Monica Sweeney

Men who have sex with men have a 140-fold higher risk for newly diagnosed HIV and syphilis compared with heterosexual men in New York City.

ObjectivesTo describe the population of men who have sex with men (MSM) in New York City, compare their demographics, risk behaviors, and new HIV and primary and secondary (P&S) syphilis rates with those of men who have sex with women (MSW), and examine trends in infection rates among MSM. DesignPopulation denominators and demographic and behavioral data were obtained from population-based surveys during 2005–2008. Numbers of new HIV and P&S syphilis diagnoses were extracted from city-wide disease surveillance registries. MethodsWe calculated overall, age-specific and race/ethnicity-specific case rates and rate ratios for MSM and MSW and analyzed trends in MSM rates by age and race/ethnicity. ResultsThe average prevalence of male same-sex behavior during 2005–2008 (5.0%; 95% CI: 4.5 to 5.6) differed by both age and race/ethnicity (2.3% among non-Hispanic black men; 7.4% among non-Hispanic white men). Compared with MSW, MSM differed significantly on all demographics and reported a higher prevalence of condom use at last sex (62.9% vs. 38.3%) and of past-year HIV testing (53.6% vs. 27.2%) but also more past-year sex partners. MSM HIV and P&S syphilis rates were 2526.9/100,000 and 707.0/100,000, each of which was over 140 times MSW rates. Rates were highest among young and black MSM. Over 4 years, HIV rates more than doubled and P&S syphilis rates increased 6-fold among 18-year-old to 29-year-old MSM. ConclusionsThe substantial population of MSM in New York City is at high risk for acquisition of sexually transmitted infections given high rates of newly diagnosed infections and ongoing risk behaviors. Intensified and innovative efforts to implement and evaluate prevention programs are required.

Averting HIV Infections in New York City: A Modeling Approach Estimating the Future Impact of Additional Behavioral and Biomedical HIV Prevention Strategies

Background New York City (NYC) remains an epicenter of the HIV epidemic in the United States. Given the variety of evidence-based HIV prevention strategies available and the significant resources required to implement each of them, comparative studies are needed to identify how to maximize the number of HIV cases prevented most economically. Methods A new model of HIV disease transmission was developed integrating information from a previously validated micro-simulation HIV disease progression model. Specification and parameterization of the model and its inputs, including the intervention portfolio, intervention effects and costs were conducted through a collaborative process between the academic modeling team and the NYC Department of Health and Mental Hygiene. The model projects the impact of different prevention strategies, or portfolios of prevention strategies, on the HIV epidemic in NYC. Results Ten unique interventions were able to provide a prevention benefit at an annual program cost of less than

Assessing the impact of a community-wide HIV testing scale-up initiative in a major urban epidemic.

360,000, the threshold for consideration as a cost-saving intervention (because of offsets by future HIV treatment costs averted). An optimized portfolio of these specific interventions could result in up to a 34% reduction in new HIV infections over the next 20 years. The cost-per-infection averted of the portfolio was estimated to be

Sexual Behaviors of Adolescent Emerging and Young Adult Men Who Have Sex With Men Ages 13-29 in New York City

106,378; the total cost was in excess of

The NYC Condom: Use and Acceptability of New York City's Branded Condom

2 billion (over the 20 year period, or approximately

The Two Faces of Fear: A History of Hard-Hitting Public Health Campaigns Against Tobacco and AIDS

100 million per year, on average). The cost-savings of prevented infections was estimated at more than

It's Never Just HIV: Exposure to an HIV Prevention Media Campaign and Behavior Change Among Men Who Have Sex with Men Participating in the National HIV Behavioral Surveillance System in New York City

5 billion (or approximately

LBO-1.5 Men who have sex with men (MSM) have a 140-fold risk for HIV and syphilis compared with other men in New York City

250 million per year, on average). Conclusions Optimal implementation of a portfolio of evidence-based interventions can have a substantial, favorable impact on the ongoing HIV epidemic in NYC and provide future cost-saving despite significant initial costs.

O1-S11.04 Targeting the use of HIV RNA screening to maximise yield and minimise cost: NYC Health Department STD Clinics, 2008–2010

Background:The Bronx, one of 5 boroughs in New York City (NYC), bears a high burden of HIV. We evaluated the impact of HIV testing initiatives in the Bronx, including the 2008 The Bronx Knows campaign. Methods:We used data from an annual telephone survey representative of NYC adults to compare 2005 and 2009 estimates of HIV testing prevalence among Bronx residents and to identify correlates of testing. We used NYC HIV surveillance data to evaluate changes in the percentage of persons concurrently being diagnosed with HIV and AIDS, an indicator of delayed HIV diagnosis. Results:Between 2005 and 2009, relative increases of 14% and 32% were found in the proportion of Bronx adults who have ever been HIV tested and who have been tested in the past year, respectively (P < 0.001). The largest increases were among those aged 24–44 years, men, non-Hispanic blacks and Hispanics, and those with low income or education, nonheterosexual identity, a personal doctor/provider, or health insurance. Factors independently associated with being recently tested included black or other race, Hispanic ethnicity, and bisexual identity. The proportion concurrently diagnosed with HIV and AIDS fell 22% from 2005 to 2009, and decreases generally occurred among subgroups experiencing increases in testing. Conclusion:Community-wide testing in the Bronx increased the proportion of people with known HIV status and reduced the proportion with delayed diagnoses.

Knowledge and Use of Pre-Exposure Prophylaxis Among an Online Sample of Young Men Who Have Sex with Men in New York City

Content: HIV infections among young men who have sex with men (YMSM), ages 13-29 in New York City have been steadily increasing over the last decade. Objective: To document the sexual onset and behavior of YMSM as a means for informing the development of new HIV prevention messaging. Design: Cross-sectional study. Participants: Five hundred fifty-eight YMSM, with more than 60% racial/ethnic minorities. Results: Young adults (25-29 years) reported a greater number of lifetime sexual partners, but the adolescents (13-17 years) and emerging adults (18-24 years) reported having their first sexual encounter with another man at a younger age. Black and Latino men first engaged in various sexual behaviors, including receptive anal intercourse, at a younger age than either Asian/Pacific Islander or white men, and were more likely to report an HIV-seropositive status. Across race/ethnicity, YMSM reported an equivalent number of recent male sex partners and selected both main and casual partners who were age and race/ethnicity matches. During the most recent sexual encounter with a casual male partner, black men were more likely than white men to have had unprotected receptive anal intercourse, whereas white men were more likely to report unprotected oral sex. Black YMSM reported more recent female partners than all other groups. Conclusions: Black and Latino YMSM may be at increased risk for seroconversion because they tend to start having sex with other men at a younger age than their white and Asian/Pacific Islander peers and because they engage in unprotected sexual behaviors with men of concordant race/ethnicity and of a similar age where levels of viremia may be more elevated but not because of the sheer number of sexual partners.