Partner Disclosure of PrEP Use and Undetectable Viral Load on Geosocial Networking Apps

Abstract

Background Recent advances in biomedical prevention strategies, including pre-exposure prophylaxis (PrEP) and achieving an undetectable viral load (UVL) among HIV-infected persons, show promise in curbing the rising incidence of HIV among men who have sex with men (MSM) in the United States. This mixed methods study aimed to investigate the frequency with which MSM encounter potential sex partners on geosocial networking apps who disclose biomedical prevention use, and how MSM make decisions about condom use after these disclosures. Method Participants were recruited via adverstiments placed on a large geosocial networking app for MSM. A total of 668 and 727 participants, respectively, responded to questionnaires assessing partner disclosure of PrEP use and UVL. Each questionnaire included an open-ended item assessing reasons for condomless anal sex (CAS) with partners using biomedical prevention. Results Across both surveys, a majority of respondents encountered potential sex partners who disclosed PrEP use or UVL, and the majority of those who met up with these partners engaged in CAS at least once. Qualitative analyses found that most participants who reported CAS did so after making a calculated risk about HIV transmission. We also describe a novel risk reduction strategy, “biomed-matching,” or having CAS only when both individuals use PrEP or have UVL. We report serostatus differences in both quantitative and qualitative findings. Conclusions Disclosure of PrEP use and UVL is not uncommon among MSM. Many MSM make accurate appraisals of the risks of CAS with biomedical prevention, and mobile apps may aid with disclosing biomedical prevention use.

The limitations of ‘Black MSM’ as a category: Why gender, sexuality, and desire still matter for social and biomedical HIV prevention methods

“…Men most affected by gender-related inequalities because of their feminine presentation may have less leverage to negotiate condom use and may thus benefit significantly from the option of taking PrEP. Studies that have begun to uncover ways in which PrEP affects sexual partnering through processes such as “biomed matching” (Newcomb, Mongrella, Weis, McMillen, & Mustanski, 2015) also need to consider the gendered dimension of sexual sorting processes.…”

Exploring Patterns of Awareness and Use of HIV Pre-Exposure Prophylaxis Among Young Men Who Have Sex with Men

“…The iPrEx, iPrEx OLE, U.S. MSM Safety Study , and PROUD studies found no significant change in sexual risk behaviors among participants (13, 26, 29, 30) with each observing declines in risk behaviors (e.g., number of sex partners, frequency of condomless sex), potentially due to the risk reduction services and regular follow-up provided in the research context (29, 30). Despite these findings, recent PrEP implementation research has reported high rates of STIs in PrEP initiators (25), and other research with MSM has indicated intentions for condomless anal sex while taking PrEP (10, 31). …”

How Different are Men Who Do Not Know Their HIV Status from Those Who Do? Results from an U.S. Online Study of Gay and Bisexual Men

“…In addition, knowing one’s status—whether HIV-positive or HIV-negative—can help an individual to make informed decisions about behavioral strategies to reduce HIV transmission risks [13] such as serosorting [11–17], strategic positioning [14–16, 18], selectively having only oral sex or mutual masturbation [18–20], using condoms with partners who do not share the same HIV status, or “biomed-sorting” [i.e., restricting behaviors to partners who are taking HIV antiretroviral medications—either HIV-positive but have undetectable viral loads, or HIV-negative and taking pre-exposure prophylaxis (PrEP)] [21]. Researchers estimate that eight transmissions would be averted for every 100 persons newly aware of their HIV infection as a result of HIV treatment combined with reductions in risk behavior [22].…”