The men in this cohort had a mean age of 35 years (range at baseline of 19–64), were mostly white (71%) and Hispanic (21%) and were highly educated (88% had at least some college education). They reported a mean of 8.8 partners in the last 3 months at baseline (range 0–30, median 4). Twenty two percent (n=42) had a main partner at baseline but did not report a continuing partner in any follow-up interviews; 29% (n=56) had a main partner at baseline and reported at least one continuing partner in at least one follow-up interview; 32% (n=62) had neither a main partner at baseline nor any main partner reported in a follow-up interview, and 17% (n=33) did not have a main partner at baseline but reported a new main partner in at least one follow-up interview. During the year of follow-up only 3 men reported abstinence in the three months prior to the interview and none reported abstinence at more than one visit or for the duration of the study.
Over the year following diagnosis there was a significant decrease in the numbers of partners reported in the past month from 8.81 to 5.84 mean partners (p < .0001) when time since baseline interview was analyzed as a continuous variable. When time since baseline interview was rounded to the nearest three months (), the most significant drop in number of sex partners was shown to occur from baseline to 3 months (Rate Ratio (RR) 0.71, p<.0001, 95%CI 0.65–0.78). Further changes were not significant but showed decreasing trends through month 9: RR 0.97 (95%CI 0.86–1.10) from months 3 to 6, RR 0.88 (95%CI 0.76, 1.02) from months 6 to 9, and RR 1.17 (95%CI 0.98–1.39) from months 9 to 12. Overall a significant decrease of 27% (95%CI 20–32%) was detected from baseline to follow-up in the number of partners reported in the last three months (p=.0005)
Mean numbers of partners reported in the prior three months over the year following HIV diagnosis:error bars are 95% confidence bounds on the means
Over the year, more men reported their last partner was a main partner than any other partner type, followed by unknown partners (). The percent of men who reported any main partner significantly increased from 20.4% to 47.6% (p<.0001); unknown and one time partners decreased over time (p=.0014 and .0004, respectively). The largest increase in number of MSM reporting main partners occurred between baseline and 3 months (p=.0002), the differences between other consecutive visits were not significant, however, the difference from baseline to follow-up was significant (OR 0.73, 95% CI 0.68, 0.80). Main partners were most frequently the last partner and the proportion of these increased slightly over the year. The percent of last partners who were unknown or anonymous partners decreased slightly over time ().
Percentage of HIV positive, negative and unknown status partners of recently infected MSM with whom with they reported recent unprotected anal intercourse: across the first year following HIV diagnosis
Over the year of follow-up, participants reported the HIV status of their partners. Among the 252 main partners with HIV status reported, more than half were reported to be HIV uninfected (56%), a third as HIV positive, and the fewest as HIV status unknown (11%). Among the 646 non-main partners with HIV status reported, about a third were reported as HIV uninfected, almost 20% as HIV positive and almost half reported that they did not know the HIV status of these partners (47%). Overall the percent reporting the use of methamphetamines during last sex decreased, yet UAI increased among those that did report methamphetamine use ().
During follow-up interviews condom use during anal intercourse with last partner was reported for 414 partners. More men reported not using condoms (i.e. UAI) with an HIV-infected partner at any time point than reported UAI with either an uninfected or status unknown partner. For those reporting UAI with HIV-uninfected partners, there was more UAI with main versus non-main HIV-uninfected partners, with a slight trend toward less UAI; 94% at baseline to 90% at one year versus 62% at baseline to 55% at one year, respectively, For UAI with HIV-uninfected main partners the pattern was the same, 67% at baseline to 64% at one year for main partners and 54% to 38% for non-main partners. For those with partners of unknown HIV status, there were too few reporting main partners to report a trend. UAI with non-main partners of unknown HIV status decreased until 9 months when it increased, 51% at baseline to 40% at 9 months and then 67% at 12 months.
When UAI with last partner was assessed by HIV status of partner the percent reporting UAI at last sex at baseline or since last interview at follow-up with a partner who was HIV-uninfected or unknown with that partner decreased from 42% at baseline to 29% at 6 months, 23% at 9 months but then rebounded at 12 months to 50% (). It should be noted that by month 12, UAI was entirely with HIV status unknown partners and none reported with HIV-uninfected partners.
Percentage of last partners of each partner type reported by MSM with recent HIV infection over the first year following diagnosis
The PAS was administered to provide a quantitative measure of the amount of intimacy within a partnership for each category of partnership asked about. Overall the mean PAS was 12.4 and increased from 10.3 at baseline to 15.9 at one year (). The minimum, maximum, and mean for main partners were 0, 27, and 22.3, respectively. PAS was significantly lower for those that use methamphetamine with their partner than for non-users (mean PAS of 8.1 vs. 13.1; p<.001). 36
. A higher PAS was associated with increased odds of disclosure to the partner of HIV status both at baseline (OR 1.16, 95% CI 1.13, 1.20) and follow-up (OR 1.19, 95% CI 1.12, 1.27).
At baseline almost all participants (98%) had detectable viral load and only 14% had initiated ART. At each timepoint, there was a significant increase in the proportion of those on therapy and without detectable viral load reaching at 12 months 60% remaining with detectable viral load and about half on therapy (). Over the year 55% (107/193) of individuals never took ART, 13% (26/193) were on ART continuously at every visit at any time point and 99% (192) of individuals had a detectable viral load at any time point. In univariate analysis, there was no significant difference in reports of UAI between those without and with detectable viral load (43.9% of those with no detectable vs. 47.9% of those with a detectable viral load, p-value =.62). Similarly, there was no difference in those reporting UAI by ART usage (49.6% of those not on ART reported UAI vs. 40.2% of those on ART, p=.14).
Based on multivariable analysis over the year following HIV diagnosis, the following were significantly associated with reported UAI: baseline methamphetamine use (AOR 7.65, 95% CI 1.87, 31.30), methamphetamine use at follow-up (AOR 14.4, 95% CI 202, 103.0), HIV-uninfected partner at follow-up (AOR 0.14, 95% CI 0.06, 0.33) and partners with unknown HIV status at follow-up (AOR0.33, 95% CI 0.11, 0.94). PAS score during the year was marginally not significant (AOR 1.04, 95% CI 0.99, 1.09); race/ethnicity and use of ART were not significant.