingham TA, Johnson DF, Cochran SD, Cunningham WE, et al. Associations of race/ethnicity with HIV prevalence and HIV-related behaviors among young men who have sex with men in 7 urban centers in the United States. J Acquir Immune Defic Syndr. 2004;35:526–36.

    Article  PubMed  Google Scholar 

  4. Sifakis F, Hylton JB, Flynn C, Solomon L, Mackellar DA, Valleroy LA, et al. Racial disparities in HIV incidence among young men who have sex with men: the Baltimore Young Men’s Survey. J Acquir Immune Defic Syndr. 2007;46:343–8.

    Article  PubMed  Google Scholar 

  5. 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;21:2083–91.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Maulsby C, Millett G, Lindsey K, Kelley R, Johnson K, Montoya D, et al. HIV among black men who have sex with men (MSM) in the United States: a review of the literature. AIDS Behav. 2014;18:10–25.

    Article  PubMed  Google Scholar 

  8. Berry M, Raymond HF, McFarland W. Same race and older partner selection may explain higher HIV prevalence among black men who have sex with men. AIDS. 2007;21:2349–50.

    Article  PubMed  Google Scholar 

  9. Calabrese SK, Rosenberger JG, Schick VR, Novak DS, Reece M. An event-level comparison of risk-related sexual practices between black and other-race men who have sex with men: condoms, semen, lubricant, and rectal douching. AIDS Patient Care STDS. 2013;27:77–84.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mimiaga MJ, Reisner SL, Cranston K, Isenberg D, Bright D, Daffin G, et al. Sexual mixing patterns and partner characteristics of black MSM in Massachusetts at increased risk for HIV infection and transmission. J Urban Health. 2009;86:602–23.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Newcomb ME, Mustanski B. Racial differences in same-race partnering and the effects of sexual partnership characteristics on HIV risk in MSM: a prospective sexual diary study. J Acquir Immune Defic Syndr. 2013;62:329–33.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hensel DJ, Rosenberger JG, Novak DS, Reece M. Sexual event-level characteristics of condom use during anal intercourse among HIV-negative men who have sex with men. Sex Transm Dis. 2012;39:550–5.

    Article  PubMed  Google Scholar 

  13. Irwin TW, Morgenstern J, Parsons JT, Wainberg M, Labouvie E. Alcohol and sexual HIV risk behavior among problem drinking men who have sex with men: an event level analysis of timeline followback data. AIDS Behav. 2006;10:299–307.

    Article  PubMed  Google Scholar 

  14. Kelly JA, DiFranceisco WJ, St Lawrence JS, Amirkhanian YA, Anderson-Lamb M. Situational, partner, and contextual factors associated with level of risk at most recent intercourse among black men who have sex with men. AIDS Behav. 2014;18:26–35.

    Article  PubMed  Google Scholar 

  15. Card KG, Lachowsky NJ, Cui Z, Shurgold S, Armstrong HL, Rich AJ, et al. An event-level analysis of the interpersonal factors associated with condomless anal sex among gay, bisexual, and other men who have sex with men (MSM) with online-met partners. AIDS Educ Prev. 2017;29:154–74.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Delgado JR, Segura ER, Lake JE, Sanchez J, Lama JR, Clark JL. Event-level analysis of alcohol consumption and condom use in partnership contexts among men who have sex with men and transgender women in Lima, Peru. Drug Alcohol Depend. 2017;170:17–24.

    Article  PubMed  Google Scholar 

  17. Pines HA, Gorbach PM, Weiss RE, Reback CJ, Landovitz RJ, Mutchler MG, et al. Individual-level, partnership-level, and sexual event-level predictors of condom use during receptive anal intercourse among HIV-negative men who have sex with men in Los Angeles. AIDS Behav. 2016;20:1315–26.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Friedman SR, Aral S. Social networks, risk-potential networks, health, and disease. J Urban Health. 2001;78:411–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Gupta S, Anderson RM, May RM. Networks of sexual contacts: implications for the pattern of spread of HIV. AIDS. 1989;3:807–17.

    Article  PubMed  CAS  Google Scholar 

  20. Bingham TA, Harawa NT, Johnson DF, Secura GM, MacKellar DA, Valleroy LA. The effect of partner characteristics on HIV infection among African American men who have sex with men in the Young Men’s Survey, Los Angeles, 1999-2000. AIDS Educ Prev. 2003;15:39–52.

    Article  PubMed  Google Scholar 

  21. Clerkin EM, Newcomb ME, Mustanski B. Unpacking the racial disparity in HIV rates: the effect of race on risky sexual behavior among Black young men who have sex with men (YMSM). J Behav Med. 2011;34:237–43.

