20% rise in those having unprotected sex

Information from the CDC shows that the number of men who have sex with men having unprotected sex has steadily been increasing from 2005, and continuing through 2011 (the last year that the figures were reported for).

The term “men who have sex with men,” or MSM, includes gay and bisexual males, and men who do not consider themselves gay or bisexual but do have sex with other men.

Presumably, the trend is continuing. The percentage increase in those having unprotected sex was almost 20%. Of course, this increases the risk for the transmission of HIV. Other data from the same study shows that only about 67% of MSMs get tested yearly for HIV.

AIDS ribbon via Shutterstock

AIDS ribbon via Shutterstock

Why is the incidence of unprotected sex steadily increasing considering that it greatly increases the risk for acquiring HIV?

The CDC presents the following as some possible reasons for the worsening data.

* In spite of CDC recommendations that MSMs get tested yearly for HIV*, only about 67% do so. The problem? Someone sexually active who has tested negative for HIV only six months ago, could now be HIV positive. So men, believing themselves to be HIV negative, may be positive and capable of spreading HIV unknowingly. And these men, as well as those who don’t get tested at all, or who are HIV positive and not taking antiretrovirals, may have a very high viral load. So, even when men try to serosort (have sex only with the same HIV status partner), they may be actually having sex with a serodiscordant partner.

* Some men may not disclose that they are HIV positive to prospective partners.

* Others may say that they will use a condom, but then do not do so.

* Other CDC data has shown that having sex under the influence of drugs and/or alcohol makes the prospective partners more likely to have unprotected sex.

* Some MSMs feel that their risk of getting HIV is much lower than it is in reality.

*Some feel that HIV is easily manageable and no longer a major health problem.

* There are some men who don’t ask each other what their HIV statuses are. The CDC estimates that anywhere from 15% to 18% of people with HIV are unaware that they have HIV.

Between 2008 and 2010 the incidence of new cases of HIV in MSMs increased by about 12%. That’s about 3,000 more men who now have HIV over the approximately 30,000 men who acquired HIV in 2010. The highest incidence of new HIV infections is in the range of ages 13-34.

Some good news, the number of new HIV infections in women decreased by about 20%, from around 12,000/year down to around 9,500/year.

Some additional background on HIV in the US, from the CDC:

• More than 1.1 million people in the United States are living with HIV infection, and almost 1 in 6 (15.8%) are unaware of their infection.
• Gay, bisexual, and other men who have sex with men (MSM), particularly young black/African American MSM, are most seriously affected by HIV.
• By race, blacks/African Americans face the most severe burden of HIV.

The CDC estimates that 1,144,500 persons aged 13 years and older are living with HIV infection, including 180,900 (15.8%) who are unaware of their infection. Over the past decade, the number of people living with HIV has increased, while the annual number of new HIV infections has remained relatively stable. Still, the pace of new infections continues at far too high a level— particularly among certain groups.

HIV Incidence (new infections): The estimated incidence of HIV has remained stable overall in recent years, at about 50,000 new HIV infections per year. Within the overall estimates, however, some groups are affected more than others. MSM continue to bear the greatest burden of HIV infection, and among races/ethnicities, African Americans continue to be disproportionately affected.

HIV Diagnoses (new diagnoses, regardless of when infection occurred): In 2011, an estimated 49,273 people were diagnosed with HIV infection in the United States. In that same year, an estimated 32,052 people were diagnosed with AIDS. Overall, an estimated 1,155,792 people in the United States have been diagnosed with AIDS.

Deaths: An estimated 15,529 people with an AIDS diagnosis died in 2010, and approximately 636,000 people in the United States with an AIDS diagnosis have overall. The deaths of persons with an AIDS diagnosis can be due to any cause—that is, the death may or may not be related to AIDS.
* A number of others (physicians, researchers, some other agencies, HIV clinics, etc.) feel strongly that HIV testing in sexually active MSMs should be more often than just yearly.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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