Georgia HIV behavioral surveillance report: men who have sex with men, Atlanta MSA, December 2003-October 2004

Georgia HIV Behavioral Surveillance Report
Men who have sex with men, Atlanta MSA, December 2003 - October 2004


Table of Contents
Table of Contents Acknowledgements............................................................................................................................................................................................................. 2
Introduction......................................................................................................................................................................................................................... 3 Methodology........................................................................................................................................................................................................................ 3 Demographics..................................................................................................................................................................................................................... 3 Sexual Behaviors................................................................................................................................................................................................................ 5 Drug Use............................................................................................................................................................................................................................. 8 Injection Drug Use............................................................................................................................................................................................................... 9 Testing and Vaccination History.......................................................................................................................................................................................... 9 HIV................................................................................................................................................................................................................................. 9 Hepatitis and STDs........................................................................................................................................................................................................ 11 HIV Prevention Programs................................................................................................................................................................................................... 12 High Risk Behaviors............................................................................................................................................................................................................ 14 Exchange sex................................................................................................................................................................................................................. 15 Unprotected anal intercourse......................................................................................................................................................................................... 16 Unprotected receptive anal intercourse ........................................................................................................................................................................ 17 Using drugs during sex.................................................................................................................................................................................................. 18
Acknowledgements
Georgia Department of Human Resources / Division of Public Health Author: Linda Beer, PhD Principal Investigator: Luke Shouse, MD, MPH
Emory University Team Principal Investigator: Richard Crosby, PhD Project Coordinator: Ben Hadsock Interviewers: Joseph Clark, Jeff Todd, Nicole Pitts, Damian Denson

Introduction
As part of a comprehensive HIV/AIDS Surveillance system, the Georgia Division of Public Health conducts National HIV Behavioral Surveillance (NHBS). NHBS is an ongoing, systematic surveillance system designed to collect information on the prevalence of HIV risk behavior and the use of HIV prevention services among groups who are at the highest risk for infection, specifically men who have sex with men (MSM), injection drug users (IDUs), and high-risk heterosexuals. This surveillance activity is conducted in rotating cycles, each year shifting the population of focus to one of these three groups. The information collected is used to develop national and local prevention programs and services, to involve community-based organizations (CBOs) in surveillance and questionnaire design, to work with HIV/AIDS prevention programs to determine exposure to and use of local HIV prevention programs, and to present data on high-risk populations for state and local prevention and treatment services planning and evaluation. This report presents information from the Atlanta MSM cycle of NHBS.
Methodology
Information was collected using a time-space sampling method. First, local staff identified venues frequented by MSM in the Atlanta Metropolitan Statistical Area (MSA). Then, the days of the week and the times of day to reach MSM at these venues were determined. Each month, venues were randomly selected from the venue list followed by randomly selecting day/time periods at the selected venues. During sampling events, men entering a pre-defined boundary were systematically approached for recruitment by a local team of interviewers. Interviews were conducted face-to-face in a private area and administered using hand-held computers. Participants gave informed consent and received a $25 incentive. Interviews were conducted from December 2003 through October 2004.
Demographics
This report presents information for 724 participants who met the eligibility criteria for the MSM cycle of NHBS. Eligible participants were male, 18 years or older, living in the Atlanta MSA and reported having had sex with another male in the year prior to the interview. Most identified as homosexual or gay (84%). Most participants were between the ages of 25 and 44 (66%). The majority of those interviewed were non-Hispanic Whites (55%). Most participants had some post-secondary education (81%). Many were privately insured (73%), although a little over 1/5 had no health insurance (21%). The largest group of participants were recruited at bars (36%), followed by dance clubs (23%).

Georgia HIV Behavioral Surveillance Report - Men who have sex with men, Atlanta MSA, December 2003 - October 2004





Percentage of participants by age group - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

45-54 (10%)

> 55 (5%)

18-24 (20%)

35-44 (33%)

25-34 (33%)

Number of Participants

Number and percentage of participants by race/ethnicity NHBS, Georgia: MSM Cycle (December 2003-October 2004)

450

55%

400

350

300

250

31%

200

150

100

50

0

White, non-HispanBilcack, non-Hispanic

Other

7%

3%

<1%

2%

HispAasniiacn/PaAcmifiecriIcsalannIdnedrian/Alaska Native

Multiracial

1% Other

Number and percentage of participants by recruitment venue NHBS, Georgia: MSM Cycle (December 2003-October 2004)