    Article  PubMed  Google Scholar 

  22. Halkitis PN, Brockwell S, Siconolfi DE, Moeller RW, Sussman RD, Mourgues PJ, et al. Sexual behaviors of adolescent emerging and young adult men who have sex with men ages 13-29 in New York City. J Acquir Immune Defic Syndr. 2011;56:285–91.

    Article  PubMed  Google Scholar 

  23. Misovich SJ, Fisher JD, Fisher WA. Close relationships and elevated HIV risk behavior: evidence and possible underlying psychological processes. Rev Gen Psychol. 1997;1:72–107.

    Article  Google Scholar 

  24. Kerr ZY, Pollack LM, Woods WJ, Blair J, Binson D. Use of multiple sex venues and prevalence of HIV risk behavior: identifying high-risk men who have sex with men. Arch Sex Behav. 2015;44:443–51.

    Article  PubMed  Google Scholar 

  25. Grov C, Hirshfield S, Remien RH, Humberstone M, Chiasson MA. Exploring the venue’s role in risky sexual behavior among gay and bisexual men: an event-level analysis from a national online survey in the U.S. Arch Sex Behav. 2013;42:291–302.

    Article  PubMed  Google Scholar 

  26. Dangerfield DT, Smith LR, Williams J, Unger J, Bluthenthal R. Sexual positioning among men who have sex with men: a narrative review. Arch Sex Behav. 2017;46:869–84.

    Article  PubMed  Google Scholar 

  27. Kent CK, Chaw JK, Wong W, Liska S, Gibson S, Hubbard G, et al. Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clin Infect Dis. 2005;41:67–74.

    Article  PubMed  Google Scholar 

  28. Van de Ven P, Kippax S, Crawford J, Rawstorne P, Prestage G, Grulich A, et al. In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care. 2002;14:471–80.

    Article  PubMed  Google Scholar 

  29. Coldiron ME, Stephenson R, Chomba E, Vwalika C, Karita E, Kayitenkore K, et al. The relationship between alcohol consumption and unprotected sex among known HIV-discordant couples in Rwanda and Zambia. AIDS Behav. 2008;12:594–603.

    Article  PubMed  Google Scholar 

  30. Kalichman SC, Simbayi LC, Jooste S, Cain D, Cherry C. Sensation seeking, alcohol use, and sexual behaviors among sexually transmitted infection clinic patients in Cape Town, South Africa. Psychol Addict Behav. 2006;20:298–304.

    Article  PubMed  Google Scholar 

  31. Fritz KE, Woelk GB, Bassett MT, et al. The association between alcohol use, sexual risk behavior, and HIV infection among men attending beer halls in Harare, Zimbabwe. AIDS Behav. 2002;6:221–8.

    Article  Google Scholar 

  32. Mbulaiteye SM, Ruberantwari A, Nakiyingi JS, Carpenter LM, Kamali A, Whitworth JA. Alcohol and HIV: a study among sexually active adults in rural southwest Uganda. Int J Epidemiol. 2000;29:911–5.

    Article  PubMed  CAS  Google Scholar 

  33. Colfax G, Vittinghoff E, Husnik MJ, McKirnan D, Buchbinder S, Koblin B, et al. Substance use and sexual risk: a participant- and episode-level analysis among a cohort of men who have sex with men. Am J Epidemiol. 2004;159:1002–12.

    Article  PubMed  Google Scholar 

  34. Vosburgh HW, Mansergh G, Sullivan PS, Purcell DW. A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men. AIDS Behav. 2012. https://doi.org/10.1007/s10461-011-0131-8.

    PubMed  Article  Google Scholar 

  35. Grov C, Rendina HJ, Ventuneac A, Parsons JT. HIV risk in group sexual encounters: an event-level analysis from a national online survey of MSM in the U.S. J Sex Med. 2013;10:2285–94.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): who collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88:791–804.

    Article  PubMed  CAS  Google Scholar 

  37. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.

    Article  Google Scholar 

  38. Xia Q, Molitor F, Osmond DH, Tholandi M, Pollack LM, Ruiz JD, et al. Knowledge of sexual partner’s HIV serostatus and serosorting practices in a California population-based sample of men who have sex with men. AIDS. 2006;20:2081–9.

    Article  PubMed  Google Scholar 

  39. NHBS Baltimore. The BESURE Study 2013 update. 2013.

  40. Bakeera-Kitaka S, Nabukeera-Barungi N, Nostlinger C, Addy K, Colebunders R. Sexual risk reduction needs of adolescents living with HIV in a clinical care setting. AIDS Care. 2008;20:426–33.

