Sexual Risk Behaviors among Men Who Have Sex with Men: Implications for the Delivery of New HIV Prevention Interventions
Recent clinical trial results suggest that new HIV prevention interventions, such as pre-exposure prophylaxis and treatment as prevention, protect against HIV infection. However, several barriers to widespread implementation of these interventions have been identified. In response to some of these challenges, many argue that new HIV prevention interventions should only be delivered to high-risk populations within integrated HIV prevention programs that consist of biomedical, behavioral, and structural interventions. In the United States, men who have sex with men (MSM) remain the most heavily HIV affected population, and thus will likely be the target of such programs. This dissertation aims to inform the development of MSM-specific HIV prevention programs by providing a better understanding of the situations in which new prevention strategies could have the greatest impact within this population.
More specifically, this dissertation examines longitudinal patterns of sexual risk behavior, socio-demographic and behavioral factors associated with partnership type and serostatus, and individual-level and sexual event-level predictors of condom use during receptive anal intercourse among MSM. Chapter 2 is based on data from the Multicenter AIDS Cohort Study (MACS) and demonstrates that HIV-negative MSM exhibit distinct sexual risk trajectories and that those following a high risk trajectory exhibit "seasons of risk" over time. Chapter 3 also uses data from the MACS to show that the reported number of male sexual partners is associated with partnership type and serostatus and that the magnitude and direction of this relationship differs by HIV status. Chapter 4 is based on longitudinal data from a cohort of racially/ethnically diverse HIV-negative MSM followed for one year in Los Angeles, and demonstrates that the effect of methamphetamine use on condom use during receptive anal intercourse at the sexual event-level is greatest in the context of non-main partnerships. Findings from this dissertation expand the current understanding of risk behaviors among MSM, and have implications for the development of integrated HIV prevention programs for MSM in the United States.