Sex Establishments & Environments Street Locations
Retail Businesses Parks & Beaches (Not Public Sex Venues)
Social Organizations Gay Pride & Similar Events
Fitness Clubs & Gyms Dance Clubs
Cafes & Restaurants Bars

5% 2%
4% 2%
5% 6%
3%

0

50

14% 23%

100

150

200

NuNmumbbeerr ooffPParaticrtipicainptsants

36%

250

300

Number of Participants

Number and percentage of participants by health insurance status - NHBS, Georgia: MSM Cycle (December 2003-October 2004)
600 73%
500

400

300

200
100
0 Private

3% Public

21% None

4% Unknown/missing

Number of Participants

Number and percentage of participants by sexual identity NHBS, Georgia: MSM Cycle (December 2003-October 2004)
700 84%
600

500

400

300

200
100 1%
0 Heterosexual

Homosexual

14% Bisexual

1% Other

Number of Participants

Number and percentage of participants by education - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

700 81%
600

500

400

300

200
100 1%
0 < High School

18%
High School Diploma or Equivalent

> High School

Sexual Behaviors

All participants reported sex with a male during the past 12 months, with an average of 10 male partners (range 1-500). Eightyeight participants (12%) reported also having a female sex partner during this time. Within this group the average number of reported female sex partners was 3 (range 1-50). African Americans and Hispanics more often reported anal or vaginal intercourse with their female partner. However, of those reporting intercourse with a female partner, 27% of African Americans reported unprotected intercourse, compared with 57% of Whites and 50% of Hispanics. The number of MSM reporting these behaviors is relatively small, so the results presented here should be interpreted with caution.

Percent

Percentage of participants who reported both male and female sex partners during the preceding 12 months by race -
NHBS, Georgia: MSM Cycle (December 2003-October 2004)
20%

18%

16%

5%

14%

12%

10% 8% 6% 4% 2% 0%

4%
3% White, non-Hispanic
(n=395)

14%
Black, non-Hispanic (n=221)

6%

6% Hispanic (n=53)

4% 2% Other/unknown (n=55)

Protected Intercourse with Female Partner

Unprotected Intercourse with a Female Partner

Respondents were also asked how many of their male partners were main partners and how many were casual partners. Main partners were those with whom the respondent had sex and to whom he felt most committed (e.g. boyfriend, spouse, significant other or life partner). Casual partners were those with whom the respondent had sex but who was not considered a main partner. Respondents were also asked how many of their casual partners were exchange partners. Exchange partners were those with whom the respondent had sex in exchange for things like money, drugs, food, shelter or transportation.
Seventy percent of participants reported having a main male partner in the 12 months prior to interview. The number of main male partners

Number of Participants

Number of male partners reported by participants in the

previous 12 months by type of relationship - NHBS, Georgia:

400 389

MSM Cycle (December 2003-October 2004)

350

300

250

200

192

150 114

100

86

118 92

50 9
0
1

19 2-4

59

18

29 03

5-9

10-24

25-49

Number of Partners Reported

0 16 1 50-99

091 100+

Main Partner Casual Partner (Includes Exchange and Non-Exchange) Exchange Partner

Georgia HIV Behavioral Surveillance Report - Men who have sex with men, Atlanta MSA, December 2003 - October 2004





reported by participants ranged from 1 to 10, with an average of 1 main male partner. Three quarters of participants reported having a casual male partner in the previous year, with an average of 12 casual partners (range 1497). Nine percent of those with casual male partners reported having engaged in exchange sex with at least one of those partners. These individuals reported an average of 10 exchange male partners, ranging from 1 to 125 partners.
Participants were asked whether they had engaged in anal sex with a male in the 12 months prior to the interview. Those who answered yes were asked if any of their anal sex partners were main partners and if any were casual partners. Respondents were also asked whether they had engaged in unprotected sex with any of their male anal sex partners.
The majority of respondents (86%) reported engaging in anal sex with a male during the year prior to the interview. This behavior was more frequently reported with a main partner, and these individuals also reported a higher rate of unprotected anal sex than those reporting anal sex with a casual partner. Overall 60% of participants reported anal sex with a main partner, with 56% of these individuals reporting unprotected anal sex with their main partner(s). Fifty-two percent of participants reported anal sex with a casual partner, and 33% of these respondents reported unprotected sex with a casual partner.

