Seroadaptive behaviors help reduce HIV risk for some men who have sex with men (MSM), and have been well documented across MSM populations. Advancements in biomedical prevention have changed the contexts in which seroadaptive behaviors occur. We thus sought to estimate and compare the prevalence of four stages of the “seroadaptive cascade” by PrEP use in the recent era: knowledge of own serostatus, knowledge of partner serostatus; serosorting (matching by status), and condomless anal intercourse. Serosorting overall appeared to remain common, especially with casual and one-time partners. Although PrEP use did not impact status discussion, it did impact serosorting and the likelihood of having condomless anal intercourse. For respondents not diagnosed with HIV and not on PrEP, condomless anal intercourse occurred in just over half of relationships with HIV-positive partners who were not on treatment. Biomedical prevention has intertwined with rather than supplanted seroadaptive behaviors, while contexts involving neither persist.
Los comportamientos seroadaptivos ayudan a reducir el riesgo de VIH en algunos hombres que tienen sexo con otros hombres (HSH) y han sido bien documentados en varias comunidades de HSH. Los avances en prevención biomédica han cambiado los contextos de los comportamientos seroadaptivos. Por ello buscamos estimar y comparar la prevalencia de cuatro fases de la ‘cascada seroadaptiva’ mediante el uso de PrEP en la era reciente: conocimiento del seroestatus personal, conocimiento del seroestatus del compañero, serosorting (emparejamiento por estatus) y coito anal sin condón. En general, el serosorting parece seguir siendo común especialmente con parejas casuales o de una noche. A pesar de que el uso de PrEP no impactó la discusión sobre el estatus, sí impactó el serosorting y la probabilidad de coito anal sin condón. Los encuestados no diagnosticados con VIH y sin PrEP tuvieron coito anal sin condón en la mitad de las relaciones con parejas VIH-positivo que no estaban bajo tratamiento. La prevención biomédica se ha entremezclado en lugar de suplantar los comportamientos seropositivos, mientras persisten los contextos en los que no aparece ninguno.
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The authors would like to thank the study participants, the full AMIS and ARTnet research teams, and the Network Modeling Group at the University of Washington. Special thanks to Ana Dobao and Marcos Llobera.
This work was supported by National Institutes of Health Grant Nos. R21 MH112449 and R01 AI138783. Partial support for this research came from a Eunice Kennedy Shriver National Institute of Child Health and Human Development research infrastructure Grant, P2C HD042828, to the Center for Studies in Demography and Ecology at the University of Washington.
Conflict of interest
The authors have no conflicts of interest to declare that are relevant to the content of this article.
This study was approved by the Emory University Institutional Review Board. It was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent was obtained from all individual participants included in the study.
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Goodreau, S.M., Maloney, K.M., Sanchez, T.H. et al. A Behavioral Cascade of HIV Seroadaptation Among US Men Who Have Sex with Men in the Era of PrEP and U = U. AIDS Behav 25, 3933–3943 (2021). https://doi.org/10.1007/s10461-021-03266-0
- Men who have sex with men
- Seroadaptive behaviors
- Pre-exposure prophylaxis (PrEP)
- Condom use
- Treatment as prevention (TasP)