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CDC: Unsafe Sex Common for HIV+ Men

After HIV Infection, 35% of Men Who Have Sex with Men Continue Unsafe Sex
By
WebMD Health News
Reviewed by Louise Chang, MD

HIV Infection Unprotected Sex

Dec. 3, 2007 -- Even after learning they have HIV, more than 35% men who have sex with men continue to have unsafe sex.

The finding, reported at the CDC's 2007 National HIV Prevention Conference, points to a big hole in what CDC AIDS chief Kevin Fenton, MD, PhD, calls "the key element of our HIV prevention strategy" -- HIV testing.

"Research shows that those who do not know they are infected are more likely to engage in HIV risk behavior," Fenton said at a conference news briefing, noting that 20% of HIV-infected Americans don't know they're carrying the AIDS virus.

Nearly two-thirds of men who have sex with men -- MSM -- do change their behavior. But as researchers finally begin to get a closer focus on the exact risk behaviors of HIV-positive men, troubling findings are emerging.

"Recent data suggest only one in five MSM have been reached by intensive HIV programs. This is 26 years into the epidemic, so we do have some way to go in targeting preventions," Fenton said.

"The scale of HIV prevention efforts is not at the critical mass to make the impact that is needed," Robert Janssen, MD, director of the CDC's division of HIV/AIDS prevention, said at the news conference. "My understanding is that state and federal budgets [for preventing sexually transmitted diseases] are stable, which means they are eroding over time. What we can do is provide the best data on the gaps that need to be covered."

That gap became apparent in several conference reports highlighted at the news briefing.

35% of HIV+ MSM Have Unsafe Sex

Fenton pointed to a study by CDC researcher Nicole Crepaz, PhD and colleagues, which analyzed data from 27 studies including more than 10,000 MSM who knew they carried HIV.

More than one in three of these men -- 35% -- reported recent unsafe sex (anal or vaginal intercourse without a condom).

That's very close to the 37% of Boston-area HIV positive MSM who reported unprotected anal intercourse in a conference report by Kenneth Mayer, MD, medical director of Boston's Fenway Community Health.

This behavior was not entirely irresponsible. More than 30% of these men in the Crepaz study and more than 41% in the Mayer study had unprotected sex only with partners already infected with HIV.

This practice, called serosorting, is not truly safe. While it does prevent infection of uninfected partners, the practice spreads sexually transmitted diseases such as syphilis and gonorrhea. And even though a person already has HIV, that person can still catch a second, potentially more dangerous HIV strain.

One in 10 HIV-positive men in the Crepaz study and 23% of the HIV-positive men in the Mayer study reported unsafe sex with partners they knew to be HIV-negative. This suggests that men who know they carry HIV are less likely to have unprotected sex with uninfected partners if these partners have had a recent HIV test.

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