Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current HIV/AIDS Reports
Published in: Current HIV/AIDS Reports 4/2013

01-12-2013 | Behavioral Aspects of HIV Management (RJ DiClemente and JL Brown, Section Editors)

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

Authors: Susan Cassels, David A. Katz

Published in: Current HIV/AIDS Reports | Issue 4/2013

Login to get access

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.
Literature
1.
Snowden JM, Raymond HF, McFarland W. Prevalence of seroadaptive behaviours of men who have sex with men, San Francisco, 2004. Sex Transm Infect. 2009;85:469–76.PubMedCrossRef
2.
3.
Dawson JM, Fitzpatrick RM, Reeves G, Boulton M, McLean J, Hart GJ, et al. Awareness of sexual partners' HIV status as an influence upon high-risk sexual behaviour among gay men. AIDS. 1994;8:837–41.PubMedCrossRef
4.
Marks G, Crepaz N. HIV-positive men's sexual practices in the context of self-disclosure of HIV status. J Acquir Immune Defic Syndr. 2001;27:79–85.PubMed
5.
Hoff CC, Stall R, Paul J, Acree M, Daigle D, Phillips K, et al. Differences in sexual behavior among HIV discordant and concordant gay men in primary relationships. J Acquir Immune Defic Syndr Hum Retrovirol. 1997;14:72–8.PubMedCrossRef
6.
McDaid LM, Hart GJ. Sexual risk behaviour for transmission of HIV in men who have sex with men: recent findings and potential interventions. Curr Opin HIV AIDS. 2010;5:311–5.PubMedCrossRef
7.
•• Vallabhaneni S, Li X, Vittinghoff E, Donnell D, Pilcher CD, Buchbinder SP. Seroadaptive practices: association with HIV acquisition among HIV-negative men who have sex with men. Plos One. 2012;7(10):e45718. This paper provides clear definitions to a number of different forms of seroadaptation. The authors test whether these forms of seroadaptive behaviors may be effective risk reduction strategies, compared with both no seroadaptation strategies or no UAI.
8.
Horvath KJ, Smolenski D, Iantaffi A, Grey JA, Rosser BR. Discussions of viral load in negotiating sexual episodes with primary and casual partners among men who have sex with men. Aids Care. 2012;24:1052–5.PubMedCrossRef
9.
Prestage G, Mao L, Kippax S, Jin F, Hurley M, Grulich A, et al. Use of viral load to negotiate condom use among gay men in Sydney, Australia. Aids Behav. 2009;13:645–51.PubMedCrossRef
10.
Van de Ven P, Mao L, Fogarty A, Rawstorne P, Crawford J, Prestage G, et al. Undetectable viral load is associated with sexual risk taking in HIV serodiscordant gay couples in Sydney. AIDS. 2005;19:179–84.PubMedCrossRef
11.
Mitchell JW. HIV-negative and HIV-discordant gay male couples' use of HIV risk-reduction strategies: differences by partner type and couples' HIV-status. Aids Behav. 2013;17:1557–69.PubMedCrossRef
12.
Darbes LA, Chakravarty D, Beougher SC, Neilands TB, Hoff CC. Partner-provided social support influences choice of risk reduction strategies in gay male couples. Aids Behav. 2012;16:159–67.PubMedCrossRef
13.
Hoff CC, Beougher SC, Chakravarty D, Darbes LA, Neilands TB. Relationship characteristics and motivations behind agreements among gay male couples: differences by agreement type and couple serostatus. Aids Care. 2010;22:827–35.PubMedCrossRef
14.
Hoff CC, Chakravarty D, Beougher SC, Darbes LA, Dadasovich R, Neilands TB. Serostatus differences and agreements about sex with outside partners among gay male couples. AIDS Educ Prev. 2009;21:25–38.PubMedCrossRef
15.
16.
Jin FY, Crawford J, Prestage GP, Zablotska I, Imrie J, Kippax SC, et al. Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS. 2009;23:243–52.PubMedCrossRef
17.
McConnell JJ, Bragg L, Shiboski S, Grant RM. Sexual seroadaptation: lessons for prevention and sex research from a cohort of HIV-positive men who have sex with men. PloS One. 2010;5(1): e8831.
18.
Wei CY, 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;15:22–9.PubMedCrossRef
19.
McFarland W, Chen YH, Raymond HF, Binh N, 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;23:261–8.PubMedCrossRef
20.
