Skip to main content

Advertisement

SpringerLink
Log in

Undetectable or Unknown? A Longitudinal Event-Level Analysis of Disclosure of HIV Serostatus and Undetectability Among Gay, Bisexual, and Other Men Who have Sex with Men (gbMSM) in Metro Vancouver

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

We examined temporal trends and factors associated with reporting partner’s serostatus and viral load among a sample of gay, bisexual and other men who have sex with men (gbMSM) in Vancouver, Canada. Participants were recruited using respondent-driven sampling and we collected prospective cohort data from 09/2014 to 02/2017 using a computer-assisted questionnaire and nurse-administered STI/HIV testing. Our study included 481 participants reporting on 3780 sexual events. Among HIV-negative/unknown gbMSM we found a trend towards decreased proportions of sexual events reporting an unknown HIV-status partner (42–19%; p =  < 0.001) and found increased proportions among gbMSM living with HIV (11–27%; p = 0.043). More participants living with HIV reported sex with undetectable partners, compared to HIV-negative/unknown participants (14.8% versus 5%). Our multivariable model found that compared with unknown status partners, undetectable partners were older, were from longer sexual relationships and were more likely to engage in condomless anal sex. Findings indicate that HIV-negative gbMSM seem more aware of the serostatus of their partners over time, but knowledge of partners’ viral load over time was not significant. Further research should assess the degree to which new campaigns such as Undetectable = Untransmittable (U = U) are associated with discussions about HIV disclosure and viral load status.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Montaner JSG, Lima VD, Harrigan PR, Lourenço L, Yip B, Nosyk B, et al. Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: the “HIV Treatment as Prevention” experience in a Canadian setting. PLoS ONE. 2014;9(2):e87872.

    Article  Google Scholar 

  2. Challacombe L. The epidemiology of HIV in gay, bisexual and other men who have sex with men CATIE2018. Available from: https://www.catie.ca/fact-sheets/epidemiology/epidemiology-hiv-gay-men-and-other-men-who-have-sex-men.

  3. Cohen J. HIV treatment as prevention. Science. 2011;334(6063):1628.

    Article  CAS  Google Scholar 

  4. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375(9):830–9.

    Article  CAS  Google Scholar 

  5. Arkell C, Harrigan M. HIV treatment and an undetectable viral load to prevent HIV transmission CATIE2018. Available from: https://www.catie.ca/en/fact-sheets/transmission/hiv-viral-load-hiv-treatment-and-sexual-hiv-transmission.

  6. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, Degen O, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet. 2019;393(10189):2428–38.

    Article  Google Scholar 

  7. Card KG, Armstrong HL, Lachowsky NJ, Cui Z, Sereda P, Carter A, et al. Belief in treatment as prevention and its relationship to HIV status and behavioral risk. J Acquir Immune DeficSyndr. 2018;77(1):8–16.

    Article  Google Scholar 

  8. Simon Rosser BR, Horvath KJ, Hatfield LA, Peterson JL, Jacoby S, Stately A, et al. Predictors of HIV disclosure to secondary partners and sexual risk behavior among a high-risk sample of HIV-positive MSM: results from six epicenters in the US. AIDS Care. 2008;20(8):925–30.

    Article  CAS  Google Scholar 

  9. Li H, Chen X, Yu B. Disclosure appraisal mediating the association between perceived stigma and HIV disclosure to casual sex partners among HIV+ MSM: a path model analysis. AIDS Care. 2016;28(6):722–5.

    Article  Google Scholar 

  10. Marcus U, Schink SB, Sherriff N, Jones A-M, Gios L, Folch C, et al. HIV serostatus knowledge and serostatus disclosure with the most recent anal intercourse partner in a European MSM sample recruited in 13 cities: results from the Sialon-II study. BMC Infect Dis. 2017;17(1):730–817.

    Article  Google Scholar 

  11. Horvath KJ, Nygaard K, Simon Rosser BR. Ascertaining partner HIV status and its association with sexual risk behavior among internet-using men who have sex with men. AIDS Behav. 2010;14(6):1376–83.

    Article  Google Scholar 

  12. Lachowsky NJ, Card KG, Cui Z, Sereda P, Roth EA, Hogg RS, et al. Agreement between gay, bisexual and other men who have sex with men’s period prevalence and event-level recall of sexual behaviour: an observational respondent-driven sampling study. Sex Health. 2019;16(1):84.

    Article  Google Scholar 

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

    Article  Google Scholar 

  14. Sullivan MC, Cruess DG, Huedo-Medina TB, Kalichman SC. Substance use, HIV serostatus disclosure, and sexual risk behavior in people living with HIV: an event-level analysis. Arch Sex Behav. 2019. https://doi.org/10.1007/s10508-019-01531-x.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Volz E, Heckathorn DD. Probability based estimation theory for respondent driven sampling. J Off Stat. 2008;24(1):79.

    Google Scholar 

  16. Lachowsky NJ, Lal A, Forrest JI, Card KG, Cui Z, Sereda P, et al. Including online-recruited seeds: a respondent-driven sample of men who have sex with men. J Med Internet Res. 2016;18(3):e51.

    Article  Google Scholar 

  17. Forrest JI, Lachowsky NJ, Lal A, Cui Z, Sereda P, Raymond HF, et al. Factors associated with productive recruiting in a respondent-driven sample of men who have sex with men in Vancouver, Canada. J Urban Health. 2016;93(2):379–87.

