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Changes in Characteristics and Behavior Among African American Men Who Have Sex with Men and Women in the Context of Reductions in HIV Diagnoses Among Women


Men who have sex with men and women (MSMW) connect lower prevalence populations of women to higher prevalence populations of men who have sex with men only. We hypothesize that HIV testing and treatment among MSMW have increased in recent years, and this increase can help explain the declining rates of new HIV diagnoses among African American women. We analyzed data from 2008, 2011, and 2014 of the National HIV Behavioral Surveillance system. African American men who have sex with men (MSM) were surveyed from 19 United States cities using venue-based sampling and tested for HIV infection. We used generalized estimating equations, using year of survey as an independent variable, adjusting for age, to determine differences for selected outcomes regarding healthcare and risk behaviors over time. Among the 1299 African American MSMW interviewed, significant increases were observed in the percent of men who had an HIV test in the previous 12 months (2008: 54%, 2011: 69%, and 2014: 68%, p-value < 0.001). Among HIV-positive men, the percentage of men who were aware of their infection at the time of the interview increased significantly over time (26, 35, and 48%, p-value = 0.002). Among those men, the percentage who reported currently being on antiretroviral therapy also increased significantly over time (46, 69, and 72%, p-value = 0.050). The percentage of men reporting high-risk sexual risk behaviors increased or remained stable. Our findings support the hypothesis that HIV testing and treatment has increased among African American MSM from 2008 to 2014. Additional research is needed to fully explore the population-level impact it has on HIV transmission among women.

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  1. 1.

    Harawa NT, McCuller WJ, Chavers C, Janson M. HIV risk behaviors among Black/African American and Hispanic/Latina female partners of men who have sex with men and women. AIDS Behav. 2013;17(3):848–55.

  2. 2.

    Harawa N, Wilton L, Wang L, Mao C, Kuo I, Penniman T, et al. Types of female partners reported by black men who have sex with men and women (MSMW) and associations with intercourse frequency, unprotected sex and HIV and STI prevalence. AIDS Behav. 2014;18(8):1548–59.

  3. 3.

    Adimora AA, Fullilove RE. Men who have sex with men and women: pieces of the U.S. HIV epidemic puzzle. Sex Transm Dis. 2006;33(10):596–8.

  4. 4.

    Hightow LB, Leone PA, Macdonald PD, McCoy SI, Sampson LA, Kaplan AH. Men who have sex with men and women: a unique risk group for HIV transmission on North Carolina College campuses. Sex Transm Dis. 2006;33(10):585–93.

  5. 5.

    Centers for Disease Control and Prevention. HIV Surveillance Report, 2016. Published November 2017. Accessed 14 March 2018.

  6. 6.

    Oster AM, Wertheim JO, Hernandez AL, Ocfemia MC, Saduvala N, Hall HI. Using molecular HIV surveillance data to understand transmission between subpopulations in the United States. J Acquir Immune Defic Syndr. 2015;70(4):444–51.

  7. 7.

    Doll L, Johnson ES, Petersen LR, Ward JW, White CR. Homosexually and nonhomosexually identified men who have sex with men: a behavioral comparison. J. Sex Res. 1992;29(1):1–14.

  8. 8.

    Millett G, Malebranche D, Mason B, Spikes P. Focusing, “down low”: bisexual black men, HIV risk and heterosexual transmission. J Natl Med Assoc. 2005;97(7 Suppl):52S–9S.

  9. 9.

    Montgomery JP, Mokotoff ED, Gentry AC, Blair JM. The extent of bisexual behaviour in HIV-infected men and implications for transmission to their female sex partners. AIDS Care. 2003;15(6):829–37.

  10. 10.

    Dodge B, Jeffries WL, Sandfort TG. Beyond the Down Low: sexual risk, protection, and disclosure among at-risk black men who have sex with both men and women (MSMW). Arch Sex Behav. 2008;37(5):683–96.

  11. 11.

    Stokes JP, McKirnan DJ, Doll LS, Burzette RG. Female partners of bisexual men: what they don’t know might hurt them. Psychol Women Q. 1996;20(2):267–84.

  12. 12.

    Mays VM, Cochran SD, Zamudio A. HIV prevention research: Are we meeting the needs of African American men who have sex with men? J Black Psychol. 2004;30(1):78–105.

  13. 13.

    Heckman TG, Kelly JA, Bogart LM, Kalichman SC, Rompa DJ. HIV risk differences between African American and white men who have sex with men. J Natl Med Assoc. 1999;91(2):92–100.

  14. 14.

    McKirnan DJ, Stokes JP, Doll L, Burzette RG. Bisexually active men: social characteristics and sexual behavior. J Sex Res. 1995;32:64–75.

  15. 15.

    Ostrow DG, Whitaker RE, Frasier K, Cohen C, Wan J, Frank C, et al. Racial differences in social support and mental health in men with HIV infection: a pilot study. AIDS Care. 1991;3(1):55–62.

  16. 16.

    Laumann EO, Gagnon JH, Michael RT, Michaels S. The social organization of sexuality: sexual practices in the United States. Chicago: The University of Chicago Press; 1994. p. 1.

  17. 17.

    Ivy W, 3rd, Paz-Bailey G, The NHBS Study Group, editors. Trends in healthcare access and HIV risk behaviors—African American women, 2006-2013. Conference on Retroviruses and Opportunistic Infections; 2015; Seattle, WA.

