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Prevalence of and Factors Associated with the Use of HIV Serosorting and Other Biomedical Prevention Strategies Among Men Who Have Sex with Men in a US Nationwide Survey

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Abstract

PrEP and treatment-as-prevention (TasP) are biomedical strategies to reduce HIV transmission. Some men who have sex with men (MSM) are combining biomedical strategies with HIV serosorting—termed “biomed matching” when both partners are either on PrEP or TasP, or “biomed sorting” when one partner is using PrEP and the other TasP. Nevertheless, there is limited data on the extent of biomed matching/sorting in large geographically diverse samples. In 2016–2017, 5021 MSM from across the US were surveyed about their HIV status and HIV viral load/PrEP use, as well as that of their recent casual male partners. For each participant, we calculated the proportion of his partners who were (1) HIV-positive and undetectable, (2) HIV-positive and detectable/unknown, (3) HIV unknown/undiscussed, (4) HIV-negative on PrEP, (5) HIV-negative, not on PrEP. In total, 66.6% (n = 3346) of participants were HIV-negative and not on PrEP, 11.9% (n = 599) on PrEP, 14.1% (n = 707) HIV-positive and undetectable, 1.1% (n = 55) HIV-positive and viral load detectable/unknown, and 6.2% (n = 313) HIV unsure/unknown. A participant’s own HIV and PrEP status/was significantly associated with that of his partners (all p < 0.001), evincing evidence of both serosorting and biomed matching. Among men on PrEP and those who were HIV-undetectable, there was also some evidence to suggest these participants dually engaged in biomed matching as well as biomed sorting. We found evidence of biomed matching and sorting, which may compound its effectiveness for those using it (i.e., both partners bring biomedical protection). Unintended consequences of biomed matching/sorting include that men not using a biomedical strategy may be less likely to benefit from a partner’s use of the strategy—potentially further driving disparities in HIV infections. Public health campaigns might be well served to highlight not only the benefits that biomedical HIV prevention strategies provide for their users (e.g., “being on PrEP protects me from getting HIV”), but also the benefits that a user brings to his partners (e.g., “my use of PrEP means my partners won’t get HIV”), and the benefits of being with a partner who is using a biomedical strategy (e.g., “my partner’s use of PrEP/TasP protects me from HIV”).

Resumen

La PrEP y el tratamiento-como-prevención (TasP, por sus siglas en inglés) son estrategias biomédicas para reducir la transmisión del VIH. Algunos hombres que tienen sexo con hombres (HSH) combinan estrategias biomédicas con la sero-clasificación de VIH—denominado “Pareo biomédico” cuando ambas parejas están en PrEP o TasP, o “clasificación biomédica” cuando una pareja usa PrEP y la otra TasP. Sin embargo, la data sobre el grado de pareo/clasificación biomédica en grandes muestras geográficamente diversas es limitada. En 2016–2017, 5021 HSH de todo EEUU fueron encuestados sobre su estado de VIH, su carga viral/uso de PrEP, así como la de sus recientes parejas masculinas casuales. Para cada participante, calculamos la proporción de parejas que eran (1) VIH-positivos e indetectables, (2) VIH-positivos y detectables/desconocidos, (3) VIH-desconocidos/No-discutidos, (4) VIH-negativos tomando PrEP, (5) VIH-negativos, sin tomar PrEP. En total, 66.6% (n = 3346) de los participantes eran VIH-negativos y sin tomar PrEP, 11.9% (n = 599) tomaban PrEP, 14.1% (n = 707) VIH-positivos e indetectables, 1.1% (n = 55) VIH-positivos con carga viral detectable/desconocida, y 6.2% (n = 313) desconocían o estaban inseguros de su estado de VIH. El estado de VIH y de PrEP de un participante estaba significativamente asociado al estado de sus parejas (todos p < 0.001), evidencia evidente de pareo y clasificación biomédica. Entre los hombres tomando PrEP y los que eran VIH-indetectables también hubo evidencia para sugerir que estos participantes dualmente utilizaban pareo biomédico tanto como clasificación biomédica. Encontramos evidencia de pareo y clasificación biomédica, los cuales pueden aumentar su efectividad para los que los utilizan (Por ejemplo, ambas parejas trayendo protección biomédica). Las consecuencias imprevistas del pareo/clasificación biomédica incluyen que los hombres quienes no utilizan una estrategia biomédica podrían ser menos probables a beneficiarse del uso de la estrategia por parte de una pareja—potencialmente impactando disparidades en infecciones de VIH. Las campañas para la salud pública pueden ser bien servidas resaltando no solo los beneficios que las estrategias biomédicas para la prevención del VIH proveen para sus usuarios (por ejemplo, “estando en PrEP me protege del VIH”), pero también los beneficios que un usuario provee a sus parejas (por ejemplo, “Mi uso de la PrEP significa que mis parejas no se contagiarán con el VIH”), y los beneficios de estar con una pareja que utiliza una estrategia biomédica (por ejemplo, “El uso de PrEP/TasP por parte de mi pareja me protege del VIH”).

