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Sexual Risk Trajectories Among MSM in the United States: Implications for Pre-exposure Prophylaxis Delivery

Pines, Heather A. MPH, PhD*; Gorbach, Pamina M. MHS, DrPH*; Weiss, Robert E. MS, PhD; Shoptaw, Steve PhD‡,§; Landovitz, Raphael J. MD, MSc; Javanbakht, Marjan MPH, PhD*; Ostrow, David G. MD, PhD¶,#; Stall, Ron D. PhD**; Plankey, Michael PhD††

JAIDS Journal of Acquired Immune Deficiency Syndromes: 15 April 2014 - Volume 65 - Issue 5 - p 579–586
doi: 10.1097/QAI.0000000000000101
Epidemiology and Prevention

Background: 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, sexual risk trajectories among HIV-negative MSM were characterized.

Methods: At semiannual visits from 2003 to 2011, HIV-negative MSM (N = 419) participating in the Multicenter AIDS Cohort Study provided data on sexual risk behaviors (SRBs) since their last visit. Based on their reported behaviors, participants were assigned a SRB score at each visit as follows: 0 = no insertive or receptive anal intercourse, 1 = no unprotected insertive or receptive anal intercourse, 2 = only unprotected insertive anal intercourse, 3 = unprotected receptive anal intercourse 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.

Results: 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 to 0.96], being White (AOR = 3.67, 95% CI: 1.48 to 9.11), earning an income ≥$20,000 (AOR = 4.98, 95% CI: 2.13 to 11.64), distress/depression symptoms (Center for Epidemiologic Studies Depression Scale ≥ 16) (AOR = 2.36, 95% CI: 1.14 to 4.92), and substance use (AOR = 2.00, 95% CI: 1.01 to 3.97).

Conclusions: Screening for the sociodemographic and behavioral factors described above may facilitate targeted PrEP delivery during high-risk periods among MSM.

Departments of *Epidemiology;

Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA;

Departments of Family Medicine;

§Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA;

Center for Clinical AIDS Research & Education, David Geffen School of Medicine, University of California, Los Angeles, CA;

David Ostrow & Associates, LLC Chicago, IL;

#The Chicago MACS, Northwestern University, Evanston, IL;

**Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; and

††Department of Medicine, Georgetown University Medical Center, Washington, DC.

Correspondence to: Heather A. Pines, MPH, PhD, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, CHS 41-295, Box 951772, Los Angeles, CA 90095-1772 (e-mail: hpines@ucla.edu).

H.A.P. was supported by a Ruth L. Kirschstein National Research Service Award for individual predoctoral fellows from the National Institute of Mental Health (F31MH097620). P.M.G. was supported by the National Institutes of Health (U01-AI35040). R.E.W. was supported by the Center for HIV Identification, Prevention, and Treatment Services (5P30MH058107-15) and the UCLA Center for AIDS Research—CORE H (AI28697). S.S. was supported by the National Institutes of Health (U01-AI35040) and the Center for HIV Identification, Prevention, and Treatment Services (5P30MH058107). M.P. was supported by the National Institutes of Health (U01 grant). For the remaining authors, no sources of funding were declared.

Presented at the STI & AIDS World Congress 2013 [joint meeting of the 20th International Society for Sexually Transmitted Diseases Research (ISSTDR) and the 14th International Union Against Sexually Transmitted Infections (IUSTI)], July 14–17, 2013, Vienna, Austria.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Data used in producing the analyses presented in this study were collected by the Multicenter AIDS Cohort Study (MACS) with centers (Principal Investigators) at: Johns Hopkins University Bloomberg School of Public Health (Joseph Margolick), U01-AI35042; Northwestern University (Steven Wolinsky), U01-AI35039; University of California, Los Angeles (Roger Detels), U01-AI35040; University of Pittsburgh (Charles Rinaldo), U01-AI35041; the Center for Analysis and Management of MACS, Johns Hopkins University Bloomberg School of Public Health (Lisa Jacobson), UM1-AI35043.

The Multicenter AIDS Cohort Study (MACS) is funded primarily by the National Institute of Allergy and Infectious Diseases, with additional co-funding from the National Cancer Institute. Targeted supplemental funding for specific projects was also provided by the National Heart, Lung, and Blood Institute, and the National Institute on Deafness and Communication Disorders. MACS data collection is also supported by UL1-TR000424 (JHU CTSA). Web site located at http://www.statepi.jhsph.edu/macs/macs.html. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health.

Received September 18, 2013

Accepted December 20, 2013

© 2014 by Lippincott Williams & Wilkins