HIV Among Men Who Have Sex With Men and Women (MSMW): Prevalence Estimates, Acquisition and Transmission Risks, and Implications for Interventions

Men who have sex with men and women (MSMW) have unique HIV-related health disparities when compared with men who have sex with men only (MSMO) and men who have sex with women exclusively (MSWE) in the United States. This dissertation characterizes these disparities, first by conducting a literature review, which contextualizes disparities found among MSMW across the domains of childhood adversities, psychosocial health conditions, and HIV risk behaviors; this review also reports estimates of the population percentage of MSMW. A meta-analysis of HIV prevalence in men was conducted: findings show that MSMW are significantly less likely to be HIV positive than MSMO but significantly more likely to be HIV positive than MSWE. Trajectory analyses of biomedical, psychosocial, and behavioral health conditions were then estimated using longitudinal data from a prospective cohort of sexually active MSM. Results indicated that MSMW are more likely to be depressed; and, among HIV positive men, more likely to have higher viral load levels unresolved over time, but also unlikely to transmit HIV to main female partners. A secondary data analysis was conducted among substance-using MSMO and MSMW; results demonstrated that MSMW were more likely to engage in transactional sex and have anal sex with men while high. Taken together, findings show that MSMW are subject to profound HIV-related health disparities that deserve theoretical attention and public health intervention design and delivery attuned to their specific needs