Abstract
ObjectivesTo estimate the number of men who have sex with men and women who are HIV-positive in the United States, and to compare HIV prevalence rates between men who have sex with men and women, men who have sex with men only, and men who have sex with women exclusively.MethodsFollowing PRISMA guidelines, we conducted a systematic review and meta-analysis of reports referencing HIV prevalence and men who have sex with men and women. We searched PubMed and Ovid PsycINFO for peer-reviewed, U.S.-based articles reporting on HIV prevalence among men who have sex with men and women. We conducted event rate, effect size, moderation and sensitivity analyses.ResultsWe estimate that 1.0% of U.S. males are bisexually-behaving, and that 121,800 bisexually-behaving men are HIV-positive. Men who have sex with men and women are less than half as likely to be HIV-positive as men who have sex with men only (16.9% vs. 33.3%; OR = 0.41, 95% CI: 0.31, 0.54), but more than five times as likely to be HIV-positive as men who have sex with women exclusively (18.3% vs. 3.5%; OR = 5.71, 95% CI: 3.47, 9.39). They are less likely to engage in unprotected receptive anal intercourse than men who have sex with men only (15.9% vs. 35.0%; OR = 0.36, 95% CI: 0.28, 0.46). Men who have sex with men and women in samples with high racial/ethnic minority proportions had significantly higher HIV prevalence than their counterparts in low racial/ethnic minority samples.ConclusionsThis represents the first meta-analysis of HIV prevalence in the U.S. between men who have sex with men and women and men who have sex with men only. Data collection, research, and HIV prevention and care delivery specifically tailored to men who have sex with men and women are necessary to better quantify and ameliorate this population’s HIV burden.
Highlights
Since the beginning of the epidemic, HIV transmission researchers have suggested that men who have sex with men and women (MSMW) are integral viral bridges, responsible for the spread of HIV and other sexually transmitted infections (STI) from a discrete population – men who have sex with men (MSM) – to the general population of heterosexuals [1,2,3,4]
Search Results 3921 unique reports were initially identified in PubMed and PsycINFO, of which 486 were duplicative. 1764 reports were excluded because they reported on studies outside of the United States. 588 studies were excluded because participants were all HIV negative or HIV-positive by design. 314 reports were excluded because they did not measure HIV status
The 769 reports remaining were subjected to full-text reviews: of these, 87 were excluded because they reflected only qualitative research; and 641 were excluded because they did not report on HIV prevalence among MSMW
Summary
Since the beginning of the epidemic, HIV transmission researchers have suggested that men who have sex with men and women (MSMW) are integral viral bridges, responsible for the spread of HIV and other sexually transmitted infections (STI) from a discrete population – men who have sex with men (MSM) – to the general population of heterosexuals [1,2,3,4]. Representative population-based surveys have consistently estimated that past-year MSMW comprise 0.3% to 1.6% of U.S males [12,13,14,15]. The composition of MSMW in these surveys is somewhat less than the proportion of men who have sex with men only (MSMO), albeit variable according to length of recall window of bisexual behavior: looking through five-year windows, estimated proportions of these two distinct groups of MSM roughly equalize [14,15]. Meaningful national estimates of MSMW-specific HIV/AIDS transmission and acquisition are subject to significant recall bias limitations when reliant on secondhand information: knowledge of male partners’ bisexuality may be limited and, uncertainly reported [6,18,19,20]. Press accounts sensationalizing bisexual men’s risk to women have, been underinformed [21,22,23,24,25]
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