HIV serosorting as a harm reduction strategy: evidence from Seattle, Washington

Persistence of racial differences in attitudes toward homosexuality in the United States

BACKGROUND

Stigma may mediate some of the observed disparity in HIV infection rates between black and white men who have sex with men (MSM).

METHODS

We used data from the General Social Survey to describe race-specific trends in the US population's attitude toward homosexuality, reporting of male same-sex sexual behavior, and behaviors that might mediate the relationship between stigma and HIV transmission among MSM.

RESULTS

The proportion of blacks who indicated that homosexuality was "always wrong" was 72.3% in 2008, largely unchanged since the 1970s. In contrast, among white respondents, this figure declined from 70.8% in 1973 to 51.6% in 2008 with most change occurring since the early 1990s. Participants who knew a gay person were less likely to have negative attitudes toward homosexuality (relative risk, 0.60; 95% confidence interval, 0.52 to 0.69). Among MSM, twice as many black MSM reported that homosexuality is "always wrong" compared with white MSM (57.1% versus 26.8%, P = 0.003). MSM with unfavorable attitudes toward homosexuality were less likely to report ever testing for HIV compared with MSM with more favorable attitudes (relative risk, 0.50; 95% confidence interval, 0.31 to 0.78).

CONCLUSIONS

US attitudes toward homosexuality are characterized by persistent racial differences, which may help explain disparities in HIV infection rates between black and white MSM.

Antiretroviral therapy use among HIV-infected men who have sex with men attending a sexually transmitted diseases clinic

We examined antiretroviral therapy (ART) use among 501 previously diagnosed HIV-infected men who have sex with men who sought care at a sexually transmitted disease clinic in King County, WA, during 2004-2008. Overall, 42% of men were not taking ART, 71% of whom had CD4 counts >350 cells per microliter. Of those who reported unprotected anal intercourse with a partner of nonconcordant HIV status in the prior year, 48% were not taking ART (78% with CD4 counts >350 cells/μL). Sexually transmitted disease clinics may be an important venue in which to identify persons who are not taking ART. Treating these persons could help diminish HIV transmission.

An overview of the relative risks of different sexual behaviours on HIV transmission

PURPOSE OF REVIEW

Sexual intercourse represents the majority of HIV transmission and is preventable. Overall, the risk of HIV transmission following a single sexual exposure is low especially in comparison with other sexually transmitted infections (STIs), with estimates of the average probability of male-to-female HIV transmission only 0.0005-0.0026 per coital act. The risk of acquiring HIV from a single contact varies enormously and is dependant upon the infectiousness of the HIV-positive individual and the susceptibility to HIV of their sexual partner.

RECENT FINDINGS

Of concern, unprotected sex among men who have sex with men (MSM) has increased in recent years and HIV incidence in both MSM and heterosexuals remains a considerable public health concern. Sexual practices and health optimism about HIV have changed, which have significantly impacted HIV risk behaviour.

SUMMARY

In this review article we summarize the current evidence regarding the observed relative risks of HIV transmission for each different types of sex act, relationship type and the strategies that have been tested to interrupt transmission.