A Latent Class Analysis of Seroadaptation Among Gay and Bisexual Men

  • Kiffer G. Card
  • Nathan J. Lachowsky
  • Zishan Cui
  • Allison Carter
  • Heather Armstrong
  • Susan Shurgold
  • David Moore
  • Robert S. Hogg
  • Eric A. Roth
Original Paper

Abstract

Initial research into seroadaptive strategies suggests that, individually, they are potentially effective behavioral methods to reduce risk of HIV transmission. Combining strategies, therefore, has the potential to increase risk reduction. The aim of this study was to determine how gay and bisexual men (GBM) combine strategies. To this end, a total of 774 sexually active GBM, aged ≥16 years, in Metro Vancouver, Canada, were recruited. Grouped by self-reported HIV status, latent class analysis of self-reported condom use, strategic positioning, anal sex avoidance, serosorting, viral-load sorting, and withdrawal were conducted. Multinomial logistical regression identified explanatory variables of class membership (i.e., sensation seeking, treatment optimism, sexual altruism, relationship status, number of partners, anal sex preference). Four latent classes were identified: Condom Users, Multiple Prevention Users, Viral-Load Sorters, and Serosorters. The majority of HIV-negative/unknown men (72 %) and a large proportion of HIV-positive men (42 %) belonged to the Condom Users class. Class membership was associated with age, relationship status, treatment optimism, sexual altruism, sensation seeking, number of recent male anal sex partners, and recent condomless anal sex with a serodiscordant or unknown-status partner. Understanding these distinct patterns allows for tailored interventions addressing GBM’s sexual health needs.

Keywords

Seroadaptation Latent class analysis Gay and bisexual men HIV Sexual orientation 

Notes

Acknowledgments

The authors would like to thank the Momentum Health Study participants, office staff, and community advisory board, Kirk J. Hepburn, who edited this article, as well as our community partner agencies: Health Initiative for Men, YouthCO HIV & Hep C Society, and Positive Living Society of BC. Momentum is funded through the National Institute on Drug Abuse (R01DA031055-01A1) and the Canadian Institutes for Health Research (MOP-107544, 143342). Dr. Lachowsky is supported by a CANFAR/CTN Postdoctoral Fellowship Award. Dr. Moore is supported by a Scholar Award from the Michael Smith Foundation for Health Research (#5209).

Funding

This study was funded by the National Institute on Drug Abuse (R01DA031055-01A1) and the Canadian Institutes for Health Research (MOP-107544, 143342).

Compliance with Ethical Standards

Conflict of interest

Kiffer G. Card, Nathan J. Lachowsky, David Moore, Robert S. Hogg, Eric A. Roth, Zishan Cui, Allison Carter, Susan Shurgold, and Heather Armstrong declare that they had no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committees at Simon Fraser University, The University of British Columbia, and the University of Victoria and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Supplementary material

10508_2016_879_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 28 kb)

