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Behavior Change Among HIV-Negative Men Who Have Sex with Men Not Using PrEP in the United States
Steven M Goodreau1,2, Michael P Barry3,4, Deven T Hamilton5
1Department of Anthropology, University of Washington, Campus Box 353100, Seattle, WA, 98122, USA. goodreau@uw.edu.
AIDS and Behavior
|February 27, 2024
Summary
Condomless anal sex (CAS) increased among HIV-negative men who have sex with men (MSM) not on pre-exposure prophylaxis (PrEP). Young and Hispanic MSM saw the largest increases, highlighting potential new HIV transmission risks and disparities.
Area of Science:
- Public Health
- Epidemiology
- Sexual Health
Background:
- Condomless anal sex (CAS) among men who have sex with men (MSM) is a key factor in HIV transmission.
- Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy, but uptake and adherence vary.
- Understanding trends in CAS among MSM not on PrEP is crucial for targeted public health interventions.
Purpose of the Study:
- To measure changes in CAS prevalence and partner numbers among HIV-negative MSM not using PrEP.
- To identify demographic subgroups experiencing significant increases in CAS.
- To assess the implications of these trends for HIV transmission and prevention strategies.
Main Methods:
- Analysis of serial, cross-sectional web-based survey data from the American Men's Internet Survey (2014-2019).
- Inclusion of cisgender MSM aged ≥15 years residing in the US.
- Comparison of CAS reports and partner numbers between survey years for individuals remaining HIV-negative and off PrEP.
Main Results:
- A significant year-over-year increase of 2.2 percentage points in any CAS was observed overall.
- Sub-populations with the largest increases included 15-24-year-olds (5.0 pp) and Hispanic respondents (5.1 pp).
- Young Hispanic MSM showed a substantial interaction effect (12.8 pp increase), with increases concentrated among HIV-negative partners.
Conclusions:
- Increasing CAS among MSM not on PrEP suggests potential new HIV transmission pathways.
- The concentration of increases among young and Hispanic MSM indicates a risk of expanding HIV disparities and future youth diagnoses.
- Condom promotion remains a vital public health practice, requiring enhanced outreach to key audiences, potentially through LGBTQ+-inclusive sex education.
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