title: High and persistent HIV seroincidence in men who have sex with men across 47 U.S. cities.
abstract: OBJECTIVE
  To provide HIV seroincidence data among men who have sex with men (MSM) in the United States and to identify predictive factors for seroconversion.
  
  
  METHODS
  From 1998-2002, 4684 high-risk MSM, age 18-60 years, participated in a randomized, placebo-controlled HIV vaccine efficacy trial at 56 U.S. clinical trial sites. Demographics, behavioral data, and HIV status were assessed at baseline and 6 month intervals. Since no overall vaccine efficacy was detected, data were combined from both trial arms to calculate HIV incidence based on person-years (py) of follow-up. Predictors of seroconversion, adjusted hazards ratio (aHR), were evaluated using a Cox proportional hazard model with time-varying covariates.
  
  
  RESULTS
  Overall, HIV incidence was 2.7/100 py and was relatively uniform across study sites and study years. HIV incidence was highest among young men and men reporting unprotected sex, recreational drug use, and a history of a sexually transmitted infection. Independent predictors of HIV seroconversion included: age 18-30 years (aHR = 2.4; 95% CI 1.4,4.0), having >10 partners (aHR = 2.4; 95% CI 1.7,3.3), having a known HIV-positive male sex partner (aHR = 1.6; 95% CI 1.2, 2.0), unprotected anal intercourse with HIV positive/unknown male partners (aHR = 1.7; 95% CI 1.3, 2.3), and amphetamine (aHR = 1.6; 95% CI 1.1, 2.1) and popper (aHR = 1.7; 95% CI 1.3, 2.2) use.
  
  
  CONCLUSIONS
  HIV seroincidence was high among MSM despite repeated HIV counseling and reported declines in sexual risk behaviors. Continuing development of new HIV prevention strategies and intensification of existing efforts will be necessary to reduce the rate of new HIV infections, especially among young men.
authors.affiliation: Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. mda6@cdc.gov
authors.forename: Marta-Louise
authors.initials: ML
authors.lastname: Ackers
authors.forename: Alan E
authors.initials: AE
authors.lastname: Greenberg
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Lin
authors.forename: Bradford N
authors.initials: BN
authors.lastname: Bartholow
authors.forename: Adrian Hirsch
authors.initials: AH
authors.lastname: Goodman
authors.forename: Michael
authors.initials: M
authors.lastname: Longhi
authors.forename: Marc
authors.initials: M
authors.lastname: Gurwith
mesh_terms: D000293:Adolescent; D000328:Adult; D002947:Cities; D015658:HIV Infections / Q000453:epidemiology*; D006679:HIV Seropositivity / Q000453:epidemiology; D015528:HIV Seroprevalence; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D055815:Young Adult