Sexual risk trajectories among MSM in the United States: implications for pre-exposure prophylaxis delivery.

Published: January 2, 2014


Despite evidence supporting pre-exposure prophylaxis (PrEP) efficacy, there are concerns regarding the feasibility of widespread PrEP implementation among men who have sex with men (MSM). To inform the development of targeted PrEP delivery guidelines, we characterized sexual risk trajectories among HIV-negative MSM.
At semiannual visits from 2003-2011, HIV-negative MSM (N=419) participating in the Multicenter AIDS Cohort Study provided data on sexual risk behaviors since their last visit. Based on reported behaviors, participants were assigned a sexual risk behavior (SRB) score at each visit as follows: (0) no insertive or receptive anal intercourse (IAI/RAI), (1) no unprotected IAI/RAI (UIAI/URAI), (2) only UIAI, (3) URAI with 1 HIV-negative partner, (4) condom-serosorting, (5) condom-seropositioning, and (6) no seroadaptive behaviors. Group-based trajectory modeling was used to examine SRB scores (<4 vs. ≥4) and identify groups with distinct sexual risk trajectories.
Three sexual risk trajectory groups were identified: low risk (N=264; 63.0%), moderate risk (N=96; 22.9%; mean duration of consecutive high risk intervals∼1 year), and high risk (N=59; 14.1%; mean duration of consecutive high risk intervals∼2 years). Compared to low risk group membership, high risk group membership was associated with younger age (in years) (adjusted odds ratio [AOR]=0.92, 95% confidence interval [CI]: 0.88-0.96), being White (AOR=3.67, 95% CI: 1.48-9.11), earning an income ≥$20,000 (AOR=4.98, 95% CI: 2.13-11.64), distress/depression symptoms (CESD≥16) (AOR=2.36, 95% CI: 1.14-4.92), and substance use (AOR=2.00, 95% CI: 1.01-3.97).
Screening for the socio-demographic and behavioral factors described above may facilitate targeted PrEP delivery during high risk periods among MSM.
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