Elford J. Changing patterns of sexual behaviour in the era of highly active antiretroviral therapy. Curr Opin Infect Dis. 2006;19:26–32.PubMedCrossRef
21.
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;49:212–8.PubMedCrossRef
22.
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:S13–25.PubMedCrossRef
23.
Truong HHM, 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;82:461–6.PubMedCrossRef
24.
Vallabhaneni S, McConnell JJ, Loeb L, Hartogensis W, Hecht FM, Grant RM, et al. Changes in Seroadaptive practices from before to after diagnosis of recent HIV infection among men who have sex with men. PloS One. 2013;8(2):e55397.
25.
Siegler AJ, Sullivan PS, Khosropour CM, Rosenberg ES. The role of intent in serosorting behaviors among MSM sexual partnerships. J Acq Immune Def Synd. 2013; [ePub ahead of print].
26.
Pearson CR, Walters KL, Simoni JM, Beltran R, Nelson KM. A cautionary tale: risk reduction strategies among urban American Indian/Alaska Native men who have sex with men. AIDS Educ Prev. 2013;25:25–37.PubMedCrossRef
27.
• Murphy RD, Gorbach PM, Weiss RE, Hucks-Ortiz C, Shoptaw SJ. Seroadaptation in a sample of very poor Los Angeles area men who have sex with men. Aids Behav. 2013;17:1862–72. This unique study documented seroadaptive behaviors among low income MSM in Southern California. They propose that these behaviors might suggest evidence of resilience, and thus raise the interesting question about the role of seroadaptive behaviors when there are not other effective HIV preventive options.PubMedCrossRef
28.
Balan IC, Carballo-Dieguez A, Ventuneac A, Remien RH, Dolezal C, Ford J. Are HIV-negative men who have sex with men and who bareback concerned about HIV infection? Implications for HIV risk reduction interventions. Arch Sex Behav. 2013;42:279–89.PubMedCrossRef
29.
Winter AK, Sullivan PS, Khosropour CM, Rosenberg ES. Discussion of HIV status by serostatus and partnership sexual risk among internet-using MSM in the United States. J Acquir Immune Defic Syndr. 2012;60:525–9.PubMedCrossRef
30.
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. 2012;24:167–73.PubMed
31.
Uuskula A, Abel-Ollo K, Markina A, McNutt LA, Heimer R. Condom use and partnership intimacy among drug injectors and their sexual partners in Estonia. Sex Transm Infect. 2012;88:58–62.PubMedCrossRef
32.
Rosenberg J. Association between serosorting and HIV risk differs by race among men with male partners. Perspect Sex Repro H. 2012;44(4):272–3.
33.
•• 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;16:121–31. This paper is one of the first studies to address intentionality in serosorting. They asked about ‘identity-based’ intentions to adopt seroadaptive behaviors at baseline, and compared this with ‘behavior-based’ definitions of seroadaptation at 12-month follow-up.PubMedCrossRef
34.
McDaid LM, Hart GJ. Serosorting and Strategic positioning during unprotected anal intercourse: are risk reduction strategies being employed by gay and bisexual men in Scotland? Sex Transm Dis. 2012;39:735–8.PubMedCrossRef
35.
Jin FY, Prestage GP, Templeton DJ, Poynten IM, Donovan B, Zablotska I, et al. The impact of HIV seroadaptive behaviors on sexually transmissible infections in HIV-negative homosexual men in Sydney, Australia. Sex Transm Dis. 2012;39:191–4.PubMedCrossRef
36.
Hotton AL, Gratzer B, Mehta SD. Association between serosorting and bacterial sexually transmitted infection among HIV-negative men who have sex with men at an urban lesbian, gay, bisexual, and transgender health center. Sex Transm Dis. 2012;39:959–64.PubMedCrossRef
37.
• Golden MR, Dombrowski JC, Kerani RP, Stekler JD. Failure of serosorting to protect African American men who have sex with men from HIV Infection. Sex Transm Dis. 2012;39:659–64. This study finds that serosorting is associated with lower risk of testing positive for HIV among White MSM but not Black MSM. The authors provide a nice discussion as to why serosorting effectiveness might differ by race, and compare their findings with other conflicting results.PubMedCrossRef
38.
