Serosorting and Sexual Risk for HIV Infection at the Ego-Alter Dyadic Level: An Egocentric Sexual Network Study among MSM in Nigeria

The objective of this egocentric network study was to investigate engagement in serosorting by HIV status and risk for HIV between seroconcordant and serodiscordant ego-alter dyads. 

Respondent-driving sampling was used to recruit 433 Nigerian men who have sex with men (MSM) from 2013 to 2014. Participant (ego) characteristics and that of five sex partners (alters) were collected. Seroconcordancy was assessed at the ego level and for each dyad. Among 433 egos, 18 % were seroconcordant with all partners. 

Among 880 dyads where participants knew their HIV status, 226 (25.7 %) were seroconcordant, with 11.7 % of HIV positive dyads seroconcordant and 37.0 % of HIV negative dyads seroconcordant. Seroconcordant dyads reported fewer casual sex partners, less partner concurrency, and partners who had ever injected drugs, but condom use did not differ significantly.

Serosorting may be a viable risk reduction strategy among Nigerian MSM, but awareness of and communication about HIV status should be increased. Future studies should assess serosorting on a partner-by-partner basis.

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By:  Rodriguez-Hart C1,2, Liu H3, Nowak RG4, Orazulike I5, Zorowitz S6, Crowell TA7,8, Baral SD9, Blattner W4, Charurat M4.

• 1Institute of Human Virology University of Maryland School of Medicine, 725 W Lombard St., Baltimore, MD, 21201, USA. crodri32@jhu.edu.
• 2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. crodri32@jhu.edu.
• 3University of Maryland School of Public Health, College Park, MD, USA.
• 4Institute of Human Virology University of Maryland School of Medicine, 725 W Lombard St., Baltimore, MD, 21201, USA.
• 5International Center on Advocacy and Rights to Health, Abuja, Nigeria.
• 6Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
• 7U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
• 8Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
• 9Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
• AIDS Behav. 2016 Feb 24. 

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Trends in Serosorting & the Association with HIV/STI Risk Over Time among Men Who Have Sex with Men

BACKGROUND:

Serosorting among men who have sex with men (MSM) is common but recent data to describe trends in serosorting are limited. How serosorting affects population-level trends in HIV and other sexually transmitted infection (STI) risk is largely unknown.

METHODS:

We collected data as part of routine care from MSM attending an STD clinic (2002-2013) and a community-based HIV/STD testing center (2004-2013) in Seattle, Washington. MSM were asked about condom use with HIV-positive, HIV-negative and unknown-status partners in the prior 12 months. We classified behaviors into four mutually exclusive categories: no anal intercourse (AI); consistent condom use (always used condoms for AI); serosorting (condomless anal intercourse [CAI] only with HIV-concordant partners); and non-concordant CAI (CAI with HIV-discordant/unknown-status partners; NCCAI).

RESULTS:

Behavioral data were complete for 49,912 clinic visits. Serosorting increased significantly among both HIV-positive and HIV-negative men over the study period. This increase in serosorting was concurrent with a decrease in NCCAI among HIV-negative MSM, but a decrease in consistent condom use among HIV-positive MSM. Adjusting for time since last negative HIV test, the risk of testing HIV positive during the study period decreased among MSM who reported NCCAI (7.1% to 2.8%; P=0.02), serosorting (2.4% to 1.3%; P=0.17) and no CAI (1.5% to 0.7%; P=0.01). Serosorting was associated with a 47% lower risk of testing HIV positive compared to NCCAI (adjusted prevalence ratio=0.53; 95% CI=0.45-0.62).

CONCLUSIONS:

Between 2002 and 2013, serosorting increased and NCCAI decreased among Seattle MSM. These changes paralleled a decline in HIV test positivity among MSM.

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By:  Khosropour CM1, Dombrowski JC, Swanson F, Kerani RP, Katz DA, Barbee LA, Hughes JP, Manhart LE, Golden MR.

• 1 Department of Epidemiology, University of Washington, Seattle, WA, USA 
• 2 Department of Medicine, University of Washington, Seattle, WA, USA 
• 3 Department of Biostatistics, University of Washington, Seattle, WA, USA 
• 4 Department of Global Health, University of Washington, Seattle, WA, USA 
• 5 Public Health - Seattle and King County HIV/STD Program, Seattle, WA, USA 
• 6 Gay City Health Project, Seattle, WA, USA.
• J Acquir Immune Defic Syndr. 2016 Feb 13. 