Percent

Percent

Percentage of participants who reported having had anal sex with a main or casual partner during the preceding 12 months
by race/ethnicity - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

80% 70%

Main Partner

Casual Partner

60%

50%

23%

38%

16%

8%

15%

40%

40%

25%

20%

30%

20%

42%

38%

45%

40%

10%

18%

28%

25%

31%

0%

White, non-

Black, non- Hispanic (n=53) Other/unknown White, non-

Black, non- Hispanic (n=53) Other/unknown

Hispanic (n=395) Hispanic (n=221)

(n=55)

Hispanic (n=395) Hispanic (n=221)

(n=55)

Protected anal sex Unprotected anal sex

Percentage of participants who reported having had anal sex

with a main or casual partner during the preceding 12 months

by education - NHBS, Georgia: MSM Cycle

80%

(December 2003-October 2004)

70%

Main Partner

Casual Partner

60%

50% 40%

29%

35%

17%

17%

30%

20% 10%

34%

25%

36%

35%

0%
HS Diploma or equiv (n=128)

> High School (n=568)

Protected anal sex

HS Diploma or equiv (n=128)

> High School (n=568)

Unprotected anal sex

Percent

Percent

Percentage of participants who reported having had anal sex

with a main or casual partner during the preceding 12 months

by age - NHBS, Georgia: MSM Cycle

80%

(December 2003-October 2004)

Main Partner

Casual Partner

70%

60%

50% 37%

37%

14%

17%

40%

32%

26%

20%

19%

12%

30%

21%

20% 33%
10%

30%

20%

29%

21%

44%

38%

26%

31%

32%

0% 18-24 25-34 35-44 45-54 (n=143) (n=237) (n=240) (n=70)
Protected anal sex

>=55 (n=34)

18-24 25-34 35-44 45-54 (n=143) (n=237) (n=240) (n=70)
Unprotected anal sex

>=55 (n=34)

Percentage of participants who reported having had anal sex with a main or casual partner during the preceding 12 months
by sexual identity - NHBS, Georgia: MSM Cycle (December 2003-October 2004)
80%

70%

Main Partner

Casual Partner

60%

50% 40%

36%

17%

16%

22%

30%

20% 10%

26%

32%

34%

36%

0% Homosexual (n=608)

Bisexual (n=104)

Protected anal sex

Homosexual (n=608)

Bisexual (n=104)

Unprotected anal sex

Respondents were also asked about the type of sex they engaged in during their most recent sexual encounter. Further, they were asked whether that person was a main or casual partner and about this person's HIV status. Of HIV negative males who reported last having sex with a main male partner, 54% reported insertive anal sex, with 48% of this group reporting unprotected insertive anal sex. These behaviors were less frequently reported when the most recent sexual encounter was with a casual partner. In this case, 40% reported insertive anal sex, and 23% of these reported unprotected insertive anal sex.
Receptive anal sex was less frequently reported than insertive anal sex. Of HIV negative males who reported last having sex with a main male partner, 35% reported receptive anal sex, with 57% of this group reporting unprotected receptive anal sex. As was the case for insertive anal sex, these behaviors were less frequently reported with a casual partner. Twenty-five percent reported receptive anal sex with a casual partner, and 22% of these reported unprotected receptive anal sex. Respondents more often reported unprotected receptive anal sex with both main and casual partners when their partner was HIV negative.

Percent

Percent

Percentage of HIV negative respondents who reported having

had insertive anal sex with a male partner during their most

recent sexual encounter by partner's HIV serostatus - NHBS,

70%

Georgia: MSM Cycle (December 2003-October 2004)

60%

Main Partner

Casual Partner

50%

40%

28%

26%

17%

11%

9%

30%

20% 10%

28%

26%

29%

33%

38%

30%

0%

Partner HIV-

Partner HIV- Partner Status Partner HIV-

Partner HIV-

negative (n=355) positive (n=27) Unknown (n=93) negative (n=176) positive (n=13)

Partner Status Unknown (n=312)

Protected Insertive Anal Sex

Unprotected Insertive Anal Sex

Percentage of HIV negative respondents who reported having

had receptive anal sex with a male partner during their most

recent sexual encounter by partner's HIV serostatus - NHBS,

70%

Georgia: MSM Cycle (December 2003-October 2004)