Dubois-Arber F, Jeannin A, Lociciro S, Balthasar H. Risk reduction practices in men who have sex with men in Switzerland: serosorting, strategic positioning, and withdrawal before ejaculation. Arch Sex Behav. 2012;41(5):1263–72.
39.
Chen YH, Vallabhaneni S, Raymond HF, McFarland W. Predictors of serosorting and intention to serosort among men who have sex with men, San Francisco. Aids Educ Prev. 2012;24:564–73.PubMedCrossRef
40.
Berg RC. High rates of unprotected sex and serosorting among men who have sex with men: a national online study in Norway. Scand J Public Health. 2012;40:738–45.PubMedCrossRef
41.
Benotsch EG, Hood K, Rodriguez V, Martin AM, Snipes D, Cejka A, et al. Serosorting assumptions and HIV risk behavior in men who have sex with men. Ann Behav Med. 2012;43:S268–S.
42.
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;87:162–4.PubMedCrossRef
43.
Velter A, Bouyssou-Michel A, Arnaud A, Semaille C. Do men who have sex with men use serosorting with casual partners in France? Results of a nationwide survey (ANRS-EN17-Presse Gay 2004). Euro Surveill. 2009;14(47): 1–6.
44.
Fendrich M, Mackesy-Amiti ME, Johnson TP, Pollack LM. Sexual risk behavior and drug use in 2 Chicago samples of men who have sex with men: 1997 vs 2002. J Urban Health. 2010;87:452–66.PubMedCrossRef
45.
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;56:176–82.PubMedCrossRef
46.
Khosropour CM, Golden MR, editors. Challenges and success in recruiting research study participants from an STD Clinic: evidence from a behavioral risk study of MSM in public health—Seattle and King County STD Clinic. UW/FHCRC CFAR Sociobehavioral and Prevention Research Core (SPRC) & Public Health-Seattle & King County Brownbag Series; 2013 May 28.
47.
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;8:184–93.PubMedCrossRef
48.
Redd AD, Quinn TC, Tobian AA. Frequency and implications of HIV superinfection. Lancet Infect Dis. 2013;13:622–8.PubMedCrossRef
49.
Centers for Disease Control. HIV Surveillance—United States, 1981–2008. Morbid Mortal Wkly Rep. 2011;60:689–93.
50.
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;21:1279–88.PubMedCrossRef
51.
Stephenson R, Sullivan PS, Salazar LF, Gratzer B, Allen S, Seelbach E. Attitudes towards couples-based HIV testing among MSM in 3 US cities. Aids Behav. 2011;15 Suppl 1:S80–7.PubMedCrossRef
52.
Wagenaar BH, Christiansen-Lindquist L, Khosropour C, Salazar LF, Benbow N, Prachand N, et al. Willingness of US men who have sex with men (MSM) to participate in Couples HIV Voluntary Counseling and Testing (CVCT). PloS One. 2012;7:e42953.PubMedCrossRef
53.
Buchbinder SP, Vittinghoff E, Heagerty PJ, Celum CL, Seage GR, Judson FN, et al. Sexual risk, nitrite inhalant use, and lack of circumcision associated with HIV seroconversion in men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2005;39:82–9.PubMedCrossRef
54.
Koblin BA, Husnik MJ, Colfax G, Huang YJ, Madison M, Mayer K, et al. Risk factors for HIV infection among men who have sex with men. AIDS. 2006;20:731–9.PubMedCrossRef
55.
Thiede H, Jenkins RA, Carey JW, Hutcheson R, Thomas KK, Stall RD, et al. Determinants of recent HIV infection among Seattle-area men who have sex with men. Am J Public Health. 2009;99 Suppl 1:S157–64.PubMedCrossRef
56.
Philip SS, Yu XS, 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.
57.
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;37:325–7.PubMed
58.
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;14:471–80.PubMedCrossRef
59.
Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health. 2006;96:1007–19.PubMedCrossRef
60.
Oster AM, Wiegand RE, Sionean C, Miles IJ, Thomas PE, Melendez-Morales L, et al. Understanding disparities in HIV infection between black and white MSM in the United States. AIDS. 2011;25:1103–12.PubMedCrossRef
61.
Butler D, Smith D. Serosorting can potentially increase HIV transmissions. AIDS. 2007;21:1218–20.PubMedCrossRef
62.
Cassels S, Menza TW, Goodreau SM, Golden MR. Available evidence does not support serosorting as an HIV risk reduction strategy: author's reply. AIDS. 2010;24:936–8.CrossRef
