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 seroadaptive 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) serostatus participants. Analyses indicated that both groups reported VLS, and that serostatus and Treatment Optimism Scale scores were significant determinants in frequency and use. Results exemplify the medicalization of sex and Rogers’ Diffusion Of Preventative Innovations Model, and they have important implications for