Knowledge of sexual partner's HIV serostatus and serosorting practices in a California population-based sample of men who have sex with men

University of California, San Francisco, San Francisco, California, United States
AIDS (Impact Factor: 5.55). 11/2006; 20(16):2081-9. DOI: 10.1097/01.aids.0000247566.57762.b2
Source: PubMed


To describe knowledge of primary and secondary sexual partner's HIV serostatus and sexual practices, including serosorting, among men who have sex with men (MSM) living in California.
Men who self-identified as gay/bisexual in the 2001 California Health Interview Survey, a statewide biennial random-digit-dial survey interviewing more than 50,000 adults on a variety of health topics, were recontacted in 2002 and interviewed by telephone about injection drug use, their own and partner's HIV serostatus, and sexual risk behaviors.
Among 220 men who reported a primary partner, 86% [95% confidence interval (CI): 77-92] knew their primary partner's serostatus; 62% (95% CI, 52-70) of the 250 men who reported a secondary partner knew their most recent secondary partner's HIV serostatus. Knowledge of one's most recent secondary partner's HIV serostatus was inversely related to history of injecting recreational drugs (odds ratio, 0.22; P < 0.01), and reporting a primary partner in the past year (odds ratio, 0.37; P < 0.05). Two-fifths (41%) of HIV-positive men and three-fifths (62%) of HIV-negative men engaged in serosorting (serocordant unprotected anal intercourse) with their primary partners, whereas 33% HIV-positive men and 20% HIV-negative men did so with their most recent secondary partners.
This population-based survey documented the extent to which MSM know their partners' serostatus and practice serosorting behaviors. The findings emphasize the need for studies to report serocordant and serodiscordant unprotected anal intercourse separately, as the former presents significant lower risk of HIV transmission.

