Serosorting

Abstract: In 2006, Millett published a seminal literature review that examined 12 hypotheses to explain the high rates of HIV among black MSM. This paper augments Millett's article by reviewing the recent literature on behavioral, biomedical, structural, social contextual, psychosocial, and social network factors that affect HIV rates among black MSM. We searched three databases: PubMed, Scopus, and Google Scholar. First we searched all articles that included black or African American and MSM and HIV. We then searched the following terms for each area: behavioral (drug use during sex, crack cocaine use, and serosorting); biomedical (circumcision, STDs, and STIs); structural (access to care, HIV care, ART, HAART, patient-provider communication, HIV quality of care); social contextual (stigma, discrimination, internalized homophobia, internalized heterosexism, medical mistrust, social isolation, and incarceration); psychosocial (peer support and mental health); and social network (sexual mixing, partner characteristics, and social networks) factors. We identified 39 articles to include in this review. We found inconclusive evidence that incarceration, stigma, discrimination, social isolation, mental health disparities, or social networks explain the elevated rates of HIV among black MSM. We found evidence that the differences in rates of HIV between black and white MSM may be explained by differences in STIs, undiagnosed seropositivity, access to care and treatment services, and use of HAART. There is an overwhelming need for HIV testing, linkage to care, retention in care, and adherence programs for black MSM.

Abstract: Objective: To test the safety of the 'negotiated safety' strategy - the strategy of dispensing with condoms within HIV-seronegative concordant regular sexual relationships under certain conditions. Method: Data from a recently recruited cohort of homosexually active men (Sydney Men and Sexual Health cohort, n = 1037) are used to revisit negotiated safety. The men were surveyed using a structured questionnaire and questions addressing their sexual relationships and practice, their own and their regular partner's serostatus, agreements entered into by the men concerning sexual practice within and outside their regular relationship, and contextual and demographic variables. Results: The findings indicate that a significant number of men used negotiated safety as an HIV prevention strategy. In the 6 months prior to interview, of the 181 men in seroconcordant HIV-negative regular relationships, 62% had engaged in unprotected anal intercourse within their relationship, and 91% (165 men) had not engaged in unprotected anal intercourse outside their relationship. Of these 165 men, 82% had negotiated agreements about sex outside their relationship. The safety of negotiation was dependent not only on seroconcordance but also on the presence of an agreement; 82% of the men who had not engaged in unprotected anal intercourse outside their regular relationship had entered into an agreement with their partner, whereas only 56% of those who had engaged in unprotected anal intercourse had an agreement. The safety of negotiation was also related to the nature of the safety agreement reached between the men and on the acceptability of condoms. Agreements between HIV-negative seroconcordant regular partners prohibiting anal intercourse with casual partners or any form of sex with a casual partner were typically complied with, and men who had such negotiated agreements were at low risk of HIV infection. Conclusions: The adoption of the strategy of negotiated safety among men in HIV-seronegative regular relationships may help such men sustain the safety of their sexual practice.

Abstract: Objective: To integrate the empirical findings on the prevalence of unprotected anal intercourse (UAI) among HIV-diagnosed men who have sex with men (MSM) in the United States. Methods: Comprehensively searching MEDLINE, EMBASE, PsycINFO (2000–2007), hand searching bibliographic lists, and contacting researchers. Thirty US studies (n = 18 121) met selection criteria. Analyses were conducted using random-effects models and meta-regression. Results: The prevalence of UAI was considerably higher with HIV-seropositive partners (30%; 95% confidence interval 25–36) than with serostatus unknown (16%; 95% confidence interval 13–21) or HIV-seronegative partners (13%; 95% confidence interval 10–16). The prevalence of UAI with either a serostatus unknown or HIV-seronegative partner was 26%. The UAI prevalence did not differ by the length of the behavioral recall window but did vary by the type of anal intercourse (insertive vs. receptive). Studies with the following features had a lower UAI prevalence: recruiting participants before 2000, MSM of color being the majority of study sample, recruiting participants from medical settings, using random or systematic sampling methods, and having interviewers administer the questionnaire. Being on antiretroviral therapy, having an undetectable viral load, and reporting more than 90% medication adherence were not associated with UAI. Conclusion: Most HIV-diagnosed MSM protect partners during sexual activity, but a sizeable percentage continues to engage in sexual behaviors that place others at risk for HIV infection and place themselves at risk for other sexually transmitted infections. Prevention with positives programs continues to be urgently needed for MSM in the United States.

Abstract: The aim of this analysis was to examine gay men's sexual risk practice to determine patterns of risk management Ten cross-sectional surveys of gay men were conducted six-monthly from February 1996 to August 2000 at Sydney gay community social, sex-on-premises and sexual health sites (average n = 827) Every February during this period, five identical surveys were conducted at the annual Gay and Lesbian Mardi Gras Fair Day (average n = 1178) Among the minority of men who had unprotected anal intercourse which involved ejaculation inside with a serodiscordant regular partner, there was a clear pattern of sexual positioning Few regular couples were both receptive and insertive Most HIV-positive men were receptive and most HIV-negative men were insertive Among the minority of men who had unprotected anal intercourse which involved ejaculation inside with casual partners, there was also a pattern of sexual positioning Whereas many casual couples were both receptive and insertive (especially those involving HIV-positive respondents), among the remainder HIV-positive men tended to be receptive and HIV-negative men tended to be insertive These patterns of HIV-positive/receptive and HIV-negative/insertive suggest strategic risk reduction positionings rather than mere sexual preferences among a minority of gay men If so, they point not to complacency but to an ever more complex domain of HIV prevention