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A Behavioral Cascade of HIV Seroadaptation Among US Men Who Have Sex with Men in the Era of PrEP and U = U

Abstract

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.

Resumen

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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References

  1. 1.

    Cairns G. New directions in HIV prevention: serosorting and universal testing. IAPAC Mon. 2006;12(2):42–5.

    PubMed  Google Scholar 

  2. 2.

    Cassels S, Menza TW, Goodreau SM, Golden MR. HIV serosorting as a harm reduction strategy: evidence from Seattle, Washington. AIDS. 2009;23(18):2497–506.

    PubMed  Google Scholar 

  3. 3.

    Chen YH, Snowden JM, McFarland W, Raymond HF. Pre-exposure prophylaxis (PrEP) use, seroadaptation, and sexual behavior among men who have sex with men, San Francisco, 2004–2014. AIDS Behav. 2016;20(12):2791–7.

    PubMed  Google Scholar 

  4. 4.

    Grov C, Rendina HJ, Moody RL, Ventuneac A, Parsons JT. HIV serosorting, status disclosure, and strategic positioning among highly sexually active gay and bisexual men. AIDS Pat Care STDS. 2015;29(10):559–68.

    Google Scholar 

  5. 5.

    Halkitis PN, Moeller RW, Pollock JA. Sexual practices of gay, bisexual, and other nonidentified MSM attending New York City gyms: patterns of serosorting, strategic positioning, and context selection. J Sex Res. 2008;45(3):253–61.

    PubMed  Google Scholar 

  6. 6.

    Khosropour CM, Dombrowski JC, Swanson F, et al. Trends in serosorting and the association With HIV/STI risk over time among men who have sex with men. J Acquir Immune Defic Syndr. 2016;72(2):189–97.

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    Kurtz SP, Buttram ME, Surratt HL, Stall RD. Resilience, syndemic factors, and serosorting behaviors among HIV-positive and HIV-negative substance-using MSM. AIDS Educ Prev. 2012;24(3):193–205.

    PubMed  PubMed Central  Google Scholar 

  8. 8.

    LeVasseur MT, Goldstein ND, Tabb LP, Olivieri-Mui BL, Welles SL. The effect of PrEP on HIV incidence among men who have sex with men in the context of condom use, treatment as prevention, and seroadaptive practices. J Acquir Immune Defic Syndr. 2018;77(1):31–40.

    PubMed  Google Scholar 

  9. 9.

    McFarland W, Chen YH, Raymond HF, et al. HIV seroadaptation among individuals, within sexual dyads, and by sexual episodes, men who have sex with men, San Francisco, 2008. AIDS Care. 2011;23(3):261–8.

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    Parsons JT, Schrimshaw EW, Wolitski RJ, et al. Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation. AIDS. 2005;19(Suppl 1):S13-25.

    PubMed  Google Scholar 

  11. 11.

    Ronn M, White PJ, Hughes G, Ward H. Developing a conceptual framework of seroadaptive behaviors in HIV-diagnosed men who have sex with men. J Infect Dis. 2014;210:S586-593.

    PubMed  PubMed Central  Google Scholar 

  12. 12.

    Vallabhaneni S, Li X, Vittinghoff E, Donnell D, Pilcher CD, Buchbinder SP. Seroadaptive practices: association with HIV acquisition among HIV-negative men who have sex with men. PLoS ONE. 2012;7(10):e45718.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. 13.

    van den Boom W, Stolte I, Sandfort T, Davidovich U. Serosorting and sexual risk behaviour according to different casual partnership types among MSM: the study of one-night stands and sex buddies. AIDS Care. 2012;24(2):167–73.

    PubMed  Google Scholar 

  14. 14.

    Eaton LA, Kalichman SC, Cain DN, et al. Serosorting sexual partners and risk for HIV among men who have sex with men. Am J Prev Med. 2007;33(6):479–85.

    PubMed  PubMed Central  Google Scholar 

  15. 15.

    Golden MR, Stekler J, Hughes JP, Wood RW. HIV serosorting in men who have sex with men: is it safe? J Acquir Immune Defic Syndr. 2008;49(2):212–8.

    PubMed  Google Scholar 

  16. 16.

    Zablotska IB, Imrie J, Prestage G, et al. Gay men’s current practice of HIV seroconcordant unprotected anal intercourse: serosorting or seroguessing? AIDS Care. 2009;21(4):501–10.

    PubMed  Google Scholar 

  17. 17.

    McFarland W, Chen YH, Nguyen B, et al. Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use. AIDS Behav. 2012;16(1):121–31.

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Paz-Bailey G, Mendoza MC, Finlayson T, et al. Trends in condom use among MSM in the United States: the role of antiretroviral therapy and seroadaptive strategies. AIDS. 2016;30(12):1985–90.

    PubMed  Google Scholar 

  19. 19.

    Sanchez TH, Zlotorzynska M, Sineath RC, Kahle E, Tregear S, Sullivan PS. National trends in sexual behavior, substance use and HIV testing among United States men who have sex with men recruited online, 2013 through 2017. AIDS Behav. 2018;22(8):2413–25.

