title: Factors associated with amplified HIV transmission behavior among American men who have sex with men engaged in care: implications for clinical providers.
abstract: BACKGROUND
  The HIV epidemic continues unabated in the USA, with men who have sex with men (MSM) being most frequently infected.
  
  
  OBJECTIVE
  The purpose of this study is to understand the biological and behavioral risk factors associated with increased HIV transmission efficiency, which is HIV transmission risk behavior in the context of uncontrolled HIV replication or intercurrent sexually transmitted infections.
  
  
  METHODS
  Participants were 201 HIV-infected MSM who received their primary care at an HIV ambulatory care center in Boston. Logistic regression models were conducted to determine factors associated with engaging in behavior associated with potentially amplified transmission.
  
  
  RESULTS
  In the final model, heavy alcohol use (AOR, 3.27; 95 % CI 1.37-7.79), as well as stimulant drug use (crystal meth, crack, or other cocaine; AOR, 3.00; CI 1.32-6.84), having at least a college degree (OR, 2.74; CI, 1.15-6.54), and decreased duration of HIV infection (OR, 0.91; CI, 0.85-0.97) were each uniquely associated with enhanced HIV transmission behavior.
  
  
  CONCLUSIONS
  HIV primary care providers should routinely assess patients for potential HIV transmission behaviors, particularly those who are younger and more recently diagnosed with HIV, who drink alcohol heavily, and who use any nonprescription drugs, particularly stimulants, in order to decrease the spread of HIV.
authors.affiliation: The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA, kmayer@fenwayhealth.org.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.forename: Margie R
authors.initials: MR
authors.lastname: Skeer
authors.forename: Conall
authors.initials: C
authors.lastname: O'Cleirigh
authors.forename: Brett M
authors.initials: BM
authors.lastname: Goshe
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
mesh_terms: D000328:Adult; D004522:Educational Status; D015658:HIV Infections / Q000150:complications / Q000523:psychology / Q000635:transmission*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology; D047568:Unsafe Sex / Q000523:psychology