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Learn More. Mean age was A majority of the sample was HIV-positive and engaged in care, with Online platforms provide an avenue to assess the progress of MSM along the HCC, as well as other subpopulations in need of appropriate behavioral interventions to decrease HIV incidence.

Cohen et al. Transmission risk is potentially greatest among those with untreated, acute HIV infections Friedman et al.


While treatment efforts prioritize early diagnosis, linkage to care, and ART initiation M. Recently, Bradley et al. While these findings are promising, a portion of individuals living with HIV continue to be disengaged in care. Specifically, the HCC tracks progression from diagnosis, linkage to care, retention in care, ART initiation, and reaching and maintaining viral suppression Yehia, et al. Identifying sexual risk behavior patterns, particularly among high-risk MSM subgroups, is critical for prevention and addressing health disparities.

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A better understanding of the gaps in engagement along the HCC may inform treatment and prevention policies that effectively maximize care at every step. While studies relied primarily on surveillance data to estimate the of people at each step of the continuum e. Data for the current report are from an online eligibility survey to participate in Sex Positive! Recruitment occurred between June and January through various US-based social networking websites, gay-oriented sexual and dating websites e.

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We used targeted recruitment to oversample Black and Hispanic MSM, and young men between 18 and 29 years old. Participants were asked about the of their most recent HIV test. While the HIV status of participants reporting any of the last three options is unknown, it was determined by the study team that those who had never been tested were categorically distinct from those with unconfirmed testsince the latter group at some point entered into care.

To determine serodiscordant CAS events, participants were asked about their of male CAS partners 0, 1, 2, 3, 4, 5 or Craigslist sex Irene in the past 6 months, and of those partners, how many were HIV-positive. CAS events were deemed as either seroconcordant e. Descriptive analysis was performed on all key variables to evaluate the frequency and distribution of the data and to examine missing data. We compared the six HCC groups on demographic characteristics and sexual risk behaviors.

Chi-square tests were used to assess group differences for dichotomous and categorical variables, with partial chi-square tests performed for post hoc analyses. One-way analysis of variance ANOVA was used to test group differences for normally distributed continuous dependent variables, with post hoc comparisons made using the Tukey HSD test. There were a total of 55, clicks on the study banner advertisements to the eligibility survey, of which 35, Of the 17, completed surveys, 1, were excluded based on identical IP match 6.

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Table 1 presents demographic and behavioral characteristics of the study sample. Mean age for this sample of 12, MSM was A majority identified as White While the study specifically recruited for HIV-positive men, 9.

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Of the 11, men who were HIV-positive Overall, most participants Among participants reporting CAS, Table 2 presents demographics and sexual risk behaviors by HCC engagement group. These men were also ificantly more likely to be White and less likely to be Black compared to all other HCC groups. Missing cases were excluded from the analyses. They were also less likely to report 5 or more male CAS partners. We classified a large national sample of high-risk MSM recruited online into HCC stages to highlight differences in demographic and sexual risk behaviors.


Similar to national estimates, a lower proportion of individuals prescribed ART reached the viral suppression stage of the HCC Singh, et al. Within each HCC category, a majority range: Almost half from this study describe a similar proportion of individuals reporting viral suppression compared to Yehia et al Our findings within each HCC stage are likely driven by the nature of the study sample, as men in the current study had to have internet access through a computer or mobile device and be able to answer questions independently about their sexual behavior and HIV care.

These characteristics may not be representative of MSM in the US who do not have internet access, who do not use the websites or apps reported in this study, or those captured by the Craigslist sex Irene systems used by the CDC. Moreover, men in our study were categorized into HCC stages based on self-reported HIV diagnosis, HIV care engagement, and viral suppression and not based on clinical or surveillance data. Data from NHBS is collected using venue-based sampling in urban areas. However, our data is consistent with HCC studies and illustrates an appreciable decline in the proportion of individuals who ultimately become virally suppressed.

Increasing the proportion of HIV-positive individuals reaching and maintaining viral suppression is a public health priority as an undetectable viral load decreases the likelihood of transmission M. Cohen, et al. Ensuring individuals reach viral suppression is contingent on them knowing their HIV status. Among our analytic sample, 3. Cases of undiagnosed HIV among this fraction of participants is of concern due to the potential of continued HIV infection.

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Even more disconcerting is the fact that among our study participants, men unaware of their HIV serostatus reported more CAS events compared to men aware of their HIV serostatus. research has found that Importantly, among a community-based sample of MSM, a recent study found that an increased belief that HIV treatment reduces transmission risk coincided with increased rates of CAS Kalichman et al.

In an age when ART is at the center of HIV prevention, such findings suggest a potentially problematic belief in treatment optimism and perceived lower infectivity among those who may not be virally suppressed. In the current study, we found that men who were not on ART were more likely to report an STI diagnosis compared to those who were HIV negative or had an unknown serostatus.

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Findings from the study also highlight stark demographic differences among individuals who reach the latter stages of the HCC. Our are consistent with surveillance reports and observational research which identify racial and age disparities at each stage of the HCC Hoots, et al. Our findings suggest that YMSM and MSM of color recruited online also experience disparities along each stage of the HCC and future research should target these subpopulations to increase their participation in online studies and increase the proportion of men reaching viral suppression Hirshfield, et al.

A few limitations should be acknowledged about our study and analyses. First, the study population was a non-probability sample of MSM recruited from social and sexual networking websites and apps, who tended Craigslist sex Irene be older, White, aware of their HIV diagnosis longer, and have access to the internet through a computer or mobile device.

Moreover, a considerable proportion of men were recruited from a high-risk website that facilitates CAS encounters, thus our findings may overestimate the true proportion of men who engage in CAS and CAS with serodiscordant partners. Potential misclassification occurred for a small proportion of MSM who were unsure of, but estimated their viral suppression status. Finally, not all behavioral risk factors that are associated with viral suppression and engagement in HIV care e.

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We also did not assess biomedical risk reduction methods e. We also report on specific sexual risk behaviors and demographic differences among groups most likely to further HIV transmission—men living with potentially undiagnosed HIV and men aware of their HIV infection but who are not on ART or not virally suppressed. Online or mobile platforms provide a possible avenue to assess MSM and their progress along the HCC, as well as other subpopulations in need of appropriate interventions to decrease HIV incidence.

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National Center for Biotechnology InformationU. AIDS Care. Author manuscript; available in PMC Aug Irene S. Yoona Martin J. Houanga Jeffrey T. Martin J. Downing, Jr. Steven T. Jeffrey T. Author information Copyright and information Disclaimer.


Copyright notice. See other articles in PMC that cite the published article. Methods Data for the current report are from an online eligibility survey to participate in Sex Positive! Table 1.

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Demographic and Behavioral Characteristics of Study Sample. Open in a separate window. Figure 1. Table 2. Discussion We classified a large national sample of high-risk MSM recruited online into HCC stages to highlight differences in demographic and sexual risk behaviors. Global epidemiology of HIV infection in men who have sex with men. The Lancet, — ZIP: 57073 57037

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