TRENDS IN HIV SEROPREVALENCE IN MEN WHO HAVE SEX WITH MEN - NEW-YORK-CITY DEPARTMENT-OF-HEALTH SEXUALLY-TRANSMITTED DISEASE CLINICS, 1988-1993

Objective: To measure HIV seroprevalence trends in a primarily non-whi te sample (n = 1618) of men who have sex with men (MSM). The MSM were sampled at New York City Department of Health (NYC-DOH) sexually trans mitted disease (STD) clinics during 1988-1993. Design: Unlinked HIV-1 serosurvey using remnant serum originally drawn for routine syphilis s creening. Method: Demographic, clinical and risk exposure data were ab stracted from clinic charts. No other sources of data were used, and p atients were not interviewed. Results: HIV seroprevalence in the overa ll sample declined from 53 to 34% between 1988 and 1993. The most dram atic decline was observed in white MSM (from 47 to 17%; n = 457). Sero prevalence in black MSM also fell (from 60 to 45%; n = 691). Seropreva lence in Hispanic men (n = 332) showed no decline, starting and ending the 5-year period at 39%. Bisexual MSM, who comprised one-quarter of the sample, experienced a shallower decline than other MSM (from 41 to 33%). The magnitude of the decline decreased with increasing age - fo r example, seroprevalence in MSM aged 20-24 years dropped by 62% (from 39 to 15%), whereas seroprevalence in MSM aged 40-44 years dropped by 10% (from 48 to 43%) - up through age 45 years, at which point anothe r dramatic decline (from 53 to 21%) was observed. There was no decline in the high seroprevalence associated with a discharge diagnosis of g onorrhea (58%) or any genital ulcer disease (GUD; e.g., primary or sec ondary syphilis, chancroid or genital herpes, 52%). The proportion of STD diagnoses attributed to GUD rose from 8 to 14%. Conclusion: A smal l number of MSM continued to present to NYC-DOH STD clinics and to lea ve with a diagnosed STD at a time when safe sex was aggressively promo ted. The biological and behavioral associations between CUD and gonorr hea and HIV seroprevalence warrant continued investigation. Prevention programs targeted to young, minority and bisexual MSM are needed.