Seroadaptive Strategies of Vancouver Gay and Bisexual Men in a Treatment as Prevention Environment

Abstract

British Columbia’s Treatment as Prevention policy has provided free access to Highly Active Antiretroviral Therapy (HAART) to all HIV-positive provincial residents since 1996. One outcome is an increase in HIV-positive gay and bisexual men (GBM) with suppressed viral loads. Previous cross-sectional analyses indicated that some Vancouver GBM now recognize condomless anal sex with men on HAART who report a suppressed viral load as a sero-adaptive strategy. To test the hypothesis that this new strategy, termed viral load sorting (VLS), is recognized and used among by GBM in the Momentum Health Study, we analyzed longitudinal data for HIV-negative/unknown (n=556) and HIV-positive (n=218) sero-status participants. Analyses indicated that both groups reported VLS, and that sero-status and Treatment Optimism Scale scores were significant determinants in frequency and use. Results exemplify the medicalization of sex and Rogers Diffusion of Preventative Innovations, and have important implications for HIV research and GBM sexual decision-making.

Epidemiologic Treatment for Contacts to Neisseria gonorrhoeae and Chlamydia trachomatis Infection in Sexually Transmitted Disease Clinic Patients in Seattle, WA; 1994 to 2018

“…13 This may be due to the recent increase in overuse of azithromycin as part of epidemiologic treatment for MSM, as prior azithromycin use has been associated with a 2-fold increase in minimal inhibitory concentration. 10 At the same time, rates of STDs continue to increase 13 concurrently with increased used of HIV preexposure prophylaxis, which has been associated with a reduction in condom use 20,21 and more sexual partners. 22,23 Exposure to more sexual partners with a lower condom usage rate in sexual networks with higher prevalence of GC/CT will result in more frequent exposure to GC/CT and thus antibiotic exposure through epidemiologic treatment, which may further drive antimicrobial-resistant gonorrhea.…”

Longitudinal Event-Level Analysis of Gay and Bisexual Men’s Anal Sex Versatility: Behavior, Roles, and Substance Use

“…Always using condoms in sero-discordant partnerships is particularly noteworthy in light of ELV having a significantly lower level of overall always using condoms compared to either insertive or receptive anal sex as shown in Table 2 (ALWAYS versatile = 24.6%, ALWAYS insertive/receptive=41.6%, aOR= 0.50, 95% CI = 0.39-0.62, p<0.001). While GBM seroadaptive strategies research increasingly focuses on HAART or PrEP use (Mosley et al, 2018;Roth et al, 2018), contemporary studies also indicate that GBM do not abandon earlier strategies like condom use (Snowden, Wei, McFarland, & Raymond, 2014;Lachowsky et al, 2016b). As such, this study's identification of two sero-adaptive strategies including condoms remains relevant to current HIV education and prevention programs (Otis et al, 2016;Beyrer et al, 2016).…”

Substance Use Patterns of Gay and Bisexual Men in the Momentum Health Study

“…Finally, having sex with a man in the past 6 months as an eligibility criterion meant our sample did not include bisexual men attracted to both men and women or who self-identify as bisexual but did not have sex with a man during this period. Instead, we focused on identifying and analyzing separately bisexual and gay men’s health parameters in a sample that previously lumped both together under the rubric Men Who Have Sex with Men ( Moore et al, 2016 ) or Gay and Bisexual Men ( Roth et al, 2018 ).…”

“…This study analyzes data generated by the Momentum Health Study. Momentum focused primarily on gay men, and previous analyses have not separated gay from bisexual study participants ( Moore et al, 2016 ; Rich et al, 2016 ; Roth et al, 2018 ). Nonetheless, Momentum data have the potential to address the three challenges outlined earlier.…”