References

  1. Adam, B. D., Husbands, W., Murray, J., & Maxwell, J. (2005). AIDS optimism, condom fatigue, or self-esteem? Explaining unsafe sex among gay and bisexual men. Journal of Sex Research, 42(3), 238–248. doi:10.1080/00224490509552278.CrossRefPubMedGoogle Scholar
  2. Albarracín, D., Johnson, B. T., Fishbein, M., & Muellerleile, P. A. (2001). Theories of reasoned action and planned behavior as models of condom use: A meta-analysis. Psychological Bulletin, 127(1), 142–161.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Ashenhurst, J. R., Wilhite, E. R., Harden, K. P., & Fromme, K. (2016). Number of sexual partners and relationship status are associated with unprotected sex across emerging adulthood. Archives of Sexual Behavior. doi:10.1007/s10508-016-0692-8.PubMedGoogle Scholar
  4. Baggaley, R. F., White, R. G., & Boily, M.-C. (2010). HIV transmission risk through anal intercourse: Systematic review, meta-analysis and implications for HIV prevention. International Journal of Epidemiology, 39(4), 1048–1063. doi:10.1093/ije/dyq057.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Berry, M., Raymond, H. F., Kellogg, T., & McFarland, W. (2008). The Internet, HIV serosorting and transmission risk among men who have sex with men, San Francisco. AIDS, 22(6), 787–789. doi:10.1097/QAD.0b013e3282f55559.CrossRefPubMedGoogle Scholar
  6. Brady, S. S., Iantaffi, A., Galos, D. L., & Rosser, B. R. S. (2013). Open, closed, or in between: Relationship configuration and condom use among men who use the internet to seek sex with men. AIDS and Behavior, 17(4), 1499–1514. doi:10.1007/s10461-012-0316-9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Braine, N., van Sluytman, L., Acker, C., Friedman, S., & Des Jarlais, D. C. (2011). Sexual contexts and the process of risk reduction. Culture, Health & Sexuality, 13(7), 797–814. doi:10.1080/13691058.2011.582688.CrossRefGoogle Scholar
  8. Brennan, D. J., Welles, S. L., Miner, M. H., Ross, M. W., Rosser, B. R. S., & Positive Connections Team. (2010). HIV treatment optimism and unsafe anal intercourse among HIV-positive men who have sex with men: Findings from the Positive Connections Study. AIDS Education and Prevention, 22(2), 126–137. doi:10.1521/aeap.2010.22.2.126.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Brinkley-Rubinstein, L., & Craven, K. (2014). A latent class analysis of stigmatizing attitudes and knowledge of HIV risk among youth in South Africa. PLoS One, 9(2), e89915. doi:10.1371/journal.pone.0089915.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Card, K. G., Lachowsky, N. J., Cui, Z., Sereda, P., Rich, A., Jollimore, J., … Roth, E. A. (2016). Seroadaptive strategies of gay & bisexual men (GBM) with the highest quartile number of sexual partners in Vancouver, Canada. AIDS and Behavior. doi:10.1007/s10461-016-1510-y.
  11. Casey, E. A., Masters, N. T., Beadnell, B., Wells, E. A., Morrison, D. M., & Hoppe, M. J. (2015). A latent class analysis of heterosexual young men’s masculinities. Archives of Sexual Behavior, 45(5), 1039–1050. doi:10.1007/s10508-015-0616-z.CrossRefPubMedGoogle Scholar
  12. Cassels, S., & Katz, D. A. (2013). Seroadaptation among men who have sex with men: Emerging research themes. Current HIV/AIDS Reports, 10(4), 305–313. doi:10.1007/s11904-013-0188-2.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Chen, Y.-H., Snowden, J. M., McFarland, W., & Raymond, H. F. (2016). Pre-exposure Prophylaxis (PrEP) use, seroadaptation, and sexual behavior among men who have sex with men, San Francisco, 2004–2014. AIDS and Behavior. doi:10.1007/s10461-016-1357-2.Google Scholar
  14. Cohen, M. S., Chen, Y. Q., McCauley, M., Gamble, T., Hosseinipour, M. C., Kumarasamy, N., … Fleming, T. R. (2011). Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine, 365(6), 493–505. doi:10.1056/NEJMoa1105243.
