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Longitudinal Analysis of HIV Risk and Substance Use Patterns for Men Who Have Sex With Men and Women and Men Who Have Sex With Men Only

Abstract Men who have sex with men and women (MSMW) experience discrimination from same-sex and heterosexual communities partially because of perceptions that they engage in high-risk sexual behavior, have elevated polysubstance use levels, and constitute an HIV bridge population. We used a longitudinal multivariate generalized linear mixed model comparing sexual risk and substance use patterns for men who have sex with men only (MSMO) with MSMW in the same cohort study. Data consisted of 771 men reporting 3,705 sexual partnerships from 2012 to 2017. For high-risk sexual behavior, multivariate results showed nonsignificant (p > .05) differences for partner number and commercial sex work and significantly less (p < .05) HIV prevalence and condomless anal sex. However, MSMW had significantly higher levels of hallucinogen and prescription opioid use as well as substance treatment histories. Only one HIV-positive MSMW had a transmittable viral load, negating the concept of MSMW being an HIV bridge population. Results indicate the need for additional longitudinal studies comparing MSMO and MSMW.