Seroadaptive behaviors are traditionally defined by self-reported sexual behavior history, regardless of whether they reflect purposely-adopted risk-mitigation strategies. Among MSM attending an STD clinic in Seattle, Washington 2013–2015 (N = 3751 visits), we used two seroadaptive behavior measures: (1) sexual behavior history reported via clinical computer-assisted self-interview (CASI) (behavioral definition); (2) purposely-adopted risk-reduction behaviors reported via research CASI (purposely-adopted definition). Pure serosorting (i.e. only HIV-concordant partners) was the most common behavior, reported (behavioral and purposely-adopted definition) by HIV-negative respondents at 43% and 60% of visits, respectively (kappa = 0.24; fair agreement) and by HIV-positive MSM at 30 and 34% (kappa = 0.25; fair agreement). Agreement of the two definitions was highest for consistent condom use [HIV-negative men (kappa = 0.72), HIV-positive men (kappa = 0.57)]. Overall HIV test positivity was 1.4 but 0.9% for pure serosorters. The two methods of operationalizing behaviors result in different estimates, thus the choice of which to employ should depend on the motivation for ascertaining behavioral information.
Men who have sex with men HIV Serosorting Seroadaptive behaviors
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The authors thank the men who participated in this study and the front desk staff and clinic staff at the Public Health – Seattle & King County STD clinic. We also thank Shirley Zhang for survey programming support and data management support.
This work was supported by the National Institutes of Health (Grant R21 AI098497; Grant T32 AI07140 trainee support to CMK; and grants K23MH090923 and L30 MH095060 to JCD); and the University of Washington Center for AIDS Research, an NIH-funded program (Grant P30 AI027757) which is supported by the following NIH Institutes and Centers: National Institute of Allergy and Infectious Diseases, National Cancer Institute, National Institutes of Mental Health, National Institute on Drug Abuse, National Institute of Child Health and Human Development, National Heart, Lung, and Blood Institute, National Institute on Aging.
Compliance with Ethical Standards
Conflict of interest
MRG has conducted studies unrelated to this work funded by grants from Cempra and Melinta. JCD has conducted studies unrelated to this work funded by grants to the University of Washington from ELITech, Melinta Therapeutics, and Genentech. All other authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in this study.
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