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Factors Associated with Unprotected Anal Sex with Multiple Non-Steady Partners in the Past 12 Months: Results from the European Men-Who-Have-Sex-with-Men Internet Survey

Background

Practising unprotected anal intercourse (UAI) with high numbers of partners is associated with increased risk for acquiring and transmitting HIV and other sexually transmitted infections. Our aim was to describe factors associated with UAI with multiple partners in a large sample of MSM from 38 European countries recruited for an online survey in 2010.

Methods

Data are from the European Men-Who-Have-Sex-With-Men Internet Survey (EMIS). The analysis was restricted to men who reported any anal sex with a non-steady partner in the past 12 months, and who were either never diagnosed with HIV, or who had been diagnosed with HIV more than 12 months ago, reported a detectable viral load and did not exclusively serosort (n = 91,477). Multivariable logistic regression was used to compare men reporting UAI with four or more (4+) non-steady partners to two comparison groups: a) no UAI with non-steady partners, and b) UAI with 1-3 non-steady partners.

Results

Overall, 9.6 % of the study population reported UAI with 4+ partners in the past 12 months. In both models, factors consistently associated with this behaviour were: having been diagnosed with HIV, lower educational levels, use of nitrite inhalants, drugs associated with sex and parties, or erectile dysfunction drugs in the past 4 weeks, using sex-on-site venues in the past 4 weeks, buying or selling sex in the past 12 months, having experienced physical violence due to sexual attraction to men in the past 12 months, reporting sexual happiness, being out to all or almost all of one’s acquaintances, and knowing that ART reduces HIV transmissibility.

Conclusions

Effective antiretroviral treatment drastically reduces HIV transmission for men diagnosed with HIV, irrespective of partner numbers. Apart from reducing partner numbers or increasing condom use no other recommendations are currently in place to reduce the risk of HIV acquisition and onward transmission for HIV-negative men practicing UAI with multiple partners. A range of factors were identified as associated with UAI with four or more partners which allow the strengthening and targeting of prevention strategies to reduce HIV transmission risks resulting from condomless anal intercourse with multiple partners.

Below:  Proportion of respondents reporting 4+ partners from each country. Bars indicate the percentage of respondents reporting UAI with four or more non-steady male partners in the past 12 months; the number of respondents reporting UAI with 4+ non-steady partners over the total number of respondents from the country is displayed to the right of each bar. The region to which each country belongs is indicated by the colour of the bars

Full article at:   http://goo.gl/KvRPLs

By:  Kramer SC1, Schmidt AJ2, Berg RC3, Furegato M4, Hospers H5, Folch C6, Marcus U7; EMIS Network.

• 1Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. sarah.kramer.374@gmail.com.
• 2Sigma Research, Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK. axel.j.schmidt@emis-project.eu.
• 3Department of Evidence-Based Health Services, Norwegian Knowledge Center for the Health Services, Oslo, Norway. Rigmor.Berg@kunnskapssenteret.no.
• 4HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK. furemiao@gmail.com.
• 5University College Maastricht, Maastricht University, Maastricht, The Netherlands. h.hospers@maastrichtuniversity.nl.
• 6Centre for Sexually Transmitted Infection and AIDS Epidemiological Studies of Catalonia (CEEISCAT), Barcelona, Spain. cfolch@iconcologia.net.
• 7Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. MarcusU@rki.de.

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Hepatitis C Virus Awareness among Men Who Have Sex with Men in Southwest Switzerland

BACKGROUND:

In Switzerland, the incidence of hepatitis C virus (HCV) infection in HIV-positive men who have sex with men (MSM) rose 18-fold between 1998 and 2011. We aimed to evaluate transmission risk factors, awareness, and seroprevalence of HCV among MSM in southwest Switzerland.

METHODS:

From 1st June 2011 to 31st August 2012, trained health care professionals invited individuals attending (1) MSM screening clinics and (2) indoor and outdoor meeting areas to complete an anonymous questionnaire. Consenting participants were rapid tested for HCV (OraQuick HCV Rapid Antibody Test).

