Time for change: Transitions between HIV risk levels and determinants of behavior change in men who have sex with men

Maartje G.J. Basten*, Daphne A. van Wees, Amy Matser, Anders Boyd, Ganna Rozhnova, Chantal den Daas, Mirjam E.E. Kretzschmar, Janneke C.M. Heijne

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
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As individual sexual behavior is variable over time, the timing of interventions might be vital to reducing HIV transmission. We aimed to investigate transitions between HIV risk levels among men who have sex with men (MSM), and identify determinants associated with behavior change. Participants in a longitudinal cohort study among HIV-negative MSM (Amsterdam Cohort Studies) completed questionnaires about their sexual behavior during biannual visits (2008-2017). Visits were assigned to different HIV risk levels, based on latent classes of behavior. We modelled transitions between risk levels, and identified determinants associated with these transitions at the visit preceding the transition using multi-state Markov models. Based on 7,865 visits of 767 participants, we classified three risk levels: low (73% of visits), medium (22%), and high risk (5%). For MSM at low risk, the six-month probability of increasing risk was 0.11. For MSM at medium risk, the probability of increasing to high risk was 0.08, while the probability of decreasing to low risk was 0.33. For MSM at high risk, the probability of decreasing risk was 0.43. Chemsex, erection stimulants and poppers, high HIV risk perception, and recent STI diagnosis were associated with increased risk at the next visit. High HIV risk perception and young age were associated with decreasing risk. Although the majority of MSM showed no behavior change, a considerable proportion increased HIV risk. Determinants associated with behavior change may help to identify MSM who are likely to increase risk in the near future and target interventions at these individuals, thereby reducing HIV transmission.

Original languageEnglish
Article numbere0259913
Number of pages13
JournalPloS ONE
Issue number12
Early online date9 Dec 2021
Publication statusPublished - 9 Dec 2021

Bibliographical note

Funding Information:
This project was funded by the Netherlands Organisation for Health Research and Development ZonMw grant 522004009. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability Statement

Data Availability: Data cannot be shared publicly, because the participants did not provide informed consent for it or for using data for other purpose than the scope of the Amsterdam Cohort Studies (ACS). Data to replicate the analysis or perform other scientific research within the scope of the ACS can be requested by submitting a research proposal to the ACS scientific board. Data data requests can be e-mailed to Dr. Neeltje Kootstra (N.A.Kootstra@amc.uva.nl), who is head Laboratory of Viral Immune Pathogenesis, Amsterdam UMC & project leader ACS.


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