Abstract
Data from 635 very poor men who have sex with men (MSM) were used to identify seroadaptation with 1,102 male partners reported between 2005 and 2007 in Los Angeles as part of the Sexual Acquisition and Transmission of HIV Cooperative Agreement Program. The mean age of the sample was 41.7 years; 53 % had experienced homelessness in the past year. Condoms were reported in 51 % of sexual events involving anal intercourse. HIV seroconcordance was reported in 41 % of sexual partnerships among HIV-positive participants. HIV-positive men were more likely to have oral-only or unprotected receptive anal intercourse and less likely to have unprotected insertive anal intercourse with HIV-negative or unknown partners compared to HIV-positive partners. Even in the face of poverty, HIV-positive MSM report mitigating risks of HIV-transmission though seroadaptation in the context of modest rates of condom use.
References
Snowden JM, Raymond HF, McFarland W. Prevalence of seroadaptive behaviours of men who have sex with men, San Francisco, 2004. Sex Transm Infect. 2009;85(6):469–76.
Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300(5):520–9.
Snowden JM, Raymond HF, McFarland W. Seroadaptive behaviours among men who have sex with men in San Francisco: the situation in 2008. Sex Transm Infect. 2011;87(2):162–4.
HIV Epidemiology Program, Los Angeles County Department of Public Health. An Epidemiologic Profile of HIV and AIDS in Los Angeles County, 2009. http://publichealth.lacounty.gov/wwwfiles/ph/hae/hiv/2009-epi.pdf. Accessed 22 March 2012.
Siconolfi DE, Moeller RW. Serosorting. BETA. 2007;19(2):45–9.
Van de Ven P, Kippax S, Crawford J, Rawstorne P, Prestage G, Grulich A, et al. In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care. 2002;14(4):471–80.
Kippax S, Race K. Sustaining safe practice: twenty years on. Soc Sci Med. 2003;57(1):1–12.
Vittinghoff E, Douglas J, Judson F, McKirnan D, MacQueen K, Buchbinder SP. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. Am J Epidemiol. 1999;150(3):306–11.
Parsons JT, Schrimshaw EW, Wolitski RJ, Halkitis PN, Purcell DW, Hoff CC, et al. Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation. AIDS. 2005;19(Suppl 1):S13–25.
van den Boom W, Stolte I, Sandfort T, Davidovich U. Serosorting and sexual risk behaviour according to different casual partnership types among MSM: the study of one-night stands and sex buddies. AIDS Care. 2011;27(12):1311–6.
McFarland W, Chen YH, Nguyen B, Grasso M, Levine D, Stall R, et al. Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use. AIDS Behav. 2011;16(1):121–31.
McFarland W, Chen YH, Raymond HF, Nguyen B, Colfax G, Mehrtens J, et al. HIV seroadaptation among individuals, within sexual dyads, and by sexual episodes, men who have sex with men, San Francisco, 2008. AIDS Care. 2011;23(3):261–8.
Wei C, Raymond HF, Guadamuz TE, Stall R, Colfax GN, Snowden JM, et al. Racial/Ethnic differences in seroadaptive and serodisclosure behaviors among men who have sex with men. AIDS Behav. 2011;15(1):22–9.
Cassels S, Menza TW, Goodreau SM, Golden MR. HIV serosorting as a harm reduction strategy: evidence from Seattle Washington. AIDS. 2009;23(18):2497–506.
Philip SS, Yu X, Donnell D, Vittinghoff E, Buchbinder S. Serosorting is associated with a decreased risk of HIV seroconversion in the EXPLORE study cohort. PLoS ONE. 2010;5(9):e12662.
Heymer KJ, Wilson D. Available evidence does not support serosorting as an HIV risk reduction strategy. AIDS. 2010;24(6):935–6.
Eaton LA, Kalichman SC, O’Connell DA, Karchner WD. A strategy for selecting sexual partners believed to pose little/no risks for HIV: serosorting and its implications for HIV transmission. AIDS Care. 2009;21(10):1279–88.
Golden MR, Stekler J, Hughes JP, Wood RW. HIV serosorting in men who have sex with men: is it safe? J Acquir Immune Defic Syndr. 2008;49(2):212–8.
Pinkerton SD, Acute HIV. Infection increases the dangers of serosorting. Am J Prev Med. 2008;35(2):184.
