Results from the STEAM Survey Elizabeth Barash, MPH

Background HIV rates higher for Black MSM in the US compared with other MSM One study found HIV prevalence among Black MSM was more than twice that among White MSM Seattle HIV/AIDS Planning Council created a needs assessment to assess HIV risk behaviors among this population Results will be used to inform the Council’s prevention prioritization process and guide development of targeted local prevention programs

Methods Recruitment and interviews conducted during the Fall of 2008 PHSKC recruited and interviewed 369 Black men in KC who reported ever having sex with men

Methods (2) Participants were recruited from a variety of venues  bars  parks  community organizations  HIV clinics After completing the 25 minute interviewer administered survey, men were paid $25 for their time

Demographic Characteristics N=369 Sex Male96% Transgender4% Country of birth US94% Other6% Education HS grad or less37% More than HS grad62%

Age Distribution of STEAM Participants

Demographic Characteristics N=369 Income <$10,00035% >$10,00065% Homeless last 12 months No74% Yes25% Incarcerated last 12 months No85% Yes15%

HIV Testing History

HIV Status

High Risk Negatives and Testing Negatives unprotected sex last 12 months N=89 Negatives no unprotected sex last 12 months N=124 Tested last 12 months 58%79% Tested last 6 months 42%62% Tested last 3 months 23%35%

Other Health Indicators N=369 Regular health care provider among HIV+ participants 98% Regular health care provider among HIV-/unknown status participants 69% History of mental health problem28% STD diagnosis last 12 months11%

N=369 Lifetime sex partners Men only37% Both men and women63% Sex partners last 12 months Men only65% Both men and women35% Sexual identity Gay57% Straight30% Bisexual7% Other6% Sexual Behavior and Identity

Sexual Behavior with Men Sex last 12 months Unprotected sex last 12 months48% Unprotected sex with unknown status partner last 12 months 43% Last sex with male Did not know HIV status of last sex partner 29% Did not use condom at last sex35%

Comparing STEAM participants who had sex with a woman with those who did not in the last 12 months Sex with Women last 12 months N=128 No sex with women last 12 months N=241 P value >3 of male sex partners last 12 months 31%41%NS > 3 of male unprotected anal sex partners 13%14%NS Unprotected sex with unknown status male partner 24%12%<.05

Comparing STEAM participants who had sex with a woman with those who did not in the last 12 months Sex with Women last 12 months N=128 No sex With women last 12 months N=241 P value Any stimulant use last 12 months 57%23%<.05 Drugs used last sex with man 46%19%<.05 HIV test last 12 months40%48%NS

Comparing risk behavior based on sexual identity among STEAM participants Gay identified N=209 Non-gay identified N=138 p-value >3 male sex partner last 12 months 59%41%<.05 Unprotected anal sex last 12 months 35%39%NS Sex with unknown status male partner last 12 months 79%54%<.05

Comparing risk behavior based on sexual identity among STEAM participants Gay identified N=209 Non-gay identified N=138 p-value Any stimulant use last 12 months 23%50%<.05 Used drugs or alcohol at last sex with male 36%63%<.05 HIV test last 12 months 59%41%<.05

Drug and Alcohol Use N=369 Currently drink alcohol72% Drug use last 12 months47% Ever injected drugs18% Injected drugs last 12 months7% Used drugs or alcohol last sex Alcohol only22% Drugs only11% Alcohol and drugs21%

Drugs Used in the Last 12 Months

Stimulant Users (cocaine, crack and/or methamphetamine) compared with non- stimulant users Stimulant use last 12 months N=128 No stimulant use last 12 months N=241 P Value Gay identified38%66%<.05 Unprotected anal sex last 12 months with male partner 47%33%<.05 Sex with unknown status male partner last 12 months 27%10%<.05

Stimulant Users (cocaine, crack and/or methamphetamine) compared with non-stimulant users Stimulant use last 12 months N=128 No stimulant use last 12 months N=241 p-value Sex with female last 12 months 56%23%<.05 Unprotected anal or vaginal sex last 12 months female partner 67%47%<.05 Sex with unknown status female partner last 12 months 31%20%NS HIV test last 12 months 41%58%<.05

Summary Almost half of the participants had unprotected anal sex with a male partner in the last 12 months Nearly the same number had sex with an unknown HIV status male partner Many of these participants were engaging in high risk sexual behavior, but only 27% had tested for HIV in the last 3 months

Summary Con’t Over a third of the participants had sex with a woman in the last 12 months Two-thirds of participants did not tell their female partners they were also having sex with men Stimulant users were more likely to engage in high risk sexual behavior such as having unprotected sex with both men and women or sex with an unknown status male partner and were less likely to have tested for HIV in the past 12 months.

Comments There are several focus areas that may help reduce HIV incidence for Black MSM and their sexual partners. Prevention efforts should focus on:  more frequent HIV testing  consistent condom use  serostatus disclosure with both male and female partners  stimulant use and how it influences HIV risk behavior