The number of new HIV diagnoses among men who have sex with men (MSM) has increased from an estimated 19,174 in 2005 to 29,341 in 2009, with MSM accounting for approximately 61% of all new HIV diagnoses in 2009 . Despite the high proportion of HIV cases occurring among US MSM, the number of best-evidence interventions targeting MSM is low relative to their contribution to the US HIV epidemic . Thus, there is an urgent need to identify and create evidence-based interventions and prevention services that are culturally appropriate for and acceptable to MSM.
An important avenue for addressing HIV prevention among MSM is considering prevention interventions and health services targeting levels beyond that of the individual. For example, a recent study conducted in five US cities estimated that 68% of HIV transmissions among MSM were attributable to main sex partners , which suggests that couples-based HIV interventions could be helpful in addressing the epidemic in this population. The proportion of transmission from a main sex partner was even higher among younger MSM, among whom rates of new HIV infections are rising most quickly .
Couples voluntary HIV counseling and testing (CVCT) has been used in Africa as an effective behavioral intervention to prevent HIV transmission among heterosexual couples , is supported programmatically by the US Government’s PEPFAR program in countries outside the United States as a prevention service, and is recommended for consideration in male couples in PEPFAR countries . In CVCT, couples receive pretest information, counseling, and test results together and are counseled on ways to prevent HIV transmission within the relationship. Data from Africa suggest that providing HIV counseling and testing to a couple together is an effective intervention for reducing HIV transmission as compared to counseling the female partner alone , . However, limited data are available on the feasibility of CVCT for MSM in the United States.
As part of a broader mixed-methods strategy to evaluate the acceptability of CVCT for US MSM, we collected and analyzed data from a large sample of internet-using MSM about willingness to receive HIV counseling and testing with a male partner and to identify factors associated with willingness to participate in CVCT. These data may help inform development of CVCT services to prevent HIV infections among MSM in the United States.
We evaluated willingness to participate in CVCT and associated factors among MSM in the United States.
5,980 MSM in the US, recruited through MySpace.com, completed an online survey March-April, 2009. A multivariable logistic regression model was built using being “willing” or “unwilling” to participate in CVCT in the next 12 months as the outcome.
Overall, 81.5% of respondents expressed willingness to participate in CVCT in the next year. Factors positively associated with willingness were: being of non-Hispanic Black (adjusted odds ratio [aOR]: 1.5, 95% confidence interval [CI]: 1.2–1.8), Hispanic (aOR: 1.3, CI: 1.1–1.6), or other (aOR: 1.4, CI: 1.1–1.8) race/ethnicity compared to non-Hispanic White; being aged 18–24 (aOR: 2.5, CI: 1.7–3.8), 25–29 (aOR: 2.3, CI: 1.5–3.6), 30–34 (aOR: 1.9, CI: 1.2–3.1), and 35–45 (aOR: 2.3, CI: 1.4–3.7) years, all compared to those over 45 years of age; and having had a main male sex partner in the last 12 months (aOR: 1.9, CI: 1.6–2.2). Factors negatively associated with willingness were: not knowing most recent male sex partner’s HIV status (aOR: 0.81, CI: 0.69–0.95) compared to knowing that the partner was HIV-negative; having had 4–7 (aOR: 0.75, CI: 0.61–0.92) or >7 male sex partners in the last 12 months (aOR: 0.62, CI: 0.50–0.78) compared to 1 partner; and never testing for HIV (aOR: 0.38, CI: 0.31–0.46), having been tested over 12 months ago (aOR: 0.63, CI: 0.50–0.79), or not knowing when last HIV tested (aOR: 0.67, CI: 0.51–0.89), all compared to having tested 0–6 months previously.
Young MSM, men of color, and those with main sex partners expressed a high level of willingness to participate in couples HIV counseling and testing with a male partner in the next year. Given this willingness, it is likely feasible to scale up and evaluate CVCT interventions for US MSM.