Added Risk: Young Gay Males with Positive HIV Viral Loads

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The incidence HIV infection in the United States remains stable at around 50,000 new cases per year, according to the Centers for Disease Control and Prevention (CDC). Men who have sex with men (MSM) account for the majority of new HIV cases, with blacks being disproportionately affected. Young MSM (YMSM) account for 25 percent of new HIV infections in the U.S.

According to research from a study published in JAMA Pediatrics, young men with detectable viral load (VL) levels are more likely to engage in condomless anal intercourse (CAI) and sex with an HIV negative partner in comparison to YMSM with undetectable virus.

VL indicates the number of HIV particles per milliliter of blood, and it is also a marker of how effective the HIV drugs are clinically (between 20-50 viral copies per mL). Additionally, the higher the VL levels in an individual the greater the risk of transmitting the virus during intercourse. The goal of any treatment is to achieve and maintain an undetectable viral load, which is also called below quantifiable levels (BQL).

The study included 991 HIV infected YMSM between the ages of 15-29 years in 20 different HIV clinics in the U.S. between December 2013 and July 2015. Researchers found that 688 (70 percent) of participants had positive VL levels, and that 458 (46.2 percent) had of them had CAI in the prior three months. Of these, participants with measurable virus were more likely to engage in CAI (55 percent vs. 44 percent) as well as intercourse with an uninfected partner (35 percent vs. 25 percent) than those with levels that were BQL.

The study also revealed that substance abuse and unemployment were correlated with riskier sexual behavior in YMSM.

These statistics are troublesome for a variety of reasons. The incidence of HIV infection continues to grow in YMSM, adding to the burden of managing a chronic illness at an age when mortality is not taken seriously. Secondly, according to Michael Weinstein, the president of the Los Angeles-based AIDS Healthcare Foundation, complacency with regard to safe sex arises from the reality that HIV infection is no longer a death sentence.

I think that people are less afraid of HIV," Weinstein said. "We re a victim of our own success.

This level of complacency with regard to risky sexual behavior is also reflected in the skyrocketing number of cases of reportable sexually transmitted diseases (STDs) such as gonorrhea, syphilis and chlamydia. MSM account for 90 percent of these cases. While pre-exposure medications (PrEp) such as Truvada significantly decrease the risk of transmitting HIV, it is not a barrier against other STDs. According to the CDC, the number of new cases of STDs are highest among young people aged 15-24.

Dealing with a youthful population poses significant challenges to healthcare such as adherence to their medications. The authors suggest that by identifying the factors associated with risky behaviors, development of more effective behavioral modifications may be possible. Substance use/abuse accounts for a significant portion of risky sexual behaviors as well as noncompliance with medication directions. Therefore, targeting substance use should remain a top focus of any health promotion intervention.

Given that we live in a digital age and there seems to be an app for everything, it would be worth developing an app for YMSM to network with each other and offer support, guidance and encouragement from peers as well as access to healthcare professionals who can answer questions.