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Brewer, D. D., Golden, M. R., Wood, R. W., Krekeler, B., & Handsfield, H. H. (2012). Comparison of men who have sex with men (MSM) in clinical samples with MSM in a community probability sample. Available at SSRN:

abstract     full article

Objective: To compare the demographic characteristics, HIV prevalence, and STD/HIV transmission behaviors among men who have sex with men (MSM) in clinical settings with a community-based sample of MSM.
Methods: In 2003, 311 MSM participated in a random digit dial telephone survey in Seattle neighborhoods with high prevalences of MSM. We compared the results with data on MSM residing in the same areas seen at a public health STD clinic (n=523) and HIV testing program (n=310).
Results: MSM in the three samples were largely similar in terms of their demographic characteristics, substance use, many aspects of sexual behavior (including unprotected anal intercourse and number of recent male sex partners), HIV testing history, and HIV prevalence. However, MSM in the STD and HIV testing samples were more likely than survey respondents to have had STD. Among HIV negative MSM, 24% of STD clinic patients and 10% of survey respondents were potentially exposed to HIV, i.e., reported unprotected anal intercourse (UAI) with a man who was HIV positive or of unknown HIV status (OR, 2.7, 95%CI, 1.7-4.4). Similarly, 50% of HIV positive MSM STD clinic patients were potential HIV transmitters, reporting UAI with a man of negative or unknown status, compared with 31% HIV positive survey respondents (OR, 2.2, 95% CI, 1.0-4.8).
Conclusions: MSM seen in STD/HIV clinical settings had higher HIV/STD risk than survey respondents. Nevertheless, clinical samples of MSM may be more broadly representative of urban MSM than previously thought, and remain useful for describing selected aspects of MSM populations.

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