60% 50% 40%

Main Partner

Casual Partner
8%

30%

11%

18%

20%

21%

8%

39%

4%

10%

13%

26%

20%

17%

20%

0%

Partner HIV-

Partner HIV- Partner Status Partner HIV-

Partner HIV-

negative (n=355) positive (n=27) Unknown (n=93) negative (n=176) positive (n=13)

Partner Status Unknown (n=312)

Protected Receptive Anal Sex

Unprotected Receptive Anal Sex

Georgia HIV Behavioral Surveillance Report - Men who have sex with men, Atlanta MSA, December 2003 - October 2004





Drug Use
Overall, 43% of respondents reported using noninjection drugs during the preceding 12 months. The most commonly reported drug used was marijuana, followed by cocaine, speed or meth, and ecstasy. The drugs most often used during sex were poppers and club drugs.

Percent

Percentage of respondents who reported noninjection drug use during the preceding 12 months by race/ethnicity - NHBS,
Georgia: MSM Cycle (December 2003-October 2004)
60%

50% 40% 30%

45%

42%

42%

31%

20%

10%

0%

White, non-Hispanic Black, non-Hispanic

(n=395)

(n=221)

Hispanic (n=53)

Other/Unknown (n=55)

Percent

Percentage of respondents who reported noninjection drug use during the preceding 12 months by age group - NHBS,
Georgia: MSM Cycle (December 2003-October 2004)
60%

50% 40% 30%

43%

47%

38%

44%

35%

20%

10%

0% 18-24 (n=143)

25-34 (n=237)

35-44 (n=240)

45-54 (n=70)

<=55 (n=34)

Percentage of respondents who reported noninjection drug use during the preceding 12 months by education - NHBS,
Georgia: MSM Cycle (December 2003-October 2004)

60%

50% 40%

49%

41%

30%

20%

10%

0% High School Diploma or Equivalent (n=128)

> High School (n=586)

Percent

Percentage of respondents who reported noninjection drug use during the preceding 12 months by sexual identity -
NHBS, Georgia: MSM Cycle (December 2003-October 2004)
60%

50% 40%

42%

45%

30%

20%

10%

0% Homosexual (n=608)

Bisexual (n=104)

Percent of Participants

Percentage of participants who reported using noninjection

drugs and being under the influence while having sex during

the preceding 12 months by type of drug used - NHBS,

Georgia: MSM Cycle (December 2003-October 2004) (n=309)

100%

100%

90%

84%

80% 70% 60% 50% 40% 30% 20% 10%
0%

71% 59%

52%

65%

55%

37%

33%

30% 28%

70% 53%

15%

17% 18%

11%

7%

6%

25%

1%

1% 0% <1%

Marijuana SpeedCorocMaietnhe
Ecstasy ClPuobpDpreurgs PaDionkwilnleerr HallucinCorgaeckn
Other Heroin

Used drug

Under influence during sex/ of those who used drug

Percent

Injection Drug Use
Thirty-eight respondents (5%) reported having ever injected drugs for nonmedical purposes. Of these, 13 (34%) had injected in the twelve months prior to interview. Three of these individuals (23%) had shared needles, syringes, or other drug-injection or preparation equipment during the preceding 12 months, and all three (100%) had a history of participating in a drug or alcohol treatment program.
Testing and Vaccination History
HIV Most respondents reported having been tested for HIV (94%). Seventy-six percent of individuals ever tested for HIV had been tested in the preceding 12 months. Testing patterns do not appear to differ substantially by race/ethnicity, education, sexual identity or health insurance status. Younger respondents more frequently reported testing in the past year compared to respondents over the age of 45. For those testing in the previous 12 months, the most common recent place of HIV testing was a private doctor's office (48%), followed by a community health center or public clinic (20%).
Twenty-nine percent of all respondents had not been tested for HIV in the preceding 12 months. Participants were asked to indicate whether each reason had contributed to not being tested for HIV. Participants could report more than one reason. Participants were also asked to indicate which reason was the most important. The most common reason given for not having an HIV test was that they had not done anything to get HIV (51%). Other reasons cited were fears of testing positive (25%) and lack of time for testing (19%).
The 107 participants who had not been tested for HIV in the preceding 12 months and felt that they had not done anything to get HIV did report engaging in HIV risk behaviors. Forty-eight of these individuals reported engaging in unprotected anal intercourse, 16 of whom reported unprotected receptive anal intercourse (7% and 2% of the total NHBS sample, respectively).

