title: Changes in sexual risk behavior among MSM participating in a research cohort in coastal Kenya.
abstract: OBJECTIVE
  To describe changes in sexual risk behavior among Kenyan MSM who received regular risk reduction counseling (RRC).
  
  
  METHODS
  Data were derived from two cohorts of HIV-1-negative and HIV-1-positive MSM in Kenya. Behavioral data were collected at enrollment and at monthly or quarterly scheduled follow-up visits. At each visit, RRC was provided to all men and HIV-1 testing to seronegative men.
  
  
  METHODS
  Random effects logistic and Poisson regression models with time since study entry as main variable of interest were used to evaluate changes in number of sex partners and unprotected sex in the past week, and insertive, receptive, and unprotected anal intercourse in the past 3 months. Analyses were adjusted for HIV-1-status, calendar year of follow-up, and several baseline characteristics. Trends over follow-up time were allowed to differ by HIV-1-status. Men were censored when they seroconverted for HIV.
  
  
  RESULTS
  Number of regular and casual sex partners and unprotected anal intercourse decreased in both HIV-1-negative and HIV-1-positive men. Unprotected sex with both regular and casual sex partners decreased more strongly early in follow-up in HIV-1-positive men than in HIV-1-negative men. Decreases in insertive anal intercourse were found for HIV-1-positive men only, whereas decreases in receptive anal intercourse were found for HIV-1-negative men only.
  
  
  CONCLUSIONS
  MSM who were regularly exposed to RRC showed some reductions in sexual risk behavior, but it is uncertain if these reductions are sustained over time. As HIV-1 incidences in Kenyan MSM are very high, RRC should be supported by comprehensive biomedical interventions.
authors.affiliation: Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, the Netherlands.
authors.forename: Lisanne M
authors.initials: LM
authors.lastname: Möller
authors.affiliation: Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, the Netherlands.|Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Ineke G
authors.initials: IG
authors.lastname: Stolte
authors.affiliation: Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, the Netherlands.|Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Geskus
authors.affiliation: Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Haile Selassie
authors.initials: HS
authors.lastname: Okuku
authors.affiliation: Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wahome
authors.affiliation: International AIDS Vaccine Initiative, New York City, New York.|Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
authors.forename: Matt A
authors.initials: MA
authors.lastname: Price
authors.affiliation: Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, the Netherlands.|Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
authors.affiliation: Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya.|Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, Washington, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
authors.affiliation: Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Headington, UK.|Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
mesh_terms: D000328:Adult; D044383:Black People; D015331:Cohort Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D015497:HIV-1; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D012731:Sex Counseling / Q000706:statistics & numerical data; D012747:Sexual Partners / Q000523:psychology; D047568:Unsafe Sex / Q000523:psychology*; D055815:Young Adult