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