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Risk Behaviors Reported by Newly Infected Men Who Have Sex With Men (MSM): Implication for Prevention Intervention Background: A comprehensive understanding of the risk behaviors associated with HIV seroconversion is critical to designing and testing prevention interventions. To avoid sampling biases that occur in studying clinic-based cohorts of newly identified seroconverters, we evaluated detailed, calendar-based retrospective interviews of newly seroconverting MSM recruited from a prospective cohort study. Methods: Men were recruited from the HIVNET Vaccine Preparedness Study, an 18-month study of 3257 MSM enrolled in 6 U.S. cities. Risk assessments and HIV testing and counseling occurred semiannually. Newly infected men underwent a calendar-based interview of all risk activities from 3 months prior to their last negative test through their first positive test. Results: Of 79 seroconverters (SC), only 4 (5%) reported being in a monogamous serodiscordant relationship. Of 77 SC with available data, ranked according to their highest level risk activity (mutually exclusive): Injection drug use 4 (5%) Unprotected receptive anal sex (URA) w/ HIV positive partner (+) 16 (21%) Unprotected receptive anal sex w/ unknown serostatus partner (U) 33 (43%) Unprotected insertive anal sex w/ + or U 7 (9%) Protected receptive anal sex w/ + or U 12 (16%) Other (protected insertive anal, unprotected oral, fisting, other) 5 (6%) Infrequent, risk (< 2 weeks at risk) occurred in 64% SC reporting URA w/ + and 56% reporting URA w/ + or U. Conclusions: Prevention strategies and study enrollment should target MSM with multiple partners including U partners; monogamous serodiscordant couples were rare in this high risk cohort of MSM. While URA is reported by most men, other lower risk activities, under-recognition of condom failure, or underreporting was associated with approximately 1/3 of seroconversions. Strategies which require infrequent interventions (e.g, post-exposure chemoprophylaxis for URA w/ + or U) could potentially benefit more than 1/3 of seroconverting MSM. Susan Buchbinder
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