    Article  Google Scholar 

  18. Lachowsky NJ, Sorge JT, Raymond HF, Cui Z, Sereda P, Rich A, et al. Does size really matter? A sensitivity analysis of number of seeds in a respondent-driven sampling study of gay, bisexual and other men who have sex with men in Vancouver, Canada. BMC Med Res Methodol. 2016;16(1):157–210.

    Article  Google Scholar 

  19. Moore DM, Cui Z, Lachowsky N, Raymond HF, Roth E, Rich A, et al. HIV community viral load and factors associated with elevated viremia among a community-based sample of men who have sex with men in Vancouver, Canada. J Acquir Immune DeficSyndr. 2016;72(1):87–95.

    Article  Google Scholar 

  20. Saunders JB, Aasland OG, Babor TF, De La Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804.

    Article  CAS  Google Scholar 

  21. McKirnan DJ, Vanable PA, Ostrow DG, Hope B. Expectancies of sexual “escape” and sexual risk among drug and alcohol-involved gay and bisexual men. J Subst Abuse. 2001;13(1–2):137.

    Article  CAS  Google Scholar 

  22. Van de Ven P, Crawford J, Kippax S, Knox S, Prestage G. A scale of optimism-scepticism in the context of HIV treatments. AIDS Care. 2000;12(2):171–6.

    Article  Google Scholar 

  23. Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138(11):923–36.

    Article  CAS  Google Scholar 

  24. BC Centre for Disease Control. HIV in British Columbia: Annual Surveillance Report 2016.

  25. BC Centre for Excellence in HIV/AIDS. HIV Monitoring Quarterly Report for British Columbia. 2018.

  26. BC Center for Excellence in HIV/AIDS. HIV Cascade of Care in British Columbia. 2016.

  27. Card KG, Lachowsky NJ, Cui Z, Shurgold S, Armstrong HL, Rich AJ, et al. An event-level analysis of the interpersonal factors associated with condomless anal sex among gay, bisexual, and other men who have sex with men (MSM) with online-met partners. AIDS EducPrev. 2017;29(2):154.

    Article  Google Scholar 

  28. Mustanski BPD, Newcomb MEPD. Older sexual partners may contribute to racial disparities in hiv among young men who have sex with men. J Adolesc Health. 2013;52(6):666–7.

    Article  Google Scholar 

  29. British Columbia Centre for Excellence in HIV/AIDS. Treatment as prevention 2019. Available from: http://www.cfenet.ubc.ca/tasp.

  30. Lourenço L, Colley G, Nosyk B, Shopin D, Montaner JSG, Lima VD, et al. High levels of heterogeneity in the HIV cascade of care across different population subgroups in British Columbia, Canada. PLoS ONE. 2014;9(12):e115277.

    Article  Google Scholar 

  31. Terrence Higgins Trust. Can't pass it on 2019. Available from: https://www.tht.org.uk/our-work/our-campaigns/cant-pass-it-on.

Download references

Acknowledgements

We would like to thank the Momentum Health Study participants, office staff and community advisory board as well as our community partners: Health Initiative for Men, YouthCO HIV & Hep C Society, and Positive Living Society of BC. This work was supported by the National Institute on Drug Abuse (R01DA031055-01A1) and the Canadian Institutes of Health Research (MOP-107544, FDN-143342, PJT-153139). NJL was supported by a CANFAR/CTN Postdoctoral Fellowship Award. HLA was supported by a Postdoctoral Fellowship award from the Canadian Institutes of Health Research (Grant #MFE-152443). DMM and NJL are supported by Michael Smith Foundation for Health Research Scholar Awards (#5209, #16863). KGC is supported by a Canadian Institutes of Health Research Health Systems Impact Fellowship award, a Michael Smith Foundation for Health Research Trainee award, and a Canadian HIV Trials Network/Canadian Foundation for AIDS Research Postdoctoral Fellowship award.

Author information

Authors and Affiliations

  1. BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada

    Jordan M. Sang, Lu Wang, David M. Moore, Nicanor Bacani, Allan Lal, Kiffer G. Card, Robert S. Hogg & Nathan J. Lachowsky

  2. University of Victoria, Victoria, Canada

    Kiffer G. Card, Eric A. Roth & Nathan J. Lachowsky

  3. Community Advisory Board, Momentum Health Study, Vancouver, Canada

    Terry Howard & Everett Blackwell

  4. Glass House Consultants, Vancouver, Canada

    Terry Howard

  5. University of Southampton, Southampton, UK

    Heather L. Armstrong

  6. University of Kentucky, Lexington, KY, USA

    Richard Crosby

  7. Simon Fraser University, Burnaby, Canada

    Robert S. Hogg

  8. Faculty of Medicine, University of British Columbia, Vancouver, Canada

    David M. Moore

Authors
  1. Jordan M. Sang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David M. Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicanor Bacani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Terry Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Everett Blackwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Allan Lal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Heather L. Armstrong
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kiffer G. Card
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Richard Crosby
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Eric A. Roth
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Robert S. Hogg
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Nathan J. Lachowsky
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jordan M. Sang.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1 (DOCX 16 kb)

Supplementary file 2 (DOCX 130 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sang, J.M., Wang, L., Moore, D.M. et al. Undetectable or Unknown? A Longitudinal Event-Level Analysis of Disclosure of HIV Serostatus and Undetectability Among Gay, Bisexual, and Other Men Who have Sex with Men (gbMSM) in Metro Vancouver. AIDS Behav 25, 2630–2643 (2021). https://doi.org/10.1007/s10461-021-03224-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03224-w

Keywords

Search

Navigation