Risk factors for incident HIV infection in men having sex with men: a case-control study
Tim R. H. Read A B C , Jane Hocking A , Vikki Sinnott A and Margaret Hellard AA Macfarlane Burnet Institute for Medical Research, Prahran, Victoria 3004, Australia.
B Melbourne Sexual Health Centre, 580 Swanston St, Carlton, Victoria 3053, Australia.
C Corresponding author. Email: tread@mshc.org.au
Sexual Health 4(1) 35-39 https://doi.org/10.1071/SH06043
Submitted: 14 July 2006 Accepted: 24 January 2007 Published: 26 February 2007
Abstract
Background: HIV notifications affecting men having sex with men (MSM) in Victoria, Australia have been increasing. This study aimed to determine current risk factors for HIV infection in this population. Methods: Case-control study. Cases were MSM infected within the previous year (incident cases) as indicated by a previous negative test or seroconversion illness. Controls were MSM with a negative HIV test at the same clinic. From May 2001 to May 2003, cases and controls were interviewed about sexual behaviour, drug and alcohol use and mental health and sexually transmissible infections (STI) in the year before their HIV diagnosis. Results: Twenty-six cases and 52 controls were recruited. Risk factors in the year before diagnosis of incident HIV infection included: receptive unprotected anal intercourse (UAI) with ejaculation with casual partners (odds ratio [OR] and 95% confidence interval 57.2 [6.7, 489.4]); insertive UAI with ejaculation with >1 casual partners (OR 19.2 [2.2, 168.9]); having >14 casual partners at sex venues (OR 3.2 [1.1, 9.1]); and consuming >60 g alcohol at one sitting at least weekly (OR 3.6 [1.1, 11.4]). Cases were also more likely to have anal sex with >100 partners in their life and cases had more casual partners than controls in the year before the test. Cases were more likely to have consumed alcohol or amphetamines during a high-risk sexual episode in the year before the test. Conclusions: UAI remains the most important behavioural risk for HIV in Australian MSM. Risk is increased by larger numbers of partners, partners met at sex venues and sex under the influence of alcohol.
Additional keywords: epidemiology, HIV transmission, homosexual men, sexual behaviour.
Acknowledgements
We thank the study participants and Kim Benton, Nick Crofts, Bill Maskill, Geoff Aldred, Rebecca Guy, Catherine Keenan, Kate Wilson, Mika Tsukiyama, Ken Sikaris, Beng Eu, Sven Strecker, Norm Roth, Mike Porter, Richard Young, Helen Wood, Darren Russell, Jeff Wilcox, Jonathan Anderson, BK Tee, Steven Rowles, Nick Medland, Ian Chenoweth, Tina Schmidt, Peter Hayes, Pat Charles, Denis Spelman, Edwina Wright and Eric Salter. This study was funded by the Victorian Department of Human Services.
[1]
[2]
[3] Centers for Disease Control and Prevention (CDC) Increases in HIV – 29 states, 1999–2002. MMWR Morb Mortal Wkly Rep 2003; 52 1145–8.
| PubMed |
[4] Wolitski RJ, Valdiserri RO, Denning PH, Levine WC. Are we headed for a resurgence in the HIV epidemic among men who have sex with men? Am J Public Health 2001; 91 883–8.
| PubMed |
[5] Guy R, Lim M, Tomnay J, Hatch B, Carter T, Breschkin A, et al. Sustained increase of HIV diagnoses in Victoria: epidemiology, testing and interventions. Victorian Infect Dis Bull 2006; 9 6–11.
| Crossref | GoogleScholarGoogle Scholar |
[6]
[7] Van De Ven P, Rawstorne P, Crawford J, Kippax S. Increasing proportions of Australian gay and homosexually active men engage in unprotected anal intercourse with regular and with casual partners. AIDS Care 2002; 14 335–41.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[8] Stolte IG, Dukers NH, Geskus RB, Coutinho RA, de Wit JB. Homosexual men change to risky sex when perceiving less threat of HIV/AIDS since availability of highly active antiretroviral therapy: a longitudinal study. AIDS 2004; 18 303–9.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[9] Stall RD, Hays RB, Waldo CR, Ekstrand M, McFarland W. The Gay ‘90s: a review of research in the 1990s on sexual behaviour and HIV risk among men who have sex with men. AIDS 2000; 14((Suppl 3)): S101–14.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[10] CASCADE Collaboration Determinants of survival following HIV-1 seroconversion after the introduction of HAART. Lancet 2003; 362 1267–74.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[11] Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect 1999; 75 3–17.
| PubMed |
[12] Grosskurth H, Mosha F, Todd J, Mwijarubi E, Klokke A, Senkoro K, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet 1995; 346 530–6.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[13] Teicher E, Casagrande T, Vittecoq D. Enhanced risk of HIV sexual transmission during structured treatment interruption. Sex Transm Infect 2003; 79 74– .
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[14] Hocking J, Rodger A, Rhode D, Crofts N. HIV seroconverters: using surveillance to characterise people with incident HIV infection in Victoria, Australia. Eur J Epidemiol 2001; 17 157–61.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[15] Winkelstein W, Lyman DM, Padian N, Grant R, Samuel M, Wiley JA, et al. Sexual practices and risk of infection by the human immunodeficiency virus. The San Francisco Men’s Health Study. JAMA 1987; 257 321–5.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[16] Vittinghoff E, Douglas J, Judson F, McKirnan D, MacQueen K, Buchbinder SP. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. Am J Epidemiol 1999; 150 306–11.
| PubMed |
[17] Binson D, Woods WJ, Pollack L, Paul J, Stall R, Catania JA. Differential HIV risk in bathhouses and public cruising areas. Am J Public Health 2001; 91 1482–6.
| PubMed |
[18] Crawford JM, Rodden P, Kippax S, Van de Ven P. Negotiated safety and other agreements between men in relationships: risk practice redefined. Int J STD AIDS 2001; 12 164–70.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[19] Purcell DW, Parsons JT, Halkitis PN, Mizuno Y, Woods WJ. Substance use and sexual transmission risk behaviour of HIV-positive men who have sex with men. J Subst Abuse 2001; 13 185–200.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[20] Koblin BA, Chesney MA, Husnik MJ, Bozeman S, Celum CL, Buchbinder S, et al. High risk behaviours among men who have sex with men in 6 US cities: baseline data from the EPLORE Study. Am J Public Health 2003; 93 926–32.
| PubMed |
[21] Halkitis PN, Parsons JT, Stirratt MJ. A double epidemic: crystal methamphetamine drug use in relation to HIV transmission among gay men. J Homosex 2001; 41 17–35.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[22] Beck A, McNally I, Petrak J. Psychosocial predictors of HIV/STI risk behaviours in a sample of homosexual men. Sex Transm Infect 2003; 79 142–6.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[23] Rogers G, Curry M, Oddy J, Pratt N, Beilby J, Wilkinson D. Depressive disorders and unprotected casual anal sex among Australian homosexually active men in primary care. HIV Med 2003; 4 271–5.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[24] Johnson WD, Hedges LV, Diaz RM. Interventions to modify sexual risk behaviors for preventing HIV infection in men who have sex with men. The Cochrane Database of Systematic Reviews 2002; 4 CD001230.
| Crossref | GoogleScholarGoogle Scholar |