63.
Heymer KJ, Wilson DP. Available evidence does not support serosorting as an HIV risk reduction strategy. AIDS. 2010;24:935–6.PubMedCrossRef
64.
Wilson DP, Regan DG, Heymer KJ, Jin FY, Prestage GP, Grulich AE. Serosorting may increase the risk of HIV acquisition among men who have sex with men. Sex Transm Dis. 2010;37:13–7.PubMedCrossRef
65.
Cassels S, Menza TW, Goodreau SA, Golden MR. HIV serosorting as a harm reduction strategy: evidence from Seattle, Washington. AIDS. 2009;23:2497–506.PubMedCrossRef
66.
Smith A, Miles I, Le B, Finlayson T, Oster A, DiNenno E. Prevalence and awareness of HIV infection among men who have sex with men—21 cities, United States, 2008. Morbid Mortal Wkly Rep. 2010;59:1201–7.
67.
Carballo-Dieguez A, Frasca T, Balan I, Ibitoye M, Dolezal C. Use of a rapid HIV home test prevents HIV exposure in a high risk sample of men who have sex with men. Aids Behav. 2012;16:1753–60.PubMedCrossRef
68.
Carballo-Dieguez A, Frasca T, Dolezal C, Balan I. Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners? J Sex Res. 2012;49:379–87.PubMedCrossRef
69.
Katz DA, Golden MR, Stekler JD. Use of a home-use test to diagnose HIV infection in a sex partner: a case report. BMC Res Notes. 2012;5:440.PubMedCrossRef
70.
Stekler JD, Swenson PD, Coombs RW, Dragavon J, Thomas KK, Brennan CA, et al. HIV testing in a high-incidence population: is antibody testing alone good enough? Clin Infect Dis. 2009;49:444–53.PubMedCrossRef
71.
Katz DA, Golden MR, Stekler J. Point-of-sex testing: intentions of men who have sex with men to use home-use HIV tests with sex partners. 2012 National Summit on HIV and Viral Hepatitis Diagnosis, Prevention, and Access to Care; November 26–28; Washington, D.C.2012.
72.
Leu CS, Ventuneac A, Levin B, Carballo-Dieguez A. Use of a rapid HIV home test to screen sexual partners: a commentary on Ventuneac, Carballo-Dieguez, Leu, et al. 2009. Aids Behav. 2012;16:1–4.PubMedCrossRef
73.
Ventuneac A, Carballo-Dieguez A, Leu CS, Levin B, Bauermeister J, Woodman-Maynard E, et al. Use of a rapid HIV home test to screen sexual partners: an evaluation of its possible use and relative risk. Aids Behav. 2009;13:731–7.PubMedCrossRef
74.
75.
County PH-SK. Serosorting among gay and bisexual men. In: County PH-SK, editor. Am J Publ Health. Seattle, WA, 2006.
76.
Eaton LA, Cherry C, Cain D, Pope H. A novel approach to prevention for at-risk HIV-negative men who have sex with men: creating a teachable moment to promote informed sexual decision-making. Am J Public Health. 2011;101:539–45.PubMedCrossRef
Metadata
Title
Seroadaptation among Men Who Have Sex with Men: Emerging Research Themes
Authors
Susan Cassels
David A. Katz
Publication date
01-12-2013
Publisher
Springer US
Published in
Current HIV/AIDS Reports / Issue 4/2013
Print ISSN: 1548-3568
Electronic ISSN: 1548-3576
DOI
https://doi.org/10.1007/s11904-013-0188-2

Other articles of this Issue 4/2013

Current HIV/AIDS Reports 4/2013 Go to the issue

HIV/HCV Coinfection (N Terrault, Section Editor)

After the Cure: Management of HCV After Achievement of SVR

Behavioral Aspects of HIV Management (RJ DiClemente and JL Brown, Section Editors)

Interventions to Reduce Alcohol Use among HIV-Infected Individuals: A Review and Critique of the Literature

Behavioral Aspects of HIV Management (RJ DiClemente and JL Brown, Section Editors)

Intergenerational Sex as a Risk Factor for HIV Among Young Men Who Have Sex with Men: A Scoping Review

Behavioral Aspects of HIV Management (RJ DiClemente and JL Brown, Section Editors)

Alcohol Use and Sexual Risk Behaviors among Individuals Infected with HIV: A Systematic Review and Meta-Analysis 2012 to Early 2013

Behavioral Aspects of HIV Management (RJ DiClemente and JL Brown, Section Editors)

Spirituality and Religion among HIV-Infected Individuals

Behavioral Aspects of HIV Management (RJ DiClemente and JL Brown, Section Editors)

Intimate Partner Violence and HIV: A Review
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits