unprotected anal intercourse among HIV

Crepaz and colleagues set out to integrate the empirical findings on the prevalence of unprotected anal intercourse among HIV-diagnosed men who have sex with men in the United States by comprehensively searching MEDLINE, EMBASE, PsycINFO (2000-2007), hand searching bibliographic lists, and contacting researchers. Thirty US studies (n = 18 121) met selection criteria. Analyses were conducted using random-effects models and meta-regression. The prevalence of unprotected anal intercourse was considerably higher with HIV-seropositive partners (30%; 95% confidence interval 25-36) than with serostatus unknown (16%; 95% confidence interval 13-21) or HIV-seronegative partners (13%; 95% confidence interval 10-16). The prevalence of unprotected anal intercourse with either a serostatus unknown or HIV-seronegative partner was 26%. The unprotected anal intercourse prevalence did not differ by the length of the behavioural recall window but did vary by the type of anal intercourse (insertive vs. receptive). Studies with the following features had a lower unprotected anal intercourse prevalence: recruiting participants before 2000, men who have sex with men of colour being the majority of study sample, recruiting participants from medical settings, using random or systematic sampling methods, and having interviewers administer the questionnaire. Being on antiretroviral therapy, having an undetectable viral load, and reporting more than 90% medication adherence were not associated with unprotected anal intercourse. Most HIV-diagnosed men who have sex with men protect partners during sexual activity, but a sizeable percentage continues to engage in sexual behaviours that place others at risk for HIV infection and place themselves at risk for other sexually transmitted infections. Prevention with positives programs continues to be urgently needed for men who have sex with men in the United States.