  15. Crawford, I., Hammack, P. L., McKirnan, D. J., Ostrow, D., Zamboni, B. D., Robinson, B., & Hope, B. (2003). Sexual sensation seeking, reduced concern about HIV and sexual risk behaviour among gay men in primary relationships. AIDS Care, 15(4), 513–524. doi:10.1080/0954012031000134755.CrossRefPubMedGoogle Scholar
  16. Davidovich, U., van den Boom, W., Witlox, R., & Stolte, I. G. (2011). The emergence of intentional viral sorting as a frequently performed risk reduction strategy among HIV-positive MSM. Sexually Transmitted Infections., 87, 250–251. doi:10.1136/sextrans-2011-050108.359.CrossRefGoogle Scholar
  17. Dias, J. G. (2006). Latent class analysis and model selection. In P. D. M. Spiliopoulou, P. D. R. Kruse, D. C. Borgelt, J.-P. D. A. Nürnberger, & P. D. W. Gaul (Eds.), From data and information analysis to knowledge engineering (pp. 95–102). Berlin: Springer. doi:10.1007/3-540-31314-1_10.CrossRefGoogle Scholar
  18. Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., … Glidden, D. V. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363(27), 2587–2599. doi:10.1056/NEJMoa1011205.
  19. Grulich, A. E., & Zablotska, I. (2010). Commentary: Probability of HIV transmission through anal intercourse. International Journal of Epidemiology, 39(4), 1064–1065. doi:10.1093/ije/dyq101.CrossRefPubMedGoogle Scholar
  20. Heckathorn, D. D., Semaan, S., Broadhead, R. S., & Hughes, J. J. (2002). Extensions of respondent-driven sampling: A new approach to the study of injection drug users aged 18–25. AIDS and Behavior, 6(1), 55–67. doi:10.1023/A:1014528612685.CrossRefGoogle Scholar
  21. Horvath, K. J., Smolenski, D., Iantaffi, A., Grey, J. A., & Rosser, B. R. S. (2012). Discussions of viral load in negotiating sexual episodes with primary and casual partners among men who have sex with men. AIDS Care, 24(8), 1052–1055. doi:10.1080/09540121.2012.668168.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Jin, F., Prestage, G. P., Templeton, D. J., Poynten, I. M., Donovan, B., Zablotska, I., … Grulich, A. E. (2012). The impact of HIV seroadaptive behaviors on sexually transmissible infections in HIV-negative homosexual men in Sydney, Australia. Sexually Transmitted Diseases, 39(3), 191–194. doi:10.1097/OLQ.0b013e3182401a2f.
  23. Kalichman, S. C., Cain, D., & Simbayi, L. C. (2010). Behavioral changes associated with testing HIV-positive among sexually transmitted infection clinic patients in Cape Town, South Africa. American Journal of Public Health, 100(4), 714–719. doi:10.2105/AJPH.2009.162602.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Kalichman, S. C., & Rompa, D. (1995). Sexual sensation seeking and sexual compulsivity scales: Reliability, validity, and predicting HIV risk behavior. Journal of Personality Assessment, 65(3), 586–601. doi:10.1207/s15327752jpa6503_16.CrossRefPubMedGoogle Scholar
  25. Lachowsky, N. J., Dewey, C. E., Dickson, N. P., Saxton, P. J. W., Hughes, A. J., Milhausen, R. R., & Summerlee, A. J. S. (2015a). Habitual condom use across partner type and sexual position among younger gay and bisexual men: Findings from New Zealand HIV behavioural surveillance 2006–2011. Sexually Transmitted Infections. doi:10.1136/sextrans-2014-051759.PubMedPubMedCentralGoogle Scholar
  26. Lachowsky, N. J., Saxton, P. J. W., Hughes, A. J., Dickson, N. P., Summerlee, A. J. S., Milhausen, R. R., & Dewey, C. E. (2015b). Younger gay and bisexual men’s condom use with main regular sexual partner in New Zealand. AIDS Education and Prevention, 27(3), 257–274. doi:10.1521/aeap.2015.27.3.257.CrossRefPubMedGoogle Scholar
