Seroconversion, sexual activity, and condom use among 2915 hiv seronegative men followed for up to 2 years

A cohort of 2915 HIV-1 seronegative men from the 4 centers of the Multicenter AIDS Cohort Study (MACS) was followed at 6-month intervals for 24 months to identify men who developed antibodies to HIV-1. 232 men (8%) were seroconverted. The highest attack rate was among men who reported practicing both receptive and insertive anal-genital intercourse. The attack rate among men who reported practicing receptive but not insertive intercourse was 3.6 times higher than among men practicing insertive intercourse although those practicing insertive only reported 38% more different partners. Only 2 men seroconverted who reported not practicing anal-genital intercourse in the 12 months prior to the 1st antibody-positive visit. Because men were followed every 6 months 1 of these men could have been infected within 6 months of the actual development of HIV-1 antibodies. The seroconversion rate was significantly lower among men who reported using condoms with all their partners. The results of this study 1) reaffirm that receptive anal-genital intercourse is the major route of infection among homosexual men of HIV-1 2) suggest that there is a low risk of HIV-1 infection to the insertive partner in anal-genital intercourse 3) suggest that infection may rarely occur through sexual activities other than anal-genital intercourse 4) provide evidence that condoms as currently used by men in the MACS provide significant but not complete protection against HIV-1 infection and 5) suggest that the number of men in the homosexual community engaging in high-risk behavior is declining. (authors)