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1 Jun 2009

US gay men mostly getting HIV from main partners

Using data from the National HIV Behavioral Surveillance System (NHBS) involving gay men in five large US cities, researchers found that over 50% of HIV transmissions in US gay men are from main sexual partners and 46% of infections were from partners who were believed to be HIV-negative.

Over 50% of HIV transmissions in US gay men are from main sexual partners, investigators report in a study published in the online edition of AIDS. The researchers also found that 46% of infections were from partners who were believed to be HIV-negative and that approximately a quarter of transmissions were the result of insertive anal sex.

A poster from San Francisco's AIDS Foundation’s 'How Do You Know What You Know?' campaign that run in 2001.
Gay men remain the group most affected by HIV in the US. There is some evidence that the number of new HIV infections in this group has increased since 2000. This has prompted calls for a renewed focus on the continuing HIV epidemic amongst gay men and the development of new prevention interventions.

Research from the Netherlands suggests that most HIV infections from young men are contracted from main sexual partners. To gain a better understanding of the dynamics of HIV transmission amongst gay men in the US, investigators designed a model using information obtained from the National HIV Behavioral Surveillance System (NHBS), involving gay men in five large US cities between 2003 and 2005, and the HIVNET Vaccine Preparedness Study (VPS), which recruited gay men in six US cities between 1995 and 1997.

Data from the NHBS study were used to estimate the number of gay men with main and casual partners in a year, the number of casual partners, the HIV status of partners, and sexual behaviour with partners. Information from the VPS was used to estimate the number of sexual episodes per year for men with main and casual partners.

A total of 3652 men from the NHBS study were included in the investigators’ analysis. These men reported 2395 main partners and 2850 casual partners. Based upon information from the VPS, the investigators estimated that the combined total of sex acts with main partners was 195,000 per year and 175,000 per year for casual partners.

The majority of HIV transmissions (68%) were estimated to be from main partners, with 32% thought to be from casual partners. This trend was observed in all age groups. The investigators also estimated that receptive anal intercourse was the main (69%) mode of HIV transmission. However, they attributed 28% of infections to insertive anal sex and 3% to oral sex.

Of the HIV transmissions from main partners, 46% were from individuals believed to be HIV-negative, with 38% from partners of unknown status, and 16% from partners who were known to be HIV-positive. The bulk (63%) of HIV transmissions from casual partners were from partners of unknown status. The investigators also found that more infections occurred from casual partners thought to be HIV-negative (24%) than HIV-positive (16%).

Annual HIV incidence was calculated at 2.2%.

The investigators believe that there are three reasons why there are more HIV transmissions from main rather than casual partners:
•    Men had more sex with their main partner than casual partners.
•    Men were more likely to have receptive anal sex with their main partner than a casual partner (40% of men reported that the last sex they had with a main partner involved receptive anal sex compared to 26% for a casual partner).
•    Men were more likely to report unprotected receptive anal sex with their main partner than a casual partner.

The finding that 28% of HIV transmissions appear to be the result of insertive anal sex is stressed by the investigators. They comment “prevention counsellors should continue to emphasise that the risk of insertive anal intercourse, although lower than the risk of receptive anal intercourse, is still an important concern for men who have sex with men”.

They also emphasise that “among main partners, transmissions mostly arise from partners believed to be HIV-negative”. Furthermore, they note that individuals of unknown status accounted for most transmissions from casual partners. The group least likely to be responsible for HIV transmission to main or casual partners were men with diagnosed HIV infection.

Although over 50% of new HIV infections in the US are amongst gay men, the investigators note that only 22% of HIV prevention interventions designated as 'best-evidence' by the US Centers for Disease Control and Prevention have been tested with gay men.

“New HIV prevention interventions for US men who have sex with men [MSM] are needed and should be responsive to current behavioral risk patterns and transmission characteristics of the US MSM epidemic”, conclude the investigators. “Our data suggest that the development and testing of HIV prevention interventions for MSM couples, a historically understudied area of HIV prevention, may be important as we approach the fourth decade of the US HIV epidemic.”

Reference
Sullivan PS et al. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS Vol. 23 (online edition), 2009.

This article was first published by NAM/Aidsmap.com in May 2009 and is republished with permission.

