Men May Underreport Male Sex Partners at Time of HIV Testing

Laurie Barclay, MD

September 24, 2015

At the time of HIV testing, nearly one quarter of newly diagnosed HIV-positive gay and bisexual men in North Carolina did not report male sex partners, according to an analysis by the Centers for Disease Control and Prevention, published in the September 24 issue of the Morbidity and Mortality Weekly Report.

"Patients do not always report sexual risk behaviors to their health care providers," write Hsiu Wu, MD, from the CDC, Atlanta, Georgia, and colleagues. "Unreported risk behaviors lead to missed opportunities to provide appropriate [HIV] prevention services."

The study sample, recruited from three sexually transmitted disease clinics in North Carolina, consisted of 179 men who have sex with men (MSM) and participating in the Screening Targeted Populations to Interrupt Ongoing Chains of HIV Transmission With Enhanced Partner Notification (STOP) project during 2011 to 2013. In two separate interviews, the first during pretest counseling and the second during a partner services interview after diagnosis, participants provided information about HIV-related risk behaviors, including partner sex and number of sex partners.

Of the 179 participants, 113 were newly diagnosed with HIV infection. Median age was 24 years, and 85.0% were black. Nearly one quarter (26 men; 23.0%) of men diagnosed with HIV infection who reported having male sex partners during partner services interviews had not reported male sex partners at the time of initial HIV testing.

"Among the primarily young and African American study population, a significant proportion of HIV-infected [MSM] did not disclose their sexual risk behaviors at the time of HIV testing," the authors write. "In this population, HIV-infected MSM who did and those who did not report male sex partners during HIV testing had similar levels for risk of HIV acquisition and shared sexual networks."

Compared with MSM who reported male sex partners at the time of testing, those who did not were more likely to also have at least one female sex partner. However, both groups reported a similar number of male sex partners during the second interview.

On the basis of their findings, the investigators conclude that men in some settings may underreport male sex partners, suggesting the need for improved tools for accurate risk assessment. Accurate reporting of male sex partners and other risk behaviors clarifies community risk and facilitates provision of preexposure prophylaxis and other suitable HIV prevention services to persons at risk.

"To effectively customize HIV prevention interventions in disproportionately affected persons such as young African American MSM, novel strategies are needed to accurately assess risk," the study authors conclude. "Bisexual men might also have additional barriers to accurately reporting HIV risk behaviors."

Reasons for underreporting risk behaviors may include lack of awareness of the importance and potential benefits of accurate reporting; concerns about privacy, confidentiality, fear of being judged, and perceived or experienced homophobia; and mistaking sexual orientation or identity as sexual behavior.

Limitations of this study include participation of only HIV-infected men who accepted partner services, inability to estimate the proportion of HIV-negative MSM who did not report male partners or to identify barriers to accurately reporting risk behaviors, and lack of generalizability to other study populations.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2015;64:1037-1041. Full text

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