Methods: This study was a secondary analysis of data collected for the Multicenter AIDS Cohort Study (MACS), a bi-annual, ongoing longitudinal panel study of the natural history of AIDS begun in 1984. These data are hierarchically structured, with multiple observation points nested within participants. First, participants that seroconverted at any time after enrollment (N = 636) were identified. Using data from the point of seroconversion for each participant as a baseline, Hierarchical linear modeling was then used to identify participants (n = 295) whose predicted slope of sex drug use over time was greater than the average, decreasing, slope of sex drug use of all seroconverting MSM in the sample. Once identified, a series of hierarchical linear models examined this subgroup on their own and compared to other seroconverting participants. Covariates included demographics, other drug use, depression scores, and sexual risk behaviors.
Results: This study identified 295 seroconverting MSM whose sex drug use pattern over time did not match the overall trend of decreasing use among seroconverting study participants. Results show that following seroconversion this subgroup over time had, on average, increasing levels of sex drug use, unprotected receptive anal intercourse (URAI), and number of sex partners. Interestingly, this subgroup over time was also found to have significantly lower levels of depression, URAI, sex drug use, and number of sex partners when compared to other seroconverting MSM.
Implications: Increasing rates of HIV risk behaviors identified among some participants in this study appear to reveal a subgroup of seroconverting MSM that, even when diagnosed with HIV, are resistant to risk-reduction behaviors. Despite this increasing risk over time, this group may be a somewhat ‘hidden’ population, whose lower levels of HIV-risk compared to other seroconverters may obscure their unique experiences and needs within wider HIV prevention efforts. This temporal pattern of HIV-risk, even in the face of HIV-infection, provides new insight into the persistent and complex challenge sex drug use poses to HIV long-term prevention efforts for ‘high-risk’ MSM, particularly with regard to issues like medication adherence and secondary HIV transmission.