Percent

Percentage of participants who reported using injection drugs
- NHBS, Georgia: MSM Cycle (December 2003-October 2004)
6%

5% 4%

<1% 1%

Injected Drugs in Past 12 Months and Shared Equipment
Injected Drugs in Past 12 Months and Did Not Share Equipment

3%

Percent of Participants

2%

3%

Injected Drugs More Than 12 Months Ago

1%

0% 1

100% 90% 80% 70%

Percentage of participants who reported having been tested for HIV by race - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

94%

93%

92%

91%

74%

80%

78%

78%

60%

50%

40%

30%

20%

10%

0%

White, non-Hispanic Black, non-Hispanic

(n=395)

(n=221)

Hispanic (n=35)

Other/Unknown (n=30)

Ever Tested

Tested in Last 12 Months (of those ever tested)

Number and percentage of reasons reported for not being testing for HIV during the preceding 12 months - NHBS, Georgia: MSM Cycle (December 2003-October 2004) (n=210)

Couldn't get transportation Worried someone would find out about test result

0 1% 0

Worried name would be reported to government <1%

Didn't have money or insurance Don't like needles

2%5% 2%

Afraid of losing job, insurance, family, housing, or friends

4%

Don't know where to get tested

5%

Didn't have time

Afraid of finding out infected with HIV

Other reason

Haven't done anything to get HIV

12% 11%

A Reason

10%

12%

11%

11%

19%

14%

25%

18%21%

Main Reason

37%

51%

0

20

40

60

80

100

120

Number of Participants

Georgia HIV Behavioral Surveillance Report - Men who have sex with men, Atlanta MSA, December 2003 - October 2004



10

Twenty-five of the 107 participants who had not been tested for HIV in the preceding 12 months and felt that they had not done anything to get HIV reported using drugs during sex (3%) and 8 had sex with a partner in exchange for drugs or money (1%). These individuals may be in particular need of targeted prevention programs. While 67 did report using an HIV prevention program during the preceding 12 months (63% of all those with no HIV test and low perceived risk), only 9 participated in individual or group-level interventions.

Percent

Percent

100% 90% 80% 70%

Percentage of participants who reported having been tested for HIV by age group - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

92% 90%

96%

93%

93%

94%

80%

72%

60% 50%

58%

59%

40%

30%

20%

10%

0% 18-24 (n=143)

25-34 (n=237)

35-44 (n=240)

45-54 (n=70)

50 (n=34)

Ever Tested

Tested in Last 12 Months (of those ever tested)

100% 90%

Percentage of participants who reported having been tested for HIV by education - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

95%

94%

80% 70%

80%

76%

60%

50%

40%

30%

20%

10%

0% HS Diploma or Equiv (n=128)

> HS Diploma (n=586)

Ever Tested

Tested in Last 12 Months (of those ever tested)

Percent

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Percentage of participants who reported having been tested for HIV by sexual identity - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

94%

92%

77%

74%

Homosexual (n=608) Ever Tested

Bisexual (n=104) Tested in Last 12 Months (of those ever tested)

Percent

100% 90% 80% 70%

Percentage of participants who reported having been tested for HIV by health insurance - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

94% 76%

95% 72%

91% 75%

93% 85%

60%

50%

40%

30%

20%

10%

0% Private (n=525)

Public (n=19)

None (n=151)

Unknown (n=29)

Ever Tested

Tested in Last 12 Months (of those ever tested)

^Of.those.ever.tested.for.HIV.

Site of most recent HIV test for those testing in the preceding 12 months - NHBS, Georgia: MSM Cycle
(December 2003-October 2004) (n=506)

Other

Drug treatment program 1%

Correctional facility 1%

Sexually transmitted disease clinic 1%

Other outpatient clinic 2%

HIV/AIDS street outreach 2%

Hospital (inpatient) 2%

HIV/AIDS specialty clinic

3%

HIV counseling and testing program

Community health center or public health clinic

Private Doctors Office

9% 12%

20%

0

50

100

150

200

Number of Participants

48%

250

300

Hepatitis and STDs Almost half of the men interviewed reported at least one vaccination for hepatitis A or B. A lower number reported having been tested for syphilis, gonorrhea or another sexually transmitted disease (STD) in the 12 months prior to interview (39%). Men over the age of 35 reported STD testing at lower rates than men under 35.