  27. Lanza, S. T., Collins, L. M., Lemmon, D. R., & Schafer, J. L. (2007). PROC LCA: A SAS procedure for latent class analysis. Structural Equation Modeling, 14(4), 671–694.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Leung, K. K., Poon, C. M., & Lee, S. S. (2015). A comparative analysis of behaviors and sexual affiliation networks among men who have sex with men in Hong Kong. Archives of Sexual Behavior, 44, 2067–2076. doi:10.1007/s10508-014-0390-3.CrossRefPubMedGoogle Scholar
  29. McCarty-Caplan, D., Jantz, I., & Swartz, J. (2014). MSM and drug use: A latent class analysis of drug use and related sexual risk behaviors. AIDS and Behavior, 18(7), 1339–1351. doi:10.1007/s10461-013-0622-x.CrossRefPubMedGoogle Scholar
  30. McFarland, W., Chen, Y.-H., Nguyen, B., Grasso, M., Levine, D., Stall, R., … Raymond, H. F. (2012). Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use. AIDS and Behavior, 16(1), 121–131. doi:10.1007/s10461-011-9936-8.
  31. McFarland, W., Chen, Y.-H., Raymond, H. F., Nyugen, B., Colfax, G., Mehrtens, J., … Truong, H.-H. M. (2011). HIV seroadaptation among individuals, within sexual dyads, and by sexual episodes, men who have sex with men, San Francisco, 2008. AIDS Care, 23(3), 261–268. doi:10.1080/09540121.2010.507748.
  32. McKechnie, M. L., Bavinton, B. R., & Zablotska, I. B. (2013). Understanding of norms regarding sexual practices among gay men: Literature review. AIDS and Behavior, 17(4), 1245–1254. doi:10.1007/s10461-012-0309-8.CrossRefPubMedGoogle Scholar
  33. Mitchell, J. W. (2013). HIV-negative and HIV-discordant gay male couples’ use of HIV risk-reduction strategies: Differences by partner type and couples’ HIV-status. AIDS and Behavior, 17(4), 1557–1569. doi:10.1007/s10461-012-0388-6.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Muthén, B., & Muthén, L. K. (2000). Integrating person-centered and variable-centered analyses: Growth mixture modeling with latent trajectory classes. Alcoholism, Clinical and Experimental Research, 24(6), 882–891.CrossRefPubMedGoogle Scholar
  35. Neville, S., & Adams, J. (2009). Condom use in men who have sex with men: A literature review. Contemporary Nurse, 33(2), 130–139.CrossRefPubMedGoogle Scholar
  36. Nimmons, D. (1998). In this together. Journal of Psychology & Human Sexuality, 10(3–4), 75–87. doi:10.1300/J056v10n03_06.CrossRefGoogle Scholar
  37. Nimmons, D., & Folkman, S. (1999). Other-sensitive motivation for safer sex among gay men: Expanding paradigms for HIV prevention. AIDS and Behavior, 3(4), 313–324. doi:10.1023/A:1025437418276.CrossRefGoogle Scholar
  38. Noor, S. W., Coleman, T., Brennan, D. J., Gardner, S., & Hart, T. A. (2015). Safer sex strategies as risk reduction: Use of latent class analysis approach to examine use of safe sex strategies among gay, bisexual and men who have sex with men in Toronto, Canada. Presented at the APHA Annual Meeting & Expo, Chicago, IL. Retrieved from https://apha.confex.com/apha/143am/webprogram/Paper336896.html.
  39. O’Dell, B. L., Rosser, B. R. S., Miner, M. H., & Jacoby, S. M. (2008). HIV prevention altruism and sexual risk behavior in HIV-positive men who have sex with men. AIDS and Behavior, 12(5), 713–720. doi:10.1007/s10461-007-9321-9.CrossRefPubMedGoogle Scholar
  40. Otis, J., McFadyen, A., Haig, T., Blais, M., Cox, J., Brenner, B., … Spot Study Group. (2016). Beyond condoms: Risk reduction strategies among gay, bisexual, and other men who have sex with men receiving rapid HIV testing in Montreal, Canada. AIDS and Behavior. doi:10.1007/s10461-016-1344-7.
  41. Roberti, J. W. (2004). A review of behavioral and biological correlates of sensation seeking. Journal of Research in Personality, 38(3), 256–279. doi:10.1016/S0092-6566(03)00067-9.CrossRefGoogle Scholar
  42. Rodger, A., Cambiano, V., Brunn, T., Vernazza, P., Collins, S., van Lunzen, J., … PARNTER Study Group. (2016). Sexual activity without condoms and risk of hiv transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. Journal of the American Medical Association, 316(2), 171–181. doi:10.1001/jama.2016.5148.