Butler DM, Smith DM. Serosorting can potentially increase HIV transmissions. AIDS. 2007;21(9):1218–20.
Marks G, Millett GA, Bingham T, Lauby J, Murrill CS, Stueve A. Prevalence and protective value of serosorting and strategic positioning among black and latino men who have sex with men. Sex Transm Dis. 2010;37(5):325–7.
McFarland W, Chen YH, Nguyen B, Grasso M, Levine D, Stall R, et al. Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use. AIDS Behav. 2012;16(1):121–31.
Jin F, Prestage GP, Ellard J, Kippax SC, Kaldor JM, Grulich AE. How homosexual men believe they became infected with HIV: the role of risk-reduction behaviors. J Acquir Immune Defic Syndr. 2007;46(2):245–7.
Parsons JT, Severino J, Nanin J, Punzalan JC, von Sternberg K, Missildine W, et al. Positive, negative, unknown: assumptions of HIV status among HIV-positive men who have sex with men. AIDS Educ Prev. 2006;18(2):139–49.
Zablotska IB, Imrie J, Prestage G, Crawford J, Rawstorne P, Grulich A, et al. Gay men’s current practice of HIV seroconcordant unprotected anal intercourse: serosorting or seroguessing? AIDS Care. 2009;21(4):501–10.
German D, Sifakis F, Maulsby C, Towe VL, Flynn CP, Latkin CA, et al. Persistently high prevalence and unrecognized HIV infection among men who have sex with men in Baltimore: the BESURE study. JAIDS. 2011;57(1):77–87.
Gorbach PM, Weiss RE, Jeffries R, Javanbakht M, Drumright LN, Daar ES, et al. Behaviors of recently HIV-infected men who have sex with men in the year postdiagnosis: effects of drug use and partner types. J Acquir Immune Defic Syndr. 2011;56(2):176–82.
Marcus U, Schmidt AJ, Hamouda O. HIV serosorting among HIV-positive men who have sex with men is associated with increased self-reported incidence of bacterial sexually transmissible infections. Sex Health. 2011;8(2):184–93.
Truong HM, Kellogg T, Klausner JD, Katz MH, Dilley J, Knapper K, et al. Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting? Sex Transm Infect. 2006;82(6):461–6.
Tieu HV, Xu G, Bonner S, Spikes P, Egan JE, Goodman K, et al. Sexual partner characteristics, Serodiscordant/Serostatus unknown unprotected anal intercourse and disclosure among human immunodeficiency virus-infected and uninfected black men who have sex with men in New York City. Sex Transm Dis. 2011;42(3):370–80.
Xia Q, Osmond DH, Tholandi M, Pollack LM, Zhou W, Ruiz JD, et al. HIV prevalence and sexual risk behaviors among men who have sex with men: results from a statewide population-based survey in California. J Acquir Immune Defic Syndr. 2006;41(2):238–45.
Lieb S, Prejean J, Thompson DR, Fallon SJ, Cooper H, Gates GJ, et al. HIV prevalence rates among men who have sex with men in the southern United States: population-based estimates by Race/Ethnicity. AIDS Behav. 2010;23(4):210–23.
Robertson MJ, Clark RA, Charlebois ED, Tulsky J, Long HL, Bangsberg DR, et al. HIV seroprevalence among homeless and marginally housed adults in San Francisco. Am J Public Health. 2004;94(7):1207–17.
Javanbakht M, Murphy R, Harawa NT, Smith LV, Hayes M, Chien M, et al. Sexually transmitted infections and HIV prevalence among incarcerated men who have sex with men, 2000–2005. Sex Transm Dis. 2009;36(2 Suppl):S17–21.
Arriola KR, Braithwaite RL, Kennedy S, Hammett T, Tinsley M, Wood P, et al. A collaborative effort to enhance HIV/STI screening in five county jails. Public Health Rep. 2001;116(6):520–9.
Hixson BA, Omer SB, del Rio C, Frew PM. Spatial clustering of HIV prevalence in Atlanta, Georgia and population characteristics associated with case concentrations. J Urban Health. 2011;88(1):129–41.
Iguchi MY, Ober AJ, Berry SH, Fain T, Heckathorn DD, Gorbach PM, et al. Simultaneous recruitment of drug users and men who have sex with men in the United States and Russia using respondent-driven sampling: sampling methods and implications. J Urban Health. 2009;86(Suppl 1):5–31.
