Sexual Risk, Substance Use and Undiagnosed Seropositivity among Men Who Have Sex with Men and Women in Miami, Florida

This paper utilizes the National HIV Behavioral Surveillance data in Miami for the men who have sex with men cycle (NHBS-MSM2) in 2008. We analyzed sexual risk, substance use and undiagnosed seropositivity in a diverse sample of men who have sex with men and women (MSMW) and compared them with MSM. Of 152 MSMW, 15.1% tested HIV positive with 73.9% previously undiagnosed. Almost half (44.1%) of the MSMW reported unprotected sex with male and female partners in the past year. More MSMW than MSM had undiagnosed HIV infection, exchanged sex for money or drugs, used crack and cocaine, been high during sex, and had not received HIV treatment if HIV positive. Undiagnosed HIV infection among MSMW was associated with Black race, older age, non-alcohol use and Ecstasy use. Our findings indicate that MSMW represent a unique population at risk of acquiring and transmitting HIV in Miami. Florida Public Health Review, 2015; 12, 1-12. BACKGROUND Men who have sex with men and women (MSMW) represent a unique population group who are at risk of HIV acquisition and transmission between populations of men who have sex with men (MSM) and heterosexual men and women (Friedman et al., 2014a; Friedman et al., 2014b; Gorbach et al., 2009; Hightow et al., 2006; Knight et al., 2007; Lauby et al., 2008; Mutchler et al., 2008; Operario et al., 2011; Prabhu et al., 2004; Siegel et al., 2008; Spikes et al., 2009; Wheeler et al., 2008; Williams et al., 2009; Zule et al., 2009). Several studies have suggested that MSMW are less likely than MSM to have ever been tested for HIV (Jeffries, 2010) and are at greater risk of undiagnosed HIV infection than are MSM (Friedman et al., 2014; Maulsby et al., 2012; Satcher et al., 2007; Young et al., 2011). A number of studies have reported that MSMW are reluctant to discuss their bisexual practices with their female partners (Gorbach et al., 2009; McKay et al., 2011; Montgomery et al., 2003; Williams et al., 2009), and are less likely to disclose and more likely to conceal their sexual activities than are MSM or MSW (Dodge et al., 2012; Millett et al., 2005; Prabhu et al., 2004; Satcher et al., 2007; Schrimshaw et al., 2012). Although several studies have assessed the factors associated with undiagnosed HIV infection among MSM, few studies have assessed associations with undiagnosed HIV infection specifically among MSMW. A number of studies have recognized that MiamiDade County, Florida, has high rates of HIV seropositivity, HIV risk behaviors, drug use, and undiagnosed HIV infection among MSM (Akin et al., 2008; Centers for Disease Control and Prevention (CDC), 2005; CDC, 2010; Darrow et al., 2005; Fernández et al., 2005; Fernández et al., 2007; Forrest et al., 2010; Friedman et al., 2014; Webster et al., 2003). Local studies also demonstrate high rates of HIV seropositivity among heterosexual males and females (LaLota et al., 2011). Purpose In this paper, we aim to add to the limited literature on undiagnosed HIV among MSMW by assessing the associations among sexual risk, substance use behaviors, and undiagnosed HIV infection in a large and diverse sample of MSMW residing in Miami-Dade County, Florida. We also compare the sexual risk and substance use behaviors of MSMW with men who have sex with men only (MSM) and discuss the potential risk of HIV infection and