title: Anal intercourse without condoms among HIV-positive men who have sex with men recruited from a sexual networking web site, United States.
abstract: BACKGROUND
  The changing landscape of HIV prevention in the United States underscores the need to improve our ability to efficiently reach HIV-positive men who have sex with men (MSM) who engage in behaviors that could transmit HIV.
  
  
  METHODS
  We examined the prevalence of anal intercourse (AI) without condoms with HIV-negative or unknown serostatus partners ("at-risk partners") among 1319 HIV-positive adult male members of a sexual networking Web site for MSM. Sexual behaviors and substance use were measured over a 60-day recall period. Logistic regression was used to identify correlates of insertive and receptive AI without condoms with at-risk partners.
  
  
  RESULTS
  Approximately 25% of the men had been diagnosed as having HIV 12 months or less before study enrollment. Overall, 32% of men engaged in AI without condoms with at-risk partners. Multiple logistic regression identified behavioral predictors of insertive AI without condoms with at-risk partners, including HIV diagnosis within the last 12 months, sex with multiple male partners, substance use in conjunction with sex, and use of phosphodiesterase type 5 inhibitors. Receptive AI without condoms with at-risk partners was associated with younger age (19-24 years), residing outside metropolitan cities, substance use in conjunction with sex, and having multiple male partners.
  
  
  CONCLUSIONS
  High levels of sexual risk were found among these MSM. Increased Internet-based HIV prevention marketing efforts and prevention strategies should be considered to efficiently reach HIV-positive MSM who engage in serodiscordant AI without condoms.
authors.affiliation: From the *Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and †Public Health Solutions, New York, NY.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Margolis
authors.forename: Heather
authors.initials: H
authors.lastname: Joseph
authors.forename: Sabina
authors.initials: S
authors.lastname: Hirshfield
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Chiasson
authors.forename: Lisa
authors.initials: L
authors.lastname: Belcher
authors.forename: David W
authors.initials: DW
authors.lastname: Purcell
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners; D012944:Social Support; D014481:United States / Q000453:epidemiology; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*