    PubMed  Google Scholar 

  20. 20.

    Kennedy CE, Bernard LJ, Muessig KE, et al. Serosorting and HIV/STI infection among HIV-negative MSM and transgender people: a systematic review and meta-analysis to inform WHO Guidelines. J Sex Trans Dis. 2013;2013:583627.

    Google Scholar 

  21. 21.

    Purcell DW, Higa D, Mizuno Y, Lyles C. Quantifying the harms and benefits from serosorting among HIV-negative gay and bisexual men: a systematic review and meta-analysis. AIDS Behav. 2017;21(10):2835–43.

    PubMed  Google Scholar 

  22. 22.

    Chen YH, Guigayoma J, McFarland W, Snowden JM, Raymond HF. Increases in pre-exposure prophylaxis use and decreases in condom use: behavioral patterns among HIV-negative San Francisco men who have sex with men, 2004–2017. AIDS Behav. 2019;23(7):1841–5.

    PubMed  Google Scholar 

  23. 23.

    Grov C, Jonathan Rendina H, Patel VV, Kelvin E, Anastos K, Parsons JT. 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. 2018;22(8):2743–55.

    PubMed  PubMed Central  Google Scholar 

  24. 24.

    Wang L, Moqueet N, Lambert G, et al. Population-level sexual mixing according to HIV status and preexposure prophylaxis use among men who have sex with men in Montreal, Canada: implications for HIV prevention. Am J Epidemiol. 2020;189(1):44–54.

    PubMed  Google Scholar 

  25. 25.

    Liu AY, Cohen SE, Vittinghoff E, et al. Preexposure prophylaxis for HIV infection integrated with municipal- and community-based sexual health services. JAMA Intern Med. 2016;176(1):75–84.

    PubMed  PubMed Central  Google Scholar 

  26. 26.

    Kelley CF, Kahle E, Siegler A, et al. Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia. Clin Infect Dis. 2015;61(10):1590–7.

    PubMed  PubMed Central  Google Scholar 

  27. 27.

    Maxwell S, Gafos M, Shahmanesh M. Pre-exposure prophylaxis use and medication adherence among men who have sex with men: a systematic review of the literature. J Assoc Nurs AIDS Care. 2019;30(4):e38–61.

    Google Scholar 

  28. 28.

    Mustanski B, Ryan DT, Remble TA, D’Aquila RT, Newcomb ME, Morgan E. Discordance of self-report and laboratory measures of HIV viral load among young men who have sex with men and transgender women in chicago: implications for epidemiology, care, and prevention. AIDS Behav. 2018;22(7):2360–7.

    PubMed  PubMed Central  Google Scholar 

  29. 29.

    Stephenson R, Bratcher A, Mimiaga MJ, et al. Brief report: accuracy in self-report of viral suppression among HIV-positive men with HIV-negative male partners. J Acquir Immune Defic Syndr. 2020;83(3):210–4.

    PubMed  Google Scholar 

  30. 30.

    To KW, Lee SS. A review of reported cases of HIV pre-exposure prophylaxis failure with resultant breakthrough HIV infections. HIV Med. 2020;22:75–82.

    PubMed  Google Scholar 

  31. 31.

    Hoff C. Negotiated safety agreements: do they protect and how they protect. Focus. 2005;20(2):1–5.

    PubMed  Google Scholar 

  32. 32.

    Hoff CC, Beougher SC. Sexual agreements among gay male couples. Arch Sex Behav. 2010;39(3):774–87.

    PubMed  Google Scholar 

  33. 33.

    Starks TJ, Payton G, Golub SA, Weinberger CL, Parsons JT. Contextualizing condom use: intimacy interference, stigma, and unprotected sex. J Health Psychol. 2014;19(6):711–20.

    PubMed  Google Scholar 

  34. 34.

    Golub SA, Starks TJ, Payton G, Parsons JT. The critical role of intimacy in the sexual risk behaviors of gay and bisexual men. AIDS Behav. 2012;16(3):626–32.

    PubMed  PubMed Central  Google Scholar 

  35. 35.

    Cassels S, Katz DA. Seroadaptation among men who have sex with men: emerging research themes. Curr HIV/AIDS Rep. 2013;10(4):305–13.

    PubMed  PubMed Central  Google Scholar 

  36. 36.

    Khosropour CM, Dombrowski JC, Hughes JP, Manhart LE, Simoni JM, Golden MR. Operationalizing the measurement of seroadaptive behaviors: a comparison of reported sexual behaviors and purposely-adopted behaviors among men who have sex with men (MSM) in Seattle. AIDS Behav. 2017;21(10):2935–44.

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    Siegler AJ, Sullivan PS, Khosropour CM, Rosenberg ES. The role of intent in serosorting behaviors among men who have sex with men sexual partnerships. J Acquir Immune Defic Syndr. 2013;64(3):307–14.

    PubMed  Google Scholar 

  38. 38.

    Weiss KM, Goodreau SM, Morris M, et al. Egocentric sexual networks of men who have sex with men in the United States: results from the ARTnet study. Epidemics. 2020;30:100386.