    Article  PubMed  Google Scholar 

  41. Erwin J, Morgan M, Britten N, Gray K, Peters B. Pathways to HIV testing and care by black African and white patients in London. Sex Transm Infect. 2002;78:37–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Hightow-Weidman LB, Phillips G 2nd, Outlaw AY, Wohl AR, Fields S, Hildalgo J, et al. Patterns of HIV disclosure and condom use among HIV-infected young racial/ethnic minority men who have sex with men. AIDS Behav. 2013;17:360–8.

    Article  PubMed  Google Scholar 

  43. Arrington-Sanders R, Leonard L, Brooks D, Celentano D, Ellen J. Older partner selection in young African-American men who have sex with men. J Adolesc Health. 2013;52:682–8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Braun V, Schmidt J, Gavey N, Fenaughty J. Sexual coercion among gay and bisexual men in Aotearoa/New Zealand. J Homosex. 2009;56:336–60.

    Article  PubMed  Google Scholar 

  45. Centers for Disease Control and Prevention (CDC). Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 US dependent areas—2010. 2012. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. Accessed 28 May 2015.

  46. Rendina HJ, Jimenez RH, Grov C, Ventuneac A, Parsons JT. Patterns of lifetime and recent HIV testing among men who have sex with men in New York City who use Grindr. AIDS Behav. 2014;18:41–9.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Chew Ng RA, Samuel MC, Lo T, Bernstein KT, Aynalem G, Klausner JD, et al. Sex, drugs (methamphetamines), and the Internet: increasing syphilis among men who have sex with men in California, 2004-2008. Am J Public Health. 2013;103:1450–6.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Saxton P, Dickson N, Hughes A. Who is omitted from repeated offline HIV behavioural surveillance among MSM? Implications for interpreting trends. AIDS Behav. 2013;17:3133–44.

    Article  PubMed  Google Scholar 

  49. Wei C, Lim SH, Guadamuz TE, Koe S. Virtual versus physical spaces: which facilitates greater HIV risk taking among men who have sex with men in East and South-East Asia? AIDS Behav. 2014;18:1428–35.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Mettey A, Crosby R, DiClemente RJ, Holtgrave DR. Associations between internet sex seeking and STI associated risk behaviours among men who have sex with men. Sex Transm Infect. 2003;79:466–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  51. Leigh BC. Alcohol and condom use: a meta-analysis of event-level studies. Sex Transm Dis. 2002;29:476–82.

    Article  PubMed  Google Scholar 

  52. Snowden JM, Raymond HF, McFarland W. Seroadaptive behaviours among men who have sex with men in San Francisco: the situation in 2008. Sex Transm Infect. 2011;87:162–4.

    Article  PubMed  Google Scholar 

  53. Marks G, Millett GA, Bingham T, Lauby J, Murrill CS, Stueve A. Prevalence and protective value of serosorting and strategic positioning among Black and Latino men who have sex with men. Sex Transm Dis. 2010;37:325–7.

    PubMed  Google Scholar 

  54. Eaton LA, Kalichman SC, Cherry C. Sexual partner selection and HIV risk reduction among Black and White men who have sex with men. Am J Public Health. 2010;100:503–9.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Jones BT, Corbin W, Fromme K. A review of expectancy theory and alcohol consumption. Addiction. 2001;96:57–72.

    Article  PubMed  CAS  Google Scholar 

  56. Mustanski BS. Are sexual partners met online associated with HIV/STI risk behaviours? Retrospective and daily diary data in conflict. AIDS Care. 2007;19:822–7.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This study was supported by a cooperative agreement between the Johns Hopkins Bloomberg School of Public Health and the Centers for Disease Control and Prevention (5UR6PS000437-03, 5UR6PS000434-03, 5UR6PS000355-03, 5UR6PS000429-03). This study was also funded by the National Institute of Alcohol Abuse and Alcoholism NIAAA R00AA020782 and the National Insitute of Mental Health NIMH R34MH116725.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention

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Authors and Affiliations

  1. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 2nd Floor, Baltimore, MD, 21205, USA

    Cui Yang, Carl Latkin & Karin Tobin

  2. Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

    David Seal

  3. Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA

    Beryl Koblin

  4. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Geetanjali Chander

  5. Rand Corporation, Pittsburg, PA, USA

    Daniel Siconolfi

  6. National Center for HIV/AIDS, Viral, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Stephen Flores & Pilgrim Spikes

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  1. Cui Yang
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Correspondence to Cui Yang.

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Yang, C., Latkin, C., Tobin, K. et al. An Event-Level Analysis of Condomless Anal Intercourse with a HIV-Discordant or HIV Status-Unknown Partner Among Black Men Who Have Sex with Men from a Multi-site Study. AIDS Behav 22, 2224–2234 (2018). https://doi.org/10.1007/s10461-018-2161-y

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Keywords

  • Condomless anal intercourse
  • Black MSM
  • Event-level analysis
  • HIV