American Journal of Epidemiology Vol. 146, No. 7: 531-542
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
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Sexual Risk Behavior and Risk Factors for HIV-1 Seroconversion in Homosexual Men Participating in the Tricontinental Seroconverter Study, 1982–1994
1Center for AIDS Prevention Studies, Department of Epidemiology and Biostatistics, University of California San Francisco San Francisco, CA
2Municipal Health Service, Department of Public Health Amsterdam, the Netherlands
3Department of Epidemiology and Biostatistics, San Francisco General Hospital, University of California San Francisco San Francisco, CA
4Department of Health Care and Epidemiology, University of British Columbia, St. Paul's Hospital Vancouver, British Columbia, Canada
5National Centre on HIV Epidemiology and Clinical Research, University of New South Wales Sydney, NSW, Australia
Reprint requests to Dr. Kimberty Page-Shafer, Center for AIDS Prevention Studies, Department of Epidemiology and Biostatistics, University of California San Francisco, 74 New Montgomery Street, Suite 510, San Francisco, CA 94105
Trends in sexual behavior associated with incident infection with human immunodeficiency virus (HIV) type 1 are described and a case-control study was conducted to examine risk factors for HIV seroconversion in homosexual men who became infected with HIV between 1982 and 1994 from four geographic sites: Amsterdam, the Netherlands; San Francisco, California; Vancouver, Canada; and Sydney, Australia. Changes in sexual behaviors were evaluated from cohort visits in the preseroconversion, seroconversion, and post-seroconversion intervals and were further examined over three time periods: 1982–1984, 1985–1987, and 1988–1994. In a case-control study, sexual behaviors, substance use, and presence of sexually transmitted disease were compared between 345 HIV-positive cases and 345 seronegative controls matched by visit date and site. Receptive anal intercourse was the sexual behavior most highly associated with seroconversion. The odds ratio (OR) per receptive anal intercourse partner increase was 1.05 (95% confidence interval (Cl) 1.02–1.09). To more carefully examine risk associated with receptive oral intercourse, analyses were done in a subgroup of men who reported no or one receptive anal intercourse partner. The risk (OR) associated with receptive oral intercourse partner increase was 1.05 (95% Cl 1.0–1.11). In multivariate conditional logistic regression analyses, presence of sexually transmitted disease (OR = 3.39, 95% Cl 1.95–5.91) and amphetamine use (OR = 2.55, 95% Cl 1.26–5.15) were independently associated with seroconversion. Although the prevalence of major risk factors has decreased over time, the associations of these behaviors and HIV infection persist, suggesting that these risk behaviors remain important avenues for public health interventions. Am J Epidemiol 1997;146:531–42.
acquired immunodeficiency syndrome; HIV; homosexuality, male; risk factors; sex behavior
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