    PubMed  PubMed Central  Google Scholar 

  39. 39.

    Sanchez TH, Sineath RC, Kahle EM, Tregear SJ, Sullivan PS. The Annual American Men’s Internet Survey of behaviors of men who have sex with men in the United States: protocol and key indicators Report 2013. JMIR Publ Health Surveill. 2015;1(1):e3.

    Google Scholar 

  40. 40.

    Zlotorzynska M, Cantu C, Rai R, Sullivan P, Sanchez T. The annual American Men’s Internet Survey of behaviors of men who have sex with men in the United States: 2017 Key Indicators Report. JMIR Public Health Surveill. 2020;6(2):e16847.

    PubMed  PubMed Central  Google Scholar 

  41. 41.

    Zlotorzynska M, Sullivan P, Sanchez T. The Annual American Men’s Internet Survey of Behaviors of men who have sex with men in the United States: 2015 key indicators report. JMIR Publ Health Surveill. 2017;3(1):e13.

    Google Scholar 

  42. 42.

    Zlotorzynska M, Sullivan P, Sanchez T. The annual American Men’s Internet Survey of Behaviors of men who have sex with men in the United States: 2016 key indicators report. JMIR Public Health Surveill. 2019;5(1):e11313.

    PubMed  PubMed Central  Google Scholar 

  43. 43.

    Centers for Disease Control and Prevention. HIV Infection Risk, Prevention, and Testing Behaviors Among Men Who Have Sex With Men—National HIV Behavioral Surveillance, 23 U.S. Cities, 2017. HIV Surveillance Special Report 22. https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published February 2019. Accessed Sep 21, 2020

  44. 44.

    Koester KA, Erguera XA, Kang Dufour MS, et al. “Losing the Phobia:” understanding how HIV pre-exposure prophylaxis facilitates bridging the serodivide among men who have sex with men. Front Public Health. 2018;6:250.

    PubMed  PubMed Central  Google Scholar 

  45. 45.

    Medina MM, Crowley C, Montgomery MC, et al. Disclosure of HIV serostatus and pre-exposure prophylaxis use on internet hookup sites among men who have sex with men. AIDS Behav. 2019;23(7):1681–8.

    PubMed  PubMed Central  Google Scholar 

  46. 46.

    Holt M, Rawstorne P, Worth H, Bittman M, Wilkinson J, Kippax S. Predictors of HIV disclosure among untested, HIV-negative and HIV-positive Australian men who had anal intercourse with their most recent casual male sex partner. AIDS Behav. 2011;15(6):1128–39.

    CAS  PubMed  Google Scholar 

  47. 47.

    Grov C, Rendina HJ, Parsons JT. How different are men who do not know their HIV status from those who do? Results from an US online study of gay and bisexual men. AIDS Behav. 2016;20(9):1989–99.

    PubMed  PubMed Central  Google Scholar 

  48. 48.

    Crosby RA, Mena L, Geter A. Favourable attitudes towards serosorting are associated with overall less frequent condom use among young Black men having sex men. Sex Health. 2016;13(1):91–2.

    PubMed  PubMed Central  Google Scholar 

  49. 49.

    Marks G, Millett GA, Bingham T, Lauby J, Murrill CS, Stueve A. Prevalence and protective value of serosorting and strategic positioning among Black and Latino men who have sex with men. Sex Transm Dis. 2010;37(5):325–7.

    PubMed  Google Scholar 

  50. 50.

    Wilton L, Koblin B, Nandi V, et al. Correlates of seroadaptation strategies among black men who have sex with men (MSM) in 4 US cities. AIDS Behav. 2015;19(12):2333–46.

    PubMed  PubMed Central  Google Scholar 

  51. 51.

    Golden MR, Dombrowski JC, Kerani RP, Stekler JD. Failure of serosorting to protect African American men who have sex with men from HIV infection. Sex Transm Dis. 2012;39(9):659–64.

    PubMed  PubMed Central  Google Scholar 

  52. 52.

    Goodreau SM, Rosenberg ES, Jenness SM, et al. Sources of racial disparities in HIV prevalence in men who have sex with men in Atlanta, GA, USA: a modelling study. Lancet HIV. 2017;4(7):e311–20.

    PubMed  PubMed Central  Google Scholar 

  53. 53.

    Sewell WC, Powell VE, Mayer KH, Ochoa A, Krakower DS, Marcus JL. Nondaily use of HIV preexposure prophylaxis in a large online survey of primarily men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2020;84(2):182–8.

    PubMed  PubMed Central  Google Scholar 

  54. 54.

    Hojilla JC, Marcus JL, Silverberg MJ, et al. Early adopters of event-driven human immunodeficiency virus pre-exposure prophylaxis in a large healthcare system in San Francisco. Clin Infect Dis. 2020;71:2710–2.

    CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

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.

Funding

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.

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Correspondence to Steven M. Goodreau.

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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.

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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

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Keywords

  • HIV-1
  • Men who have sex with men
  • Seroadaptive behaviors
  • Pre-exposure prophylaxis (PrEP)
  • Condom use
  • Treatment as prevention (TasP)