Young Men With Detectable HIV More Likely to Have Risky Sex

Young men who have sex with men and have detectable levels of HIV were more likely to report not using a condom during anal intercourse with a partner not infected with HIV, compared with virologically suppressed young men who have sex with men, according to researchers at Columbia University’s Mailman School of Public Health. Findings are published online in JAMA Pediatrics.

HIV disproportionately affects men who have sex with men. Particularly vulnerable to HIV are young men who have sex with men, ages 13 to 29, among whom more than one-quarter of new infections in the U.S. occur.

“While many of these young men are engaged in care, and success stories are many, we still have work to do to reduce the rate of new infections,” said Patrick A. Wilson, PhD, assistant professor of Sociomedical Sciences at the Mailman School, who led the study. “We must remain engaged in finding new behavioral approaches for those young men who have yet to seek HIV testing, antiretroviral treatment, and adhere to viral suppression activities.”

Dr. Wilson and colleagues examined differences in demographic and psychosocial factors between virologically suppressed young men who have sex with men and those with detectable HIV. The authors also sought to identify psychosocial factors associated with risky sexual behavior and between partners of differing HIV status among the young men who have sex with men with detectable HIV viral load.

The researchers studied 991 young men who have sex with men with HIV between the ages of 15 and 26 at 20 adolescent HIV clinics in the U.S. from December 2009 through June 2012. Of the 991 participants, 69 percent had a detectable HIV viral load. Nearly half of the young men (46 percent) reported condomless anal intercourse in the past three months and 31 percent reported engaging in intercourse without a condom with partners of differing HIV status.

More than half (266 or 55 percent) of young men who have sex with men with detectable HIV reported anal intercourse without a condom, while 91 or 44 percent of the young men virologically suppressed reported that behavior. Likewise, 35 percent of the young men with detectable HIV reported condomless anal intercourse with a partner who was HIV-negative, while 25 percent of the virologically suppressed young men who have sex with men reported having condomless anal intercourse with partners of differing HIV status, the study reports.

Dr. Wilson suggests that among young men who have sex with men with detectable HIV, those who reported problematic substance use were more likely to report not using a condom during anal intercourse with or without partners of differing HIV status. Young men with detectable HIV who disclosed their HIV status to sex partners were more likely to report engaging in sexual risky behavior compared with the non-disclosing group of men.

“To truly curb HIV among this group, we cannot solely rely on one strategy,” says Dr. Wilson. “These findings speak to the need for targeting substance use and mental health concerns—factors related to viral suppression and sexual risk taking.”

The study was supported by the National Institutes of Health, grants U01 HD 040533 and U01 D 040474, and National Institute on Drug Abuse.