RESULTS:

Of 918 MSM approached, 654 agreed to participate, most of whom (536, 82%) were enrolled via MSM screening clinics. Of 654 participants, 21 (3.2%) disclosed being HIV positive; 140 (21%) had unknown HIV status. In the preceding 12 months, 357 (55%) of 654 participants reported unprotected anal intercourse (UAI) and 321 (49%) of 654 participants reported UAI with partners of different/unknown HIV status. Not HIV serosorting was reported more frequently among HIV-positive individuals (76%, P < 0.001). Three hundred two participants (46%) were aware of HCV, awareness being higher among clinic than meeting area participants (49% vs. 33%, P = 0.04). One individual (of 654; 0.2%), with a negative HIV test result 18 months previously was newly diagnosed as being HCV positive on rapid testing.

CONCLUSIONS:

In this sample of predominantly HIV-negative MSM, half the participants were aware of HCV and HCV seroprevalence was low. However, high rates of UAI and of UAI without HIV serosorting were reported. Given the increasing incidence of HCV among HIV-positive men, we propose that HCV counseling should be offered to MSM regardless of HIV status, with testing offered to those at high risk.

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By:   Clerc O1, Darling K, Calmy A, Dubois-Arber F, Cavassini M.

• 1From the *Infectious Diseases Service and †Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland; and ‡HIV Unit, Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland. 

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Similarities and Differences in Sexual Risk Behaviors Between Young Black MSM Who Do and Do Not Have Sex with Females

The objective of this study is to determine whether young Black MSM who also have sex with females report similar levels of sexual risk behaviors as those not having sex with females. 

YBMSM (N = 400) were recruited from an STI clinic, located in the Southern U.S. Men completed an audio-computer assisted self-interview and donated specimens for STI/HIV testing. 

Forty-three percent recently engaged in penile-vaginal sex. They were less likely to report having concurrent partners, unprotected fellatio, multiple partners as a bottom, any unprotected anal sex as a bottom, and any anal sex. They were equally likely to report favorable attitudes toward serosorting, multiple male partners as a top, unprotected anal insertive sex with males. Frequency of sex with males as a top or bottom did not differ. 

Compared to YBMSM not having sex with females, those having sex with females may be exercising greater caution.

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By:  Crosby RA1,2, Mena L3, Geter A4, Hickson D3.

• 1College of Public Health at the University of Kentucky, 151 Washington Ave., Lexington, KY, 40506-0003, USA. crosbyr3@gmail.com.
• 2University of Mississippi Medical Center, Jackson, USA. crosbyr3@gmail.com.
• 3University of Mississippi Medical Center, Jackson, USA.
• 4College of Public Health at the University of Kentucky, 151 Washington Ave., Lexington, KY, 40506-0003, USA. 

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Seroadaptive Behaviors of Men Who Have Sex with Men in Myanmar

Serosorting (i.e., choosing partners of the same HIV serostatus to reduce the risk of transmission with unprotected sex) and other forms of seroadaptation (i.e., engaging in diverse behaviors according to a hierarchy of risk by type of sex and partner serostatus) are phenomena widely described for men who have sex with men (MSM) in the developed world. We assessed seroadaptive behaviors among MSM surveyed in Yangon, Myanmar in 2013-2014. 

Among HIV-negative MSM, 

• 43.1 % engaged in some form seroadaptation including 
• serosorting (21.8 %), 
• using condoms with potentially serodiscordant anal sex (19.3 %), and 
• seropositioning (1.7 %). 

Among HIV-positive MSM,

• 3.5 % engaged in serosorting, 
• 36.0 % in using condoms with potentially serodiscordant anal sex, 
• 7.0 % in seropositioning, and 
• 46.5 % in any form of seroadaptation. 

For HIV-negative and HIV-positive MSM, seroadaptation was more common than consistent condom use (38.0 and 26.7 %, respectively). MSM in Myanmar are engaging in seroadaptive behaviors in magnitude and ways similar to MSM in industrialized countries.

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By: Aung T1, Thein ST1, McFarland W2,3.

• 1Population Services International-Myanmar, Yangon, Myanmar.
• 2San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102-6033, USA. willi_mcfarland@hotmail.com.
• 3University of California, San Francisco, San Francisco, CA, USA. willi_mcfarland@hotmail.com.

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Favourable Attitudes Towards Serosorting Are Associated with Overall Less Frequent Condom Use among Young Black Men Having Sex Men

This study determined whether YBMSM endorsing serosorting are less likely to use condoms. 

