Racial/Ethnic Differences in Seroadaptive and Serodisclosure Behaviors Among Men Who Have Sex With Men

Chongyi Wei; H. Fisher Raymond; Thomas E. Guadamuz; Ron Stall; Grant N. Colfax; Jonathan M. Snowden; Willi McFarland

Disclosures

AIDS and Behavior. 2011;15(1):22-29. 

In This Article

Abstract and Introduction

Abstract

We examined racial/ethnic differences in reported seroadaptive and serodisclosure behaviors among the partnerships of MSM recruited for a cross-sectional survey using time-location sampling (TLS) in San Francisco during 2007–2008. The sample (N = 1,199) consisted of 12.2% Asian/Pacific Islander (API), 52.4% White, 6.8% Black, 20.2% Latino, and 8.5% of "other" race/ethnicity. Pure serosorting was most common (about 20%) among HIV-negative men while seropositioning was most used (about 15%) by HIV-positive men. Reported seroadaptive behaviors did not differ significantly across races/ethnicities among both HIV-negative and HIV-positive men. However, HIV-positive Black and Latino men were significantly more likely to report no preventive, seroadaptive behavioral strategy (i.e., unprotected insertive anal intercourse with unknown status or serodiscordant partners). Among men who reported engaging in seroadaptive behaviors, they reported not discussing HIV status with a third of their partners—a major concern in that lack of disclosure undermines the effectiveness and means to practice serosorting. Partnerships of API and Black men were least likely to involve serodisclosure behaviors. Our study confirms that seroadaptive behaviors are common preventive strategies reported by MSM of all races/ethnicities, and does not find strong evidence that racial/ethnic differences in seroadaptive behaviors are enhancing disparities in HIV prevalence. The implications are that condom promotion and safe sex messages are not the only prevention measures adopted by MSM and that public health professionals should be well aware of current trends within the MSM community in order to better assist HIV prevention efforts.

Introduction

"Seroadaptation"—broadly defined as diverse community-originated behavioral strategies undertaken to reduce HIV transmission or acquisition risk by selecting sexual partners of the same HIV serostatus or by modifying sexual practices depending on knowledge of one's own and one's partner's serostatus—may explain observed discrepancies between increasing rates of unprotected anal intercourse (UAI) and sexually transmitted infections (STIs) and stable HIV incidences among men who have sex with men (MSM) in San Francisco.[1–5] Several studies have documented adoption of seroadaptive behaviors among HIV-negative and HIV-positive MSM in the industrialized world.[6–9] It has also been posited that the Internet may assist seroadaptation in that the anonymity it affords can facilitate HIV serostatus disclosure.[10,11]

Although in theory such sexual harm reduction strategies should prevent HIV infection, in practice each carries a different and uncertain level of risk due to a range of biological and contextual factors. For example, persons using seroadaptive strategies may have to weigh the relative risks of unprotected oral sex with a serodiscordant partner compared to using a condom during anal sex.[12] Among HIV-positive persons, there is concern over re-infection leading to drug resistance and limiting treatment options.[13] In addition, the effectiveness of seroadaptation relies on accurate knowledge of one's own and his partner's serostatus, which involves open discussion and honest disclosure—a point that has been emphasized as needed in a true definition of serosorting.[14,15]

Unfortunately, such a desired scenario may not occur for a range of reasons. First, HIV testing is not universal among MSM and seroadaptive strategies require a high and frequent level of checking one's serostatus. Second, some men may hide their HIV status in fear of rejection. One study found that 42% of HIV-positive MSM reported sex without disclosing their status.[16] Third, substance use, mood, and emotional state may impair decision making. Fourth, some men may lack the necessary skills to openly discuss issues around HIV status and may wrongly assume their partners' serostatus based on perception or using covert ways to find it out. Fifth, HIV-antibody negative MSM may actually be in the highly contagious pre-seroconversion window.[17] Finally, there may be some populations of MSM where the ability to serosort is limited by lower levels of HIV testing and disclosure efficacy. In particular, Black and Latino MSM have been documented to have lower testing rates[18–20] and at present disproportionately more HIV infection.[21,22]

To our knowledge, no empirical study has examined racial/ethnic differences in seroadaptive behaviors among MSM. In this paper, we compare rates of several seroadaptive behaviors reported by MSM of different races/ethnicities. We also examine racial/ethnic differences in serodisclosure behaviors among MSM who engaged in some form of seroadaptive behavior.

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