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Background: Targeting high-risk subgroups of men who have sex with men (MSM) with enhanced HIV prevention interventions may be cost-effective in resource limited settings.
Objectives: We sought to identify candidates for intensified prevention interventions such as pre-exposure prophylaxis (PrEP).
Methods: Data on behavioral risk in the past 12 months and socio-demographics were collected from MSM seeking anonymous HIV testing. Multivariable logistic regression models generated odds ratios for associations with HIV infection and population attributable fractions (PAFs) were calculated to identify relative contributions of exposures to overall infection.
Results: January 2010 – June 2011, 102 (2.4%) HIV infections were identified among 4338 MSM. Men were median age 31, 64% White, 10% Black, 16% Hispanic, and 10% other race/ethnicity. Factors associated with increased odds of HIV in multivariable regression were: Black race (OR 1.8; 95% CI 1.4-2.4); STI history (OR 1.6; 95% CI 1.0-2.7); ≥3 partners for receptive anal intercourse (RAI) (OR 1.9; 95% CI 1.2-3.0); any unprotected RAI (OR 2.9; 95% CI 1.8-4.6); and methamphetamine use (OR 3.8; 95% CI 1.8-8.1). Adjusted PAFs were 9.0% (95% CI -2.3-19.1) for STI history; 24.0% (95% CI 4.1-49.3) for ≥3 RAI partners; 40.5% (95% CI 21.5-55.0) for any unprotected RAI; and 7.2% (95% CI 0.9-13.1) for methamphetamine use. The total combined PAF adjusted for race/ethnicity was 58.7% (95% CI 43.4-69.8). Overall, 51% of those screened had at least one of these factors: STI history (14%); ≥3 RAI partners (27%); any unprotected RAI (33%); and methamphetamine use (2%).
Conclusions: Although STI history, unprotected RAI, ≥3 RAI partners, and methamphetamine use accounted for 59% of new HIV infections, they were present in half those screened.
Implications for Programs, Policy, and Research: Risk assessment algorithms should be further adapted to efficiently identify high-risk subgroups of MSM for targeted interventions.