Percent

Percentage of participants reporting hepatitis vaccination and STD testing by education - NHBS, Georgia: MSM Cycle (December 2003-October 2004)
60%

50%

52%

40%

39%

41%

38%

30%

20%

10%

0% High School Diploma or Equivalent (n=128)
Ever had hepatitis A or B vaccine

> High School (n=586) STD testing in past 12 months

Percent

Percentage of participants reporting hepatitis vaccination and STD testing by race/ethnicity - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

60%

52%

55%

50%

46%

45%

43%

40%

40%

35%

35%

30%

20%

10%

0%

White, non-Hispanic Black, non-Hispanic

(n=395)

(n=221)

Ever had hepatitis A or B vaccine

Hispanic (n=35)

Other/Unknown (n=55)

STD testing in past 12 months

Percent

Percentage of participants reporting hepatitis vaccination and STD testing by sexual identity - NHBS, Georgia: MSM Cycle (December 2003-October 2004)
60%

50%

52%

40%

38%

37%

41%

30%

20%

10%

0% Homosexual (n=608)
Ever had hepatitis A or B vaccine

Bisexual (n=104) STD testing in past 12 months

Percent

Percentage of participants reporting hepatitis vaccination and

STD testing by age group - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

60%

52%

52%

50%

47%

48%

44%

53%

40%

38%

30%

31%

30%

20%

21%

10%

0% 18-24 (n=143)

25-34 (n=237)

35-44 (n=240)

45-54 (n=70)

<=55 (n=34)

Ever had hepatitis A or B vaccine

STD testing in past 12 months

Percent

Percentage of participants reporting hepatitis vaccination and STD testing by insurance status - NHBS, Georgia: MSM Cycle
(December 2003-October 2004)
60% 53%

50%

47%

45%

40% 30%

39%

32%

38% 35%

38%

20%

10%

0% Private (n=525)

Public (n=19)

Ever had hepatitis A or B vaccine

None (n=151)

Unknown/missing

(n=29)

STD testing in past 12 months

Georgia HIV Behavioral Surveillance Report - Men who have sex with men, Atlanta MSA, December 2003 - October 2004

11

HIV Prevention Programs
Seventy percent of those interviewed reported participating in some type of HIV prevention service or program during the preceding 12 months (n=509). The majority reported receiving free condoms (68%). Eleven percent of respondents reported participating in individual-level intervention programs and eight percent participated in group-level intervention programs. Individual-level interventions consist of one-on-one conversations with an outreach worker, a counselor, or a prevention program worker about ways to protect against HIV or other sexually transmitted diseases. Grouplevel interventions are small-group discussions about ways to protect against HIV or other sexually transmitted diseases. HIV/AIDS Community Based Organizations (CBOs) were the most commonly cited providers of free condoms and individual-level interventions (32% and 50% respectively). Gay, Lesbian, Bisexual or Transgender Community Health Centers/Organizations were the most commonly reported provider of group-level interventions (38%), followed closely by HIV/ AIDS CBOs (36%).

Percent

Percent

Percentage of participants who reported using HIV prevention

programs during the preceding 12 months by race/ethnicity -

90% NHBS, Georgia: MSM Cycle (December 2003-October 2004)
81%

80%

72%

76%

70%

60%

59%

50%

40%

30%

20% 10%

8% 7%

15% 10%

11% 8%

16% 9%

0%

White, non-Hispanic Black, non-Hispanic

(n=395)

(n=221)

Hispanic (n=53)

Other/unknown (n=55)

Free Condoms

Individual-level Intervention

Group-level Intervention

Percentage of participants who reported using HIV prevention programs during the preceding 12 months by education NHBS, Georgia: MSM Cycle (December 2003-October 2004)
80%

70%

70%

68%

60%

50%

40%

30%

20% 10%

9%

7%

11%

9%

0% High School Diploma or Equivalent (n=128)

> High School (n=586)

Free Condoms

Individual-level Intervention

Group-level Intervention

Percent

Percent

12

Percentage of participants who reported using HIV prevention programs during the preceding 12 months by age group -
90% NHBS, Georgia: MSM Cycle (December 2003-October 2004)

80% 70%

80%

71%

64%

60%

57%

50% 40%

44%

30% 20% 10%
0%

18%19%

13% 6%

7% 7%

18-24 (n=143) 25-34 (n=237) 35-44 (n=240)

Free Condoms

Individual-level Intervention

4% 6%

6%
0%

45-54 (n=70)

<=55 (n=34)

Group-level Intervention

100%

Percentage of participants who reported using HIV prevention programs during the preceding 12 months by sexual identity -
NHBS, Georgia: MSM Cycle (December 2003-October 2004)

