Seroadaptation among Men Who Have Sex with Men: Emerging Research Themes

Abstract

Seroadaptation describes a diverse set of potentially harm-reducing behaviors that use HIV status to inform sexual decision making. Men who have sex with men (MSM) in many settings adopt these practices, but their effectiveness at preventing HIV transmission is debated. Past modeling studies have demonstrated that serosorting is only effective at preventing HIV transmission when most men accurately know their HIV status, but additional modeling is needed to address the effectiveness of broader seroadaptive behaviors. The types of information with which MSM make seroadaptive decisions is expanding to include viral load, treatment status, and HIV status based on home-use tests, and recent research has begun to examine the entire seroadaptive process, from an individual’s intentions to seroadapt to their behaviors to their risk of acquiring or transmitting HIV and other STIs. More research is needed to craft clear public health messages about the risks and benefits of seroadaptive practices.

Infectious and congenital syphilis in Canada, 2010–2015

“…Changing community norms and behaviours as well as new preventive interventions such as pre-exposure prophylaxis (PrEP) might explain this rise. Many MSM have adopted behaviour patterns such as serosorting (choosing to have condomless sex with partners with the same HIV status) or having condomless oral sex, with the intention of decreasing HIV transmission (12,13). However, the lowered condom use might increase the risk of contracting other STIs (13,14).…”

Gonorrhea in Canada, 2010–2015

“…Literature findings show that some MSM have adopted changes in their sexual behaviour, such as seroadaptation, as a harm reduction strategy for HIV infection (25). Seroadaptation includes serosorting, defined as choosing a sexual partner known to be of the same HIV serostatus to engage in unprotected sex, in order to reduce the risk of acquiring or transmitting HIV (25).…”

“…Seroadaptation includes serosorting, defined as choosing a sexual partner known to be of the same HIV serostatus to engage in unprotected sex, in order to reduce the risk of acquiring or transmitting HIV (25). However, these behaviours potentially increase their risk of contracting other STIs (25,26). Another factor that may explain the increased rates in males would be the fact that gonorrhea tends to be symptomatic more often in males than in females, which may motivate men to seek health care more often, and consequently, get diagnosed (23).…”

"No quiero que me rechacen”: Experiencias sobre la revelación del estado serológico a las parejas sexuales en hombres VIH-positivos que tienen sexo con hombres

“…La "seroadaptación" describe un conjunto diverso de conductas que potencialmente reducen el riesgo y que utilizan el seroestatus del VIH para tomar decisiones sexuales (Cassels y Katz, 2013). La "seroadaptación" incluye el "serosorting" (selección de parejas sexuales para tener sexo sin condón con la suposición de tener el mismo estado serológico, o para usar condón con parejas serodiscordantes) y el "seroposicionamiento" (adopción de los roles sexuales insertivo o receptivo durante la penetración anal sin condón, de tal forma que se minimiza el riesgo de transmisión en relaciones serodiscordantes o serodesconocidas), estrategias de reducción de riesgos que utilizan algunos hombres VIH-positivos para gestionar el riesgo sexual y que han sido identificadas en países con altos ingresos (Dubois-Arber, Jeannin, Lociciro y Balthasar, 2012; Marcus, Schmidt y Hamouda, 2011; Snowden, Raymond y McFarland, 2011; Velter, Bouyssou, Arnaud y Semaille, 2009).…”