Background: Men who have sex with men (MSM) are heterogeneous with respect to sexual behavior. We examined differences in sexual risk behaviors and HIV protective behaviors between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO). Among MSMW, we also examined associations between partner gender and disclosure of same-sex attraction to sexual risk behaviors.

Methods: Data for this analysis were from MSM who participated in National HIV Behavioral Surveillance (NHBS) in 2011 and 2014. Prevalence differences comparing MSMW and MSMO were calculated for demographics and behaviors. Adjusted prevalence ratios comparing MSMW to MSMO were calculated for the outcomes condomless sex, exchange sex, testing for HIV, and disclosure of same-sex behavior.

Results: MSMW were less likely than MSMO to have condomless sex with male partners (aPR 0.77; 95%CI 0.73-0.80), to have been diagnosed with another STD (aPR 0.83; 95%CI 0.73-0.95), and to disclose their same-sex behavior to healthcare providers (aPR 0.72; 95%CI 0.69-0.76). However, MSMW were more likely than MSMO to engage in exchange sex (aPR 2.43; 95%CI 2.17-2.72) and to have ever injected drugs (aPR 2.00; 95%CI 1.76-2.28)

Conclusions: MSMW have distinctive sexual risk behaviors and could benefit from tailored interventions to reduce the prevalence of HIV in this population.