  18. 18.

    Gallagher KM, Sullivan PS, Lansky A, Onorato IM. Behavioral surveillance among people at risk for HIV infection in the U.S.: the National HIV Behavioral Surveillance System. Public Health Rep. 2007;122(Suppl 1):32–8.

  19. 19.

    Finlayson TJ, Le B, Smith A, Bowles K, Cribbin M, Miles I, et al. HIV risk, prevention, and testing behaviors among men who have sex with men–National HIV Behavioral Surveillance System, 21 U.S. cities United States 2008. MMWR Surveill Summ. 2008;60(14):1–34.

  20. 20.

    MacKellar DA, Gallagher KM, Finlayson T, Sanchez T, Lansky A, Sullivan PS. Surveillance of HIV risk and prevention behaviors of men who have sex with men–a national application of venue-based, time-space sampling. Public Health Rep. 2007;122(Suppl 1):39–47.

  21. 21.

    Friedman MR, Wei C, Klem ML, Silvestre AJ, Markovic N, Stall R. HIV infection and sexual risk among men who have sex with men and women (MSMW): a systematic review and meta-analysis. PLoS ONE. 2014;9(1):e87139.

  22. 22.

    Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

  23. 23.

    Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81.

  24. 24.

    Donnell D, Baeten JM, Kiarie J, Thomas KK, Stevens W, Cohen CR, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet. 2010;375(9731):2092–8.

  25. 25.

    Fideli US, Allen SA, Musonda R, Trask S, Hahn BH, Weiss H, et al. Virologic and immunologic determinants of heterosexual transmission of human immunodeficiency virus type 1 in Africa. AIDS Res Hum Retroviruses. 2001;17(10):901–10.

  26. 26.

    Quinn TC, Wawer MJ, Sewankambo N, Serwadda D, Li C, Wabwire-Mangen F, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med. 2000;342(13):921–9.

  27. 27.

    Milone A. Seen, but now heard: How increased LGBT visibility contributed to cultural acceptance of gay marriage. Phi Alpha Theta Upper New York Regional Conference; April 30, 2016; Plattsburgh, NY2016.

  28. 28.

    Montopoli B. Poll: With higher visibility, less disapproval for gays. CBS News. 2010 June 9.

  29. 29.

    Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017;29(11):1351–8.

  30. 30.

    Parker CM, Garcia J, Philbin MM, Wilson PA, Parker RG, Hirsch JS. Social risk, stigma and space: key concepts for understanding HIV vulnerability among black men who have sex with men in New York City. Cult Health Sex. 2017;19(3):323–37.

  31. 31.

    Stahlman S, Sanchez TH, Sullivan PS, Ketende S, Lyons C, Charurat ME, et al. The prevalence of sexual behavior stigma affecting gay men and other men who have sex with men across Sub-Saharan Africa and in the United States. JMIR Public Health Surveill. 2016;2(2):e35.

  32. 32.

    Jeffries WL. Beyond the bisexual bridge: sexual health among US men who have sex with men and women. Am J Prevent Med. 2014;47(3):320–9.

  33. 33.

    Tieu HV, Spikes P, Patterson J, Bonner S, Egan JE, Goodman K, et al. Sociodemographic and risk behavior characteristics associated with unprotected sex with women among black men who have sex with men and women in New York City. AIDS Care. 2012;24(9):1111–9.

  34. 34.

    Zule WA, Bobashev GV, Wechsberg WM, Costenbader EC, Coomes CM. Behaviorally bisexual men and their risk behaviors with men and women. J Urban Health. 2009;86(Suppl 1):48–62.

  35. 35.

    Jeffries WL, Dodge B. Male bisexuality and condom use at last sexual encounter: results from a national survey. J Sex Res. 2007;44(3):278–89.

  36. 36.

    Vittinghoff E, Douglas J, Judson F, McKirnan D, MacQueen K, Buchbinder SP. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. Am J Epidemiol. 1999;150(3):306–11.

  37. 37.

    Pathela P, Schillinger JA. Sexual behaviors and sexual violence: adolescents with opposite-, same-, or both-sex partners. Pediatrics. 2010;126(5):879–86.

  38. 38.

    Shadaker S, Magee M, Paz-Bailey G, Hoots BE, Group NS. Characteristics and risk behaviors of men who have sex with men and women compared with men who have sex with men – 20 U.S. cities, 2011 and 2014. J Acquir Immune Defic Syndr. 2017;75(Suppl 3):S281–7.

  39. 39.

    Jeffries WL. HIV testing among bisexual men in the United States. AIDS Educ Prev. 2010;22(4):356–70.

  40. 40.

    O’Leary A, Fisher HH, Purcell DW, Spikes PS, Gomez CA. Correlates of risk patterns and race/ethnicity among HIV-positive men who have sex with men. AIDS Behav. 2007;11(5):706–15.

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This research was funded by the Centers for Disease Control and Prevention, US Department of Health and Human Services.

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Correspondence to Wade Ivy III.

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Ivy, W., Paz-Bailey, G. Changes in Characteristics and Behavior Among African American Men Who Have Sex with Men and Women in the Context of Reductions in HIV Diagnoses Among Women. AIDS Behav 24, 960–966 (2020). https://doi.org/10.1007/s10461-019-02528-2

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  • HIV
  • MSM
  • MSMW
  • Women
  • Behaviors