• DSHS HIV/STD Program

    Post Office Box 149347, MC 1873
    Austin, Texas 78714

    Phone: (512) 533-3000

    E-mail the HIV/STD Program

    E-mail data requests to HIV/STD Program - This email can be used to request data and statistics on HIV, TB, and STDs in Texas. It cannot be used to get treatment or infection history for individuals, or to request information on programs and services. Please do not include any personal, identifying health information in your email such as HIV status, Date of Birth, Social Security Number, etc.

    For treatment/testing history, please contact your local Health Department.

    For information on HIV testing and services available to Persons Living with HIV and AIDS, please contact your local HIV services organization.

Epi Profile Section 9 - Indicators of HIV Risk in PLWH Currently in Care

A note on risk reduction for persons at risk of or living with HIV: Serosorting and Viral Suppression.

Serosorting is the risk-reduction practice of choosing sexual partners with the same HIV status. In order to be effective, serosorting requires accurate knowledge of one’s own HIV status and the status of all potential partners. Serosorting by HIV status is not protective against bacterial sexually transmitted infections. Findings from this survey, detailed below, indicate that persons living with HIV in Texas may be serosorting as a risk reduction strategy.

Persons living with HIV are said to have achieved viral suppression once the level of HIV circulating in the body is very low (undetectable, <200 copies/ml). This is accomplished with the use of anti-retroviral therapy (ART) prescribed by a clinician. Rigorous research has shown that in addition to improving the health of persons living with HIV, viral suppression prevents transmission of HIV. In 2017, the CDC formally announced that they support the science that shows that Undetectable = Untransmittable. In other words, persons living with HIV who are virally suppressed cannot transmit HIV to anyone else through sexual contact.

Results from the Medical Monitoring Project, a survey of persons living with HIV, show that many persons living with HIV who are sexually active are virally suppressed and unlikely to transmit HIV.



Table 9-1. Sexual Activity, Risk Reduction, and Risk Behavior in HIV-positive MSM by Race and Age, 2014-2015 Texas

Sexually Active Men Who Have Sex With Men

Average
number of
male sex partners
in past
12 months

Had condomless anal sex with a male partner in the past 12 months

Had condomless anal sex with a male partner whose HIV status was discordant or unknown in the past 12 months

Primary, secondary, or syphilis infection of unknown duration in the past 12 months

Used injection or non-injection drugs in the past 12 months

N

N

N

%**

N

%**

N

%**

N

%**

Race/Ethnicity
White

36

3

23

56%

9

27%

3

10%

12

29%

Black

51

4

21

35%

10

16%

17

26%

19

33%

Hispanic

54

5

25

45%

11

17%

9

18%

16

30%

Total

141

4

69

45%

30

19%

29

18%

47

30%

Age

18-29

35

5

19

54%

9

24%

9

21%

13

38%

30-39

35

5

20

59%

12

13%

13

33%

16

51%

40-49

44

4

18

35%

4

9%

6

14%

13

24%

50+

27

2

12

38%

5

11%

*

*

5

12%

Total

141

4

69

45%

30

19%

28

18%

47

30%

* Cell suppressed for numbers less than 3
** Percentages are weighted
Cell sizes lass than 10 may produce unstable estimates

  • According to results from Texas’ Medical Monitoring Project (MMP) Survey, nearly half (45%) of the 141 sampled MSM living with HIV reported having condomless anal sex with a male partner in the past 12 months, and 30 (19%) MSM LWH had condomless anal sex with someone who was not known to be living with HIV. This means that 81% of MSM LWH who reported condomless anal sex only did so with a partner who was also living with HIV, a potential indicator of serosorting.

  • Serosorting for condomless anal sex leaves persons vulnerable to bacterial sexually transmitted infections. Eighteen (18%) percent of MSM living with HIV were diagnosed with syphilis diagnosis in the past 12 months. A larger proportion of Black MSM living with HIV (26%) had evidence of a syphilis infection compared to White MSM (10%) and Hispanic MSM (18%). About a third of MSM living with HIV reported non-injection or injection drug use in the past 12 months. This is concerning as drug use can lower inhibitions and contribute to high-risk sexual behavior.