A questionnaire assessed men's attitudes towards serosorting with a three-item scale; various sexual risk behaviours were measured using a 90-day recall period. Favourable attitudes toward serosorting were associated with a greater likelihood of condomless sex as a top and as a bottom, as well as a lower likelihood of using condoms with main partners. 

Findings suggest that YBMSM having favourable attitudes toward serosorting may be more likely to report condomless sex than their counterparts without favourable attitudes.

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By: Crosby RA, Mena L, Geter A.

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Correlates of Seroadaptation Strategies among Black Men Who have Sex with Men (MSM) in 4 US Cities

We assessed associations of demographic, psychosocial, and substance use factors with seroadaptation strategies among 835 BMSM in four US cities. 

• Seroadaptation strategies were practiced by 59.8% of men, 
• with 10.5% practicing 100% condom use, 
• 26.5% serosorting, 
• 7.2% condom serosorting, 
• and 15.6% seropositioning. 

In multivariable analyses, compared to men who used no seroadaptation strategies, serosorters were older, were less likely to be HIV infected, had fewer male sex partners, and had higher levels of social support and sexual self-efficacy. 

Condom serosorters had less psychological distress, were more likely to use methamphetamine, and had higher levels of sexual self-efficacy. 

Seropositioners were older, were less likely to be HIV infected, to have a main partner, and report alcohol/drug use with sex, while having higher levels of sexual self-efficacy. 

Seroadaptation practices among BMSM need to be considered to address perceived safer sex strategies and strengthen access to a broader reach of culturally-relevant prevention efforts.

Via: http://ht.ly/SsPgH   Purchase full article at: http://goo.gl/iwP9ua

By: Wilton L1,2, Koblin B3, Nandi V3, Xu G3, Latkin C4, Seal D5, Flores SA6, Spikes P6.

• 1Department of Human Development, State University of New York at Binghamton, 4400 Vestal Parkway East, Binghamton, NY, 13902, USA
• 2Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
• 3Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA.
• 4Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
• 5Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
• 6National Center for HIV/AIDS, Viral, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.

HIV Serosorting, Status Disclosure, and Strategic Positioning among Highly Sexually Active Gay and Bisexual Men

Researchers have identified harm reduction strategies that gay, bisexual, and other men who have sex with men (GBMSM) use to reduce HIV transmission-including serosorting, status disclosure, and strategic positioning. We report on patterns of these behaviors among 376 highly sexually active (i.e., 9+partners, <90 days) GBMSM: mean age of 37, 49.5% men of color, 87.8% gay identified, 57.5% college educated. 

We found evidence that many men engaged in serosorting, status disclosure, and strategic positioning; however, rates varied based on the participant's HIV status. HIV-positive and HIV-negative men both engaged in sex with men of similar status more often than they engaged in sex with men known to be a different HIV status (i.e., serosorting). However, HIV-negative men disclosed their HIV-status with about half of their partners, whereas HIV-positive participants disclosed with only about one-third. 

With regard to strategic positioning, HIV-positive participants were the receptive partner about half the time with their HIV-negative partners and with their HIV-positive partners. 

In contrast, strategic positioning was very common among HIV-negative participants-they rarely bottomed with HIV-positive partners, bottomed about one-third of the time with status-unknown partners, and 42% of the time (on average) with HIV-negative partners. 

Highly sexually active GBMSM are a critical population in which to both investigate HIV prevention strategies as well as develop effective intervention programs. Providers and clinicians might be well served to include a wide range of behavioral harm reduction strategies in addition to condom use and biomedical approaches to reduce onward HIV transmission.

Via; http://ht.ly/S1GzB 

By: Grov C1,2,3, Rendina HJ1, Moody RL1,4, Ventuneac A1, Parsons JT1,3,5,4,6.

• 11 The Center for HIV/AIDS Educational Studies and Training (CHEST) , New York, New York.
• 22 Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York (CUNY) , Brooklyn, New York.
• 33 CUNY School of Public Health , New York, New York.
• 45 Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY) , New York, New York.
• 54 Department of Psychology, Hunter College of CUNY , New York, New York.
• 66 Basic and Applied Social Psychology Doctoral Program, The Graduate Center of the City University of New York (CUNY) , New York, New York