90%

80% 70%

68%

65%

60%

50%

40%

30%

20% 10%

11%

8%

11%

12%

0% Homosexual (n=608)

Bisexual (n=104)

Free Condoms

Individual-level Intervention

Group-level Intervention

Percentage of participants who reported using free condoms during the preceding 12 months by type of provider - NHBS, Georgia: MSM Cycle (December 2003-October 2004) (n=492)

Private Doctors Office 1%

Outreach Organization For Injection Drug Users <1%

Other Organization

17%

HIV/AIDS Focused Community Based Organization

Gay, Lesbian, Bisexual, or Transgender Community Health Center or Organization

Community or Public Health Center, STD Clinic, or Family Planning Clinic

3%

Adult HIV/AIDS Specialty Clinic 1%

16%

32%

0 20 40 60 80 100 120 140 160 180 Number of Participants

Percentage of participants who reported using individual-level interventions during the preceding 12 months by type of provider - NHBS, Georgia: MSM Cycle (December 2003- October 2004) (n=78)

Other Organization

17%

HIV/AIDS Focused Community Based Organization

Gay, Lesbian, Bisexual, or Transgender Community Health Center or Organization

10%

Drug Treatment Program 1%

Community or Public Health Center, STD Clinic, or Family Planning Clinic

12%

Adult HIV/AIDS Specialty Clinic

4%

50%

0 5 10 15 20 25 30 35 40 45 Number of Participants

Percentage of participants who reported using group-level interventions during the preceding 12 months by type of provider - NHBS, Georgia: MSM Cycle (December 2003-October 2004) (n=61)

Other Organization

21%

HIV/AIDS Focused Community Based
Organization
Gay, Lesbian, Bisexual, or Transgender Community
Health Center or Organization
Community or Public Health Center, STD Clinic, or Family Planning Clinic
0

5% 5

36% 38%

10

15

20

25

Number of Participants

Georgia HIV Behavioral Surveillance Report - Men who have sex with men, Atlanta MSA, December 2003 - October 2004

13

14
High Risk Behaviors Almost half of respondents (45%) reported engaging in unprotected anal intercourse with a male during the year prior to interview and 17% reported receptive unprotected anal intercourse (37% of all those who reported unprotected anal intercourse). Seven percent reported exchanging sex with a male for drugs, food or money in the past year. Smaller numbers had injected drugs or shared drug injection equipment. Almost a third (31%) had used drugs during sex in the past year.

Number of Participants

Number and percentage of participants who reported high HIV risk behaviors during the preceding 12 months -
NHBS, Georgia: MSM Cycle (December 2003-October 2004)

350
300
250
200
150
100
50 2%
0 Injected Drugs

45%

31%

17%

<1%
Shared Injection
Drugs

7%

Had an exchange
partner

Had unprotected
anal intercourse

Had receptive unprotected
anal intercourse

Used drugs during sex

Exchange sex
Percentage of participants who reported having had exchange sex with a male during the preceding 12 months by race/ethnicity - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

Percent

20% 18% 16% 14% 12% 10%
8% 6% 4% 2% 0%

7% 6%

White, non-Hispanic Black, non-Hispanic

(n=395)

(n=221)

6% Hispanic (n=53)

7%
Other/unknown (n=55)

Percent

Percentage of participants who reported having had exchange sex with a male during the preceding 12 months by age -
NHBS, Georgia: MSM Cycle (December 2003-October 2004)

20% 18% 16% 14% 12% 10%
8% 6% 4% 2% 0%

6% 18-24 (n=143)

6% 25-34 (n=237)

8% 35-44 (n=240)

6% 45-54 (n=70)

15% <=55 (n=34)

Percentage of participants who reported having had exchange sex with a male during the preceding 12 months by sexual identity - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

20% 18% 16% 14% 12% 10%
8% 6% 4% 2% 0%

5% Homosexual (n=608)

17% Bisexual (n=104)

Percent

Percentage of participants who reported having had exchange sex with a male during the preceding 12 months by education -
NHBS, Georgia: MSM Cycle (December 2003-October 2004)

20%

18%

16%

14% 12%

13%

10%

8%

6%

4%

2%

0% High School Diploma or Equivalent (n=128)

5% > High School (n=586)

Percent

Georgia HIV Behavioral Surveillance Report - Men who have sex with men, Atlanta MSA, December 2003 - October 2004

