A Latent Class Analysis of Seroadaptation Among Gay and Bisexual Men
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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.
KeywordsSeroadaptation Latent class analysis Gay and bisexual men HIV Sexual orientation
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).
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.
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 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.
- 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
- 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
- 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.
- 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.
- 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
- 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
- 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.
- 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
- 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.
- 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
- 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
- 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
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
- 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
- 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
- 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.