Risk Behaviors Drive the HIV Epidemic in MSM

Summary and Comment |
December 16, 2013

Risk Behaviors Drive the HIV Epidemic in MSM

  1. Abigail Zuger, MD

Unprotected anal sex is on the rise in both infected and uninfected men.

  1. Abigail Zuger, MD

In honor of World AIDS Day, the CDC has released a new set of statistics describing some aspects of the HIV epidemic among men who have sex with men (MSM) in the U.S.

In 2011, MSM accounted for at least half of all new HIV infections reported in every state except Pennsylvania and South Dakota. On behavioral surveillance questionnaires, the proportion of all MSM reporting unprotected anal sex during the preceding 12 months increased from 48% in 2005 to 54% in 2008 and 57% in 2011. This trend was observed among MSM who were uninfected (or unaware of their infection) and also among those who knew they were infected, but was statistically significant only in the former group.

In 2011, 33% of HIV-infected MSM who were unaware of their infection reported recent unprotected “discordant” anal sex — anal sex with a partner not known to be infected. In contrast, such behavior was reported by only 13% of those who were HIV infected and aware of their infection, and 12% those who were uninfected. Only 67% of all sexually active MSM reported getting an HIV test in the preceding year.


Connecting the dots provided by these data suggests that knowledge of HIV infection may reduce risky behavior, either with increased use of protection or with the more rudimentary behavioral variant of “serosorting” — avoiding sex with uninfected individuals. Thus, the data provide yet another argument in favor of aggressive testing policies.

Editor Disclosures at Time of Publication

  • Disclosures for Abigail Zuger, MD at time of publication Editorial boards Journal Watch AIDS Clinical Care; Clinical Infectious Diseases Other New York Times medical writer


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