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Acknowledgements

Support for this manuscript was provided by the Centers for Disease Control and Prevention-funded NYU-CUNY Prevention Research Center (U48DP005008) Special Interest Project (SIP 15-009: Christian Grov/Simona Kwon—MPI) and the Einstein-Rockefeller-CUNY Center for AIDS Research (P30-AI-124414). H. Jonathon Rendina was supported by a Career Development Award from the National Institute on Drug Abuse (K01-DA039030; H. Jonathon Rendina, PI). One Thousand Strong was supported by the National Institute on Drug Abuse of the National Institutes of Health (R01-DA036466; Jeffrey T. Parsons & Christian Grov, MPI). Dr. Patel was also supported by a Career Development Award from the National Institute of Mental Health (K23-MH102118; Viraj V. Patel, PI). Special thanks to members of the team at CHEST (Chris Murphy, Carlos Ponton, Chris Hietikko, Mark Pawson, Lamar Lewis, Desmond Dutcher, Andrew Cortopassi, Chloe Mirzayi, Demetria Cain, Darren Agboh), Albert Einstein (Shirlyn Charles, Zoe Ginsburg), and NYU (Smiti Nadkarni). Finally thank you to Virginia “Ginny” Bowen and Kyle Bernstein at the CDC and the many participants who gave their time. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control or National Institutes for Health.

Funding

Funding attributable to this study or its authors has come from the Centers for Disease Control (U48DP005008- SIP 15-009) and the National Institutes for Health (P30-AI-124414, K01-DA039030, R01-DA036466, and K23-MH102118).

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Authors and Affiliations

  1. Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA

    Christian Grov

  2. CUNY Institute for Implementation Science in Population Health, New York, NY, USA

    Christian Grov & Elizabeth Kelvin

  3. The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA

    H. Jonathan Rendina & Jeffrey T. Parsons

  4. Department of Psychology, Hunter College of CUNY, New York, NY, USA

    H. Jonathan Rendina & Jeffrey T. Parsons

  5. Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of CUNY, New York, NY, USA

    H. Jonathan Rendina & Jeffrey T. Parsons

  6. Division of General Internal Medicine, Montefiore Health System and Albert Einstein College of Medicine, Bronx, NY, USA

    Viraj V. Patel & Kathryn Anastos

  7. Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA

    Elizabeth Kelvin

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Grov, C., Jonathan Rendina, H., Patel, V.V. et al. Prevalence of and Factors Associated with the Use of HIV Serosorting and Other Biomedical Prevention Strategies Among Men Who Have Sex with Men in a US Nationwide Survey. AIDS Behav 22, 2743–2755 (2018). https://doi.org/10.1007/s10461-018-2084-7

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