A Single Question to Examine the Prevalence and Protective Effect of Seroadaptive Strategies Among Men Who Have Sex With Men

Abstract

Background Seroadaptive behaviors among men who have sex with men (MSM) are common but ascertaining behavioral information is challenging in clinical settings. To address this, we developed a single seroadaptive behaviors question. Methods MSM aged ≥18 attending an STD clinic in Seattle, Washington, 2013–2015 were eligible for this cross-sectional study. Respondents completed a comprehensive seroadaptive behaviors questionnaire which included a single question that asked HIV-negative MSM to indicate which of 12 strategies they used in the past year to reduce their HIV risk. HIV testing was performed per routine clinical care. We used the kappa statistic to examine agreement between the comprehensive questionnaire and the single question. Results We enrolled HIV-negative MSM at 3,341 (55%) of 6,105 eligible visits. The agreement between the full questionnaire and single question for five behaviors was fair to moderate (kappa values of 0.34 to 0.59). From the single question, the most commonly reported behaviors were: avoiding sex with HIV-positive (66%) or unknown-status (52%) men and using condoms with unknown-status partners (53%); 8% of men reported no seroadaptive behavior. Men tested newly HIV positive at 38 (1.4%) of 2,741 visits. HIV test positivity for the most commonly reported behaviors ranged from 0.8%–1.3%. Men reporting no seroadaptive strategy had a significantly higher HIV test positivity (3.5%) compared to men who reported at least one strategy (1.3%; P=0.02). Conclusions The single question performed relatively well against a comprehensive seroadaptive behaviors assessment and may be useful in clinical settings to identify men at greatest risk of HIV.

Seroadaptive Strategy Patterns of Young Black Gay, Bisexual, and Other Men Who Have Sex With Men in Atlanta, Georgia

“…The incident HIV findings also supported the latent class results: The latent class using the least serosorting strategies (class 3) had the highest incident HIV, and the class using the most serosorting strategies had the lowest incident HIV (class 2). This is similar to other seroadaptive strategy study findings: In a study of MSM not living with HIV by Khosropour et al, 22 MSM reporting no seroadaptive strategy had a significantly higher HIV test positivity at a follow-up clinic visit. These findings indicate that while reported serosorting strategies comprise complex sexual risk profiles, these profiles translate to actual sexual behaviors and HIV risk.…”

“…The single question seroadaptive strategy format has been used and validated in other US studies. 22 They also were asked about current PrEP use ("Are you currently taking anti-HIV medication (pre-exposure prophylaxis or PrEP, eg, Truvada)? ").…”

Temporal Variation in One-Time Partnership Rates Among Young Men Who Have Sex With Men and Transgender Women

“…[3][4][5]17,18 Ascertaining detailed partner-level data is challenging, particularly in clinical settings, because of the complexity of data collection and the length of time required for patients to complete behavioral assessments. Although traditionally our SHC has not collected this type of information, we have recently included a question 19 in our routine behavioral data collection instrument to more accurately monitor the prevalence of these HIV prevention strategies.…”