  • Sexual risk behavior and drug use among MSM living with HIV decreases with age. Of those 50 years of age and older, 38% reported condomless anal sex with a male partner compared to 54% of those 18-29. Only 12% of MSM living with HIV over the age of 50 reporting using injection or non-injection drugs compared to 38% of those 29 years of age or younger.

  • It is important to note that 86% of the MSM living with HIV who reported condomless anal sex with a male partner in the last 12 months were virally suppressed. Of the 30 MSM living with HIV who reported condomless anal sex with a partner of discordant status, 88% were virally suppressed. This means that the vast majority of MSM living with HIV sampled in this survey are not at risk of transmitting HIV to their sexual partners. However, high rates of new HIV diagnosis among MSM in Texas demonstrate that new transmissions from persons who have not achieved viral suppression are still occurring.


Table 9-2. Sexual Activity, Risk Reduction, and Risk Behavior in HIV-positive Heterosexuals by Race and Age, 2014-2015 Texas

Sexually Active Heterosexuals

Average number
of sex partners
of the opposite sex
in the past
12 months

Had condomless vaginal or anal sex with a partner of the opposite sex in the past 12 months

Had condomless vaginal or anal sex with a partner whose HIV status was discordant or unknown in past 12 months

Used injection or non-injection drugs in the past 12 months

N

N

N

%

N

%

N

%

Race/Ethnicity
White

18

1

12

73%

9

62%

7

37%

Black

71

2

24

31%

16

21%

15

20%

Hispanic

45

2

14

32%

10

19%

*

*

Total

134

2

50

37%

35

25%

22

15%

Age

18-29

11

1

7

57%

7

57%

*

*

30-39

27

3

14

50%

10

33%

6

14%

40-49

49

1

16

35%

9

23%

7

11%

50+

47

1

13

27%

9

17%

9

20%

Total

134

2

50

37%

35

25%

22

15%

* Cell suppressed for numbers less than 3
** Percentages are weighted
Cell sizes lass than 10 may produce unstable estimates

  • Seventy-three percent (73%) of white heterosexual persons living with HIV reported condomless sex with a partner of the opposite sex in the past 12 months. This is noticeably higher than Black persons living with HIV (31%) and Hispanic persons living with HIV (32%) who reported condomless sex with a partner of the opposite sex. Similarly, 62% of white heterosexual persons living with HIV had condomless sex with a partner whose HIV status was discordant or unknown in past 12 months, compared to 21% of Black persons living with HIV and 19% of Hispanic persons living with HIV. Similar to MSM living with HIV, 77% of the 50 heterosexuals who reported condomless anal sex in the last 12 months were virally suppressed. Furthermore, 83% of the 35 heterosexual PLWH who reported condomless anal sex with a partner who did not have HIV or whose HIV serostatus was unknown were virally suppressed.

  • Similar to MSM, the proportion of heterosexual persons living with HIV who engaged in high-risk sexual behaviors decreased with age. Half of heterosexual persons aged 18-29 (57%) and fifty percent of those 30 to 39 years of age reported condomless sex in the past 12 months. A higher proportion of White heterosexuals and older heterosexuals reported drug use in the last 12 months.


Epi Profile

Table of Contents | 1. Executive Summary | 2. New HIV Diagnoses | 3. Persons Living with HIV | 4. Co-Morbidities | 5. HIV/AIDS Deaths | 6. HIV Incidence | 7. Focused and Routine HIV Testing | 8. Indicators of HIV Risk in HIV-negative Persons at High Risk for HIV | 9. Indicators of HIV Risk in PLWH Currently in Care | 10. Men Who Have Sex With Men (MSM) | 11. HIV Treatment Cascade | Data Sources and Notes


Last updated December 21, 2017