Men Who Have Sex with Men (MSM)

For MSM, the following measures of risk behavior are available in Louisiana to provide important information on factors that may affect the risk of acquiring or transmitting HIV infection:

• number of sex partners (Figure 16)
• condom use or unprotected sex (Figures 17 and 18)
• substance use

Both HITS and MOS (surveys conducted by prevention outreach workers at gay bars) provide information on the risk behaviors of MSM. HITS is an anonymous, cross-sectional survey of populations at high risk for HIV infection, including MSM, which was conducted in 3 cities in Louisiana (New Orleans, Baton Rouge, and Monroe) in 2001. Participants, recruited from gay bars, had to be at least 18 years of age, able to give informed consent, and residents of the state for at least 1 year. In addition, to be considered eligible for the MSM risk group, a man must have had sex with another man within the last 12 months. The MOS is a self-administered survey of MSM in gay bars, which was conducted during 1995–2000 by outreach workers from CBOs. The fact that the surveys were conducted in gay bars may limit their applicability to all MSM. However, these surveys do provide valuable information on risk behaviors in a population at high risk for HIV infection. (For a more detailed description of these surveys and their strengths and limitations, see Appendix A.)

According to both surveys, most of the men interviewed had 3 or more sex partners during the last 12 months (HITS, 54% had 4 or more; MOS, 57% had 3 or more). Of the men interviewed in HITS, 75% reported having had at least 1 casual (i.e., non-primary) sex partner during the last 12 months. Younger MSM tended to have higher numbers of casual sex partners, and the number of casual partners decreased with age (HITS) (Figure 16).

Figure 16: Casual Sexual Partners Among Men Who Have Sex with Men
Louisiana HIV Testing Survey, 2001

In addition, 45% of the men with at least 1 casual sex partner during the last 12 months were unaware of the HIV status of their most recent partners (HITS). Lastly, according to the MOS, 15% of the men had both male and female sex partners, which means that risk behaviors in the MSM population may also affect the levels of heterosexual transmission.

Condom Use or Unprotected Sex

Both surveys describe high proportions of men who engage in unprotected sex (Figures 17 and 18). A large proportion of men throughout the state reported having had unprotected receptive anal sex during the past 30 days. Since 1997, a larger proportion of men surveyed in New Orleans, compared with men elsewhere in the state, have reported unprotected sex. The rates of unprotected anal sex may have stabilized in recent years in all areas of the state.

Figure 17: Unprotected Receptive Anal Sex During Past 30 Days, Louisiana
MSM Outreach Survey, 1995-2000

Figure 18: Condom Use Among MSM in Gay Bars
Louisiana HIV Testing Survey, 2001

In HITS, nearly half of the men surveyed did not always use condoms with their casual sex partners (43%, sometimes or never during receptive anal sex; 41%, sometimes or never during insertive anal sex). In MOS, 32% of the men reported having engaged in unprotected receptive anal sex during the past 30 days; 34% had engaged in unprotected insertive anal sex. Although a large proportion of MSM in HITS reported always using a condom during sex with casual partners, 6% to 7% reported never using condoms.

Of the men interviewed in HITS, 59% reported having ever used drugs to get high and having used drugs during the past year. Nearly 1 in 5 (18%) reported having traded money or drugs for sex during the past 12 months.

In HITS, 13% of the men reported having ever injected drugs. Of those, 45% (6% of the total) had injected drugs during the past year. (Note: These results are consistent with surveillance data, which show similar levels of injection drug use among MSM: 9% among MSM whose HIV infection was diagnosed in 2001; 16% among MSM living with HIV infection.)

Among MSM, STD surveillance data may provide information about the potential occurrence of high-risk behavior.

One indirect measure that can indicate increasing rates of infections among MSM is the male-to-female ratio of gonorrhea or syphilis in a particular area. In Louisiana, during 1997–2001, the male-to-female ratio of gonorrhea remained stable (Figure 19). The ratio was approximately 1.0 each year (i.e., each year the same number of men and women were reported to have gonorrhea). These data do not indicate an increasing trend in gonorrhea among MSM. The male-to-female ratio of early syphilis increased slightly, from 0.8 in 1997 to 1.1 in 2001 (Figure 19). This increase, although relatively small, may be an early sign of a trend toward more cases of syphilis among MSM.

Figure 19: Trends in Male-to-Female Ratios of STDs
Louisiana, 1997-2001

Go to Injection Drug Users (IDUs)