Search

We determined whether methamphetamine use is associated with the increased prevalence of primary HIV drug resistance among a cohort of men who have sex with men recently infected with HIV. In multivariate analysis, we found that frequent methamphetamine use was strongly associated with primary non-nucleoside reverse transcriptase inhibitor resistance, but not with protease inhibitor or nucleoside reverse transcriptase inhibitor resistance. We postulate that this association may be caused by methamphetamine-associated treatment interruptions among source partners.

Objectives To determine the potential for secondary HIV transmission among newly HIV-infected men who have sex with men (MSM) during their HIV antibody seroconversion period, and for the 12 months after seroconversion. Design A cohort study. Methods Risk assessment questionnaires administered before receipt of the first positive HIV antibody result, plasma and seminal viral load measurements, and risk assessments one month and quarterly after receipt of the first HIV-positive test, and generalized estimating equation modelling techniques to analyse behavioral trends. Results Of 66 seroconverters, more than half reported unprotected anal intercourse (UAI) with HIV-negative or unknown-serostatus partners during seroconversion, with 27% reporting insertive UAI with an HIV-negative partner. The initial median plasma viral load was 4.6 log/ml, the median seminal viral load was 2.7 log/ml, suggesting a high level of infectiousness. Compared with risk behavior during seroconversion, UAI with HIV-negative or unknown-serostatus partners was reduced after the receipt of positive antibody results; however, a substantial proportion of participants reported high-risk behaviors for transmission for 12 months of follow-up. After learning of their HIV infection, recent seroconverters did not reduce the risk of secondary transmission by engaging in proportionally more high-risk practices with HIV-infected partners (compared with HIV-negative or unknown-serostatus partners), or engaging in proportionally more receptive compared with insertive UAI. Conclusion Substantial potential exists for secondary HIV transmission during and for one year after HIV seroconversion. Receipt of an HIV-positive test is associated with a significant reduction in risk behavior, reinforcing the need to identify and counsel recently HIV-infected MSM.

Objectives: To assess the prevalence of and factors associated with 'barebacking' as a sociocultural phenomenon in a sample of HIV-positive and -negative men who have sex with men (MSM), and to assess the reasons for barebacking and venues for meeting partners. Design: A cross-sectional survey of MSM recruited in the San Francisco Bay Area from July 2000 to February 2001. Methods: Barebacking, defined as 'intentional anal sex without a condom with someone other than a primary partner', was assessed among men who had heard of the term. Participants were recruited outside multiple venues and interviewed later at community locations. Chi-square and multivariate logistic regression were used for analysis. Results: The sample (n = 554) of MSM were African-American (28%), Latino (27%), white (31 %) and other race/ethnicity (14%); 35% reported being HIV-positive. Seventy per cent of the men had heard of barebacking. Among men aware of the term, 14% had barebacked in the past 2 years (22% of HIV-positive versus 10% of HIV-negative men, P < 0.001); 10% of the full sample did so. The prevalence of barebacking did not differ by race/ethnicity or sexual orientation identification. Men tended to report bareback partners who had the same HIV serostatus; however, a sizeable proportion of men had partners of different or unknown serostatus. Increased physical stimulation and emotional connectedness were the primary reasons for barebacking. Conclusion: New approaches are needed to reduce bareback behavior and the risk of HIV transmission, including innovative health-promoting behavioral and biomedical interventions.