  43. Roland, M. E., Neilands, T. B., Krone, M. R., Katz, M. H., Franses, K., Grant, R. M., … Martin, J. N. (2005). Seroconversion following nonoccupational postexposure prophylaxis against HIV. Clinical Infectious Diseases, 41(10), 1507–1513. doi:10.1086/497268.
  44. Rönn, M., White, P. J., Hughes, G., & Ward, H. (2014). Developing a conceptual framework of seroadaptive behaviors in HIV-diagnosed men who have sex with men. Journal of Infectious Diseases, 210(Suppl. 2), S586–S593. doi:10.1093/infdis/jiu482.CrossRefPubMedPubMedCentralGoogle Scholar
  45. Rowniak, S. (2009). Safe sex fatigue, treatment optimism, and serosorting: New challenges to HIV prevention among men who have sex with men. Journal of the Association of Nurses in AIDS Care, 20(1), 31–38. doi:10.1016/j.jana.2008.09.006.CrossRefPubMedGoogle Scholar
  46. Ryzin, M. J. V., Johnson, A. B., Leve, L. D., & Kim, H. K. (2010). The number of sexual partners and health-risking sexual behavior: Prediction from high school entry to high school exit. Archives of Sexual Behavior, 40(5), 939–949. doi:10.1007/s10508-010-9649-5.CrossRefPubMedGoogle Scholar
  47. Snowden, J. M., Wei, C., McFarland, W., & Raymond, H. F. (2014). Prevalence, correlates and trends in seroadaptive behaviours among men who have sex with men from serial cross-sectional surveillance in San Francisco, 2004–2011. Sexually Transmitted Infections, 90(6), 498–504. doi:10.1136/sextrans-2013-051368.CrossRefPubMedGoogle Scholar
  48. Stephenson, R., White, D., & Mitchell, J. W. (2015). Sexual agreements and perception of HIV prevalence among an online sample of partnered men who have sex with men. Archives of Sexual Behavior, 44(7), 1813–1819. doi:10.1007/s10508-015-0532-2.CrossRefPubMedGoogle Scholar
  49. Vallabhaneni, S., Li, X., Vittinghoff, E., Donnell, D., Pilcher, C. D., & Buchbinder, S. P. (2012). Seroadaptive practices: Association with HIV acquisition among HIV-negative men who have sex with men. PLoS One, 7(10), e45718. doi:10.1371/journal.pone.0045718.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Van de Ven, P., Crawford, J., Kippax, S., Knox, S., & Prestage, G. (2000). A scale of optimism-scepticism in the context of HIV treatments. AIDS Care, 12(2), 171–176. doi:10.1080/09540120050001841.CrossRefPubMedGoogle Scholar
  51. Van de Ven, P., Kippax, S., Crawford, J., Rawstorne, P., Prestage, G., Grulich, A., & Murphy, D. (2002). In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care, 14(4), 471–480. doi:10.1080/09540120208629666.CrossRefPubMedGoogle Scholar
  52. Vermunt, J. K. (2010). Latent class modeling with covariates: Two improved three-step approaches. Political Analysis, 18(4), 450–469. doi:10.1093/pan/mpq025.CrossRefGoogle Scholar
  53. Zhang, H., Lu, H., Pan, S. W., Xia, D., Zhao, Y., Xiao, Y., … Shao, Y. (2015). Correlates of unprotected anal intercourse: The influence of anal sex position among men who have sex with men in Beijing, china. Archives of Sexual Behavior, 44(2), 375–387. doi:10.1007/s10508-014-0396-x.

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Kiffer G. Card
    • 1
    • 2
  • Nathan J. Lachowsky
    • 1
    • 3
  • Zishan Cui
    • 1
  • Allison Carter
    • 1
    • 2
  • Heather Armstrong
    • 1
  • Susan Shurgold
    • 1
  • David Moore
    • 1
    • 3
  • Robert S. Hogg
    • 1
    • 2
  • Eric A. Roth
    • 4
    • 5
  1. 1.BC Centre for Excellence in HIV/AIDSVancouverCanada
  2. 2.Faculty of Health ScienceSimon Fraser UniversityVancouverCanada
  3. 3.Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  4. 4.Department of AnthropologyUniversity of VictoriaVictoriaCanada
  5. 5.Centre for Addiction Research of British ColumbiaUniversity of VictoriaVictoriaCanada

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