15

Unprotected anal intercourse
Percentage of participants who reported having had unprotected anal intercourse during the preceding 12 months
by age - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

60% 50% 40% 30%

46%

49%

45%

39%

32%

Percent

20%

10%

0% 18-24 (n=143)

25-34 (n=237)

35-44 (n=240)

45-54 (n=70)

<=55 (n=34)

Percentage of participants who reported having had unprotected anal intercourse during the preceding 12 months
by education - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

60%

50%

46%

40%

38%

30%

20%

10%

0% High School Diploma or Equivalent (n=128)

> High School (n=586)

Percent

Percent

Percent

16

Percentage of participants who reported having had unprotected anal intercourse during the preceding 12 months
by race/ethnicity - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

60% 50% 40% 30%

53%

33%

45%

38%

20%

10%

0%

White, non-Hispanic Black, non-Hispanic

(n=395)

(n=221)

Hispanic (n=53)

Other/unknown (n=55)

Percentage of participants who reported having had unprotected anal intercourse during the preceding 12 months
by sexual identity - NHBS, Georgia: MSM Cycle (December 2003-October 2004)
60%

50%

47%

40% 30%

34%

20%

10%

0% Homosexual (n=608)

Bisexual (n=104)

Unprotected receptive anal intercourse
Percentage of participants who reported having had unprotected receptive anal intercourse during the preceding
12 months by race/ethnicity - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

25% 20%

21%

21%

Percent

15%

10%

9%

13%

5%

0%

White, non-Hispanic Black, non-Hispanic

(n=395)

(n=221)

Hispanic (n=53)

Other/unknown (n=55)

Percent

Percentage of participants who reported having had unprotected receptive anal intercourse during the preceding
12 months by age - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

25%

20% 15% 10%

18%

20%

14%

16%

12%

5%

0% 18-24 (n=143)

25-34 (n=237)

35-44 (n=240)

45-54 (n=70)

<=55 (n=34)

Percentage of participants who reported having had unprotected receptive anal intercourse during the preceding
12 months by education - NHBS, Georgia: MSM Cycle (December 2003-October 2004)

25%

20% 15%

20%

16%

Percentage of participants who reported having had unprotected receptive anal intercourse during the preceding
12 months by sexual identity - NHBS, Georgia: MSM Cycle (December 2003-October 2004)
25%

20%

19%

15%

Percent

Percent

10%
5%
0% High School Diploma or Equivalent (n=128)

> High School (n=586)

10% 5% 0%

Homosexual (n=608)

6% Bisexual (n=104)

Georgia HIV Behavioral Surveillance Report - Men who have sex with men, Atlanta MSA, December 2003 - October 2004

17

Using drugs during sex
Percentage of participants who reported using drugs during sex during the preceding 12 months by race/ethnicity - NHBS,
Georgia: MSM Cycle (December 2003-October 2004)

Percent

50%

45%

40% 35%

36%

30% 25%

27%

20%

15%

10%

5%

0%

White, non-Hispanic Black, non-Hispanic

(n=395)

(n=221)

26% Hispanic (n=53)

18%
Other/unknown (n=55)

Percentage of participants who reported using drugs during sex during the preceding 12 months by education -
NHBS, Georgia: MSM Cycle (December 2003-October 2004)

50%

45% 40%

41%

35%

30%

25%

20%

15%

10%

5%

0% High School Diploma or Equivalent (n=128)

29% > High School (n=586)

Percent

Percent

Percent

18

Percentage of participants who reported using drugs during sex during the preceding 12 months by age - NHBS, Georgia:
MSM Cycle (December 2003-October 2004)

50% 45% 40% 35% 30% 25% 20% 15% 10%
5% 0%

27% 18-24 (n=143)

35% 25-34 (n=237)

30% 35-44 (n=240)

37% 45-54 (n=70)

21% <=55 (n=34)

Percentage of participants who reported using drugs during sex during the preceding 12 months by sexual identity -
NHBS, Georgia: MSM Cycle (December 2003-October 2004)

50% 45% 40% 35% 30% 25% 20% 15% 10%
5% 0%

30% Homosexual (n=608)

35% Bisexual (n=104)

DHR

GEORGIA

DEPARTMENT OF

Georgia HIV Behavioral Surveillance Report - Men who have sex with mHeUnM, AANtlaRnEtSaOMUSRAC,EDSecember 2003 - October 2004

20