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    • "Knowledge of a partner’s HIV serostatus is uncommon among high-risk MSM and TW in Peru. The rate of knowledge of partner serostatus ranged from 8.3% for exchange sex partners to 32.6% for stable partners, much lower than that found in previous studies of MSM populations in the U.S. and Australia, which have reported knowledge of partner serostatus ranging from 15.6% for casual partners [3] to 86.3% for stable partners [4]. Of partners whose serostatus was known, only 5.7% were reported HIV-positive, a level far below the actual HIV prevalence rate of 9.6-30.0% "
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    ABSTRACT: Background Knowledge of a sex partner’s HIV serostatus can influence sexual behavior and inform harm-reduction strategies. We sought to determine how often Peruvian men who have sex with men (MSM) and transgender women (TW) knew the HIV serostatus of their sex partners, if this knowledge was associated with any predictive factors or unprotected anal intercourse (UAI), and if UAI was associated with partner serostatus. Methods We analyzed data from the 2008 Peruvian MSM Sentinel Surveillance Survey. Data were collected by CASI about each participant’s three most recent male sex partners. Primary outcome was knowledge of a partner's HIV test result. Multivariate analysis assessed the effect of age, education, sexual identity, number of male partners, alcohol use during intercourse, type of partnership and length of partnership using logistic regression. Results 735 participants provided data on 1,643 of their most recent sex partners from the last 3 months. 179/735 (24.4%) of all participants knew HIV test results for at least one of their 3 most recent partners, corresponding to 230/1643 (14.0%) of all sexual partnerships in the last 3 months. In multivariate analysis, casual (OR: 0.27, 95% CI: 0.17-0.42) and exchange sex (OR: 0.31, 95% CI: 0.11-0.88) partners, compared to stable partners, were negatively associated with knowledge of partner serostatus, whereas relationships lasting longer than one night (<3 months OR: 2.20, 95% CI: 1.39-3.51; 3 months to 1 year OR: 3.00, 95% CI: 1.80-5.01; ≥ 1 year OR: 4.13, 95% CI: 2.40-7.10) were positively associated with knowledge of partner serostatus. Knowledge of partner serostatus was not associated with unprotected anal intercourse with that partner. Conclusions Few MSM and TW in Peru know their partners’ HIV serostatus. Our findings suggest that the type and length of partnership influence the likelihood of knowing a partner’s serostatus. Further research should explore the contexts and practices of partner communication, their effect on sexual behavior, and interventions to promote discussion of HIV testing and serostatus as an HIV prevention strategy in this population.
    BMC Public Health 02/2013; 13(1):181. DOI:10.1186/1471-2458-13-181 · 2.26 Impact Factor
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    • "In addition, men who participated in UAI, regardless of role, described a strong norm of the insertive partner withdrawing prior to ejaculation. These strategies reflected conscious calculations of risk probabilities and may be widespread among men who have sex with men in developed countries (Hart and Elford 2010; van der Bij 2007; Xia et al. 2006). "
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    ABSTRACT: Understanding the dynamics of sexual risks for HIV among men who have sex with men has been one of the ongoing challenges of HIV prevention. While the majority of HIV-prevention interventions target individual behaviour and decision making, multiple studies point to the importance of social context in shaping risk behaviour. Analysis of qualitative data from a study of men who have sex with men, drug use and sex found that sexual encounters were made up multiple contextual and interpersonal elements, which interacted to shape sexual practices and risk reduction strategies. Semi-structured interviews were conducted with 60 racially diverse men who have sex with men in NYC, recruited from multiple venues. The majority of respondents were gay-identified and half were 40 or older. Respondents described risk assessment and risk-reduction processes that develop throughout a sexual encounter, embedded in ongoing negotiations of sexual practices. Strategies of risk assessment and reduction draw on probability-based approaches to HIV prevention, presenting a challenge to health education.
    Culture Health & Sexuality 08/2011; 13(7):797-814. DOI:10.1080/13691058.2011.582688 · 1.55 Impact Factor
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    • "Data from a population-based sample of MSM living in California in 2002 led researchers in 2006 to conclude that knowledge of sexual partner's serostatus was associated with sexual practices frequently indicating an apparent seroadaptive strategy to reduce the risk of transmission without necessarily limiting numbers of partnerships or ruling out UAI. Serosorting, generally understood to refer to the selection of only concordant-serostatus partners, at least for UAI, was only one tactic characteristic of this seroadaptive strategy. While MSM often chose partners of discordant or unknown status those partnerships were less likely to involve anal intercourse or more likely to include condom use [14]. "
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    ABSTRACT: Surveillance data on sexually transmitted infections (STIs) and behavioral characteristics identified in studies of the risk of seroconversion are often used as to track sexual behaviors that spread HIV. However, such analyses can be confounded by "seroadaptation"--the restriction of unprotected anal intercourse (UAI), especially unprotected insertive UAI, to seroconcordant partnerships. We utilized sexual network methodology and repeated-measures statistics to test the hypothesis that seroadaptive strategies reduce the risk of HIV transmission despite numerous partnerships and frequent UAI. In a prospective cohort study of HIV superinfection including 168 HIV-positive men who have sex with men (MSM), we found extensive seroadaptation. UAI was 15.5 times more likely to occur with a positive partner than a negative one (95% confidence interval [CI], 9.1-26.4). Receptive UAI was 4.3 times more likely in seroconcordant partnerships than with negative partners (95% CI, 2.8-6.6), but insertive UAI was 13.6 times more likely with positives (95% CI, 7.2-25.6). Our estimates suggest that seroadaptation reduced HIV transmissions by 98%. Potentially effective HIV prevention strategies, such as seroadaptation, have evolved in communities of MSM before they have been recognized in research or discussed in the public health forum. Thus, to be informative, studies of HIV risk must be designed to assess seroadaptive behaviors rather than be limited to individual characteristics, unprotected intercourse, and numbers of partners. STI surveillance is not an effective indicator of trends in HIV incidence where there are strong patterns of seroadaptation.
    PLoS ONE 01/2010; 5(1):e8831. DOI:10.1371/journal.pone.0008831 · 3.23 Impact Factor
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