Reader's Comments

1. 2009-06-01 22:38  
Hrm...trust issues, lies and deceit seem to be main agenda on the spread of HIV in America.
2. 2009-06-01 23:52  

Aput,

Re-read the article.

The investigators believe that there are three reasons why there are more HIV transmissions from main rather than casual partners:
• Men had more sex with their main partner than casual partners.
• Men were more likely to have receptive anal sex with their main partner than a casual partner (40% of men reported that the last sex they had with a main partner involved receptive anal sex compared to 26% for a casual partner).
• Men were more likely to report unprotected receptive anal sex with their main partner than a casual partner.

the TRANSMISSION PROBLEM is UNPROTECTED sex - with anyone, not your so-called "trust issues, lies and deceit...".

NO GLOVE, NO LOVE!!!
Comment #3 was deleted by its author
4. 2009-06-02 09:21  
I also read these lines, laoshiyan.

"They also emphasise that “among main partners, transmissions mostly arise from partners believed to be HIV-negative”. Furthermore, they note that individuals of unknown status accounted for most transmissions from casual partners. The group least likely to be responsible for HIV transmission to main or casual partners were men with diagnosed HIV infection."

Partners believed to be HIV negative.

5. 2009-06-02 09:43  
Why would one believe their partners to be HIV negative, laoshiyan?

A blood test would prove it, sure. But if they're in a monogamous relationship, you have trust as well.

In an open relationship, you obviously think that a partner would be more cautious with who he sleeps with because in the end he's supposed to come back to you.

I don't doubt that there are morons out there who screw others without asking their HIV status first before they decide to go raw, particularly when it's with a casual partner they met for the first time.

While "no love, no glove" is a mantra you and I may practice, it is obvious that it's not the highest priority in America itself.
6. 2009-06-02 12:02  
Without state (FEDERAL) support of same-gendered marriage, HIV will never be sufficiently controlled. You cannot simultaneously support HIV management while supporting inequality. IT'S THAT SIMPLE.

We continue to send the message to GLBTs that they are worthless by not supporting a monogamous institution.
7. 2009-06-02 12:19  
Aput, to single out America as not having this as a high priority does a disservice to your own countrymen. In your declarative statement, you suggest that men outside of the U.S. have nothing to fear and that they would not be just as promiscuous or irresponsible which we know is not the case. It is hypocritical and almost criminal to suggest otherwise.
8. 2009-06-02 13:59  
I'm not singling out America. The report is based on a study in America. If it were a worldwide survey, I'd be willing to make it a worldwide statement.
9. 2009-06-02 14:13  
I'm a lesbian and I don't have any surveys to back me up but it would seem to me that the three reasons given by researchers as to why there are more HIV transmissions from main rather than casual partners (and highlighted by laoshiyan a few posts above) would easily apply to gay couples outside of the US.

A & B who are both HIV- agree to be in a "monogamous" relationship and have unprotected sex from then on but someone slips up and "forgets" to tell... I imagine this might happen anywhere...
10. 2009-06-02 14:18  
I'm pretty sure you're right, kellen. But then again, we don't have the statistics, so I'd rather not venture into a sweeping statement.

So I agree with the statement that it might happen anywhere, though we don't have a factual background to go with as of right now.
11. 2009-06-02 15:04  
There has been a lot of discussion about this article amongts activists and scientists when it came out first las month. The data are not very good and it does not explain how the "main partner" was himself infected.

Overall, one gets infected because of unprotected sex. The more you have of it with a large number of people the higher the risk.

Trust does not protect against HIV, but many gay men are still very much delusional about this, thinking that their loved one would tell them. Well, does he know first? Then would you have sex with him and would he still be your loved one if you knew he was HIV positive? Here too there is a lot of delusion going on...

12. 2009-06-02 15:17  
bull shit, HIV DO NOT CAUSE AIDS
13. 2009-06-02 16:13  
A blood test is only proof of being HIV negative if you can also prove that the person engaged in no risky behaviors for the last 6 months or more. That's awfully difficult to prove.

You need to really really trust someone before you bareback.

A lot of guys with HIV thought they could trust their partners. They were wrong.
14. 2009-06-02 16:56  
@jw20: yeah, I remember I had read the article about HIV has never been isolated from AIDS patients but many claim that there is a strong connection between high levels of HIV and the development of AIDS.
So, it's not totally b.s I guess.

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