Gorbach PM, Murphy R, Weiss RE, Hucks-Ortiz C, Shoptaw S. Bridging sexual boundaries: men who have sex with men and women in a street-based sample in Los Angeles. J Urban Health. 2009;86(Suppl 1):63–76.
Kushel MB, Colfax G, Ragland K, Heineman A, Palacio H, Bangsberg DR. Case management is associated with improved antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection. Clin Infect Dis. 2006;43(2):234–42.
Moss AR, Hahn JA, Perry S, Charlebois ED, Guzman D, Clark RA, et al. Adherence to highly active antiretroviral therapy in the homeless population in San Francisco: a prospective study. Clin Infect Dis. 2004;39(8):1190–8.
Los Angeles Country Department of Public Health. An epidemiologic profile of HIV and AIDS in Los Angeles country. In: HIV Epidemiology program, Los Angeles Country Department of Public Health; 2009.
Golub SA, Starks TJ, Payton G, Parsons JT. The critical role of intimacy in the sexual risk behaviors of gay and bisexual men. AIDS Behav. 2011;15(3):509–20.
Theodore PS, Duran RE, Antoni MH, Fernandez MI. Intimacy and sexual behavior among HIV-positive men-who-have-sex-with-men in primary relationships. AIDS Behav. 2004;8(3):321–31.
Sullivan PS, Salazar L, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS. 2009;23(9):1153–62.
Davidovich U, de Wit J, Albrecht N, Geskus R, Stroebe W, Coutinho R. Increase in the share of steady partners as a source of HIV infection: a 17-year study of seroconversion among gay men. AIDS. 2001;15(10):1303–8.
Harawa NT, Williams JK, Ramamurthi HC, Bingham TA. Perceptions towards condom use, sexual activity, and HIV disclosure among HIV-positive African American men who have sex with men: implications for heterosexual transmission. J Urban Health. 2006;83(4):682–94.
Walls NE, Bell S. Correlates of engaging in survival sex among homeless youth and young adults. J Sex Res. 2011;48(5):423–36.
Marshall BD, Shannon K, Kerr T, Zhang R, Wood E. Survival sex work and increased HIV risk among sexual minority street-involved youth. J Acquir Immune Defic Syndr. 2010;53(5):661–4.
Haley N, Roy E, Leclerc P, Boudreau JF, Boivin JF. HIV risk profile of male street youth involved in survival sex. Sex Transm Infect. 2004;80(6):526–30.
Burt RD, Hagan H, Sabin K, Thiede H. Evaluating respondent-driven sampling in a major metropolitan area: comparing injection drug users in the 2005 Seattle area national HIV behavioral surveillance system survey with participants in the RAVEN and Kiwi studies. Ann Epidemiol. 2010;20(2):159–67.
Reback CJ, Kamien JB, Amass L. Characteristics and HIV risk behaviors of homeless, substance-using men who have sex with men. Addict Behav. 2007;32(3):647–54.
Robbins JL, Wenger L, Lorvick J, Shiboski C, Kral AH. Health and oral health care needs and health care-seeking behavior among homeless injection drug users in san francisco. J Urban Health. 2010;87(6):920–30.
Palepu A, Milloy MJ, Kerr T, Zhang R, Wood E. Homelessness and adherence to antiretroviral therapy among a cohort of HIV-infected injection drug users. J Urban Health. 2011;88(3):545–55.
Nelson KM, Thiede H, Hawes SE, Golden MR, Hutcheson R, Carey JW, et al. Why the wait? Delayed HIV diagnosis among men who have sex with men. J Urban Health. 2010;87(4):642–55.
Acknowledgments
This study was funded by the National Institute on Drug Abuse Award Number U01DA17394. The project described was supported in part by Award Number T32AA007240, Graduate Research Training on Alcohol Problems, from the National Institute on Alcohol Abuse and Alcoholism. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institute on Alcohol Abuse and Alcoholism or the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Murphy, R.D., Gorbach, P.M., Weiss, R.E. et al. Seroadaptation in a Sample of Very Poor Los Angeles Area Men Who Have Sex with Men. AIDS Behav 17, 1862–1872 (2013). https://doi.org/10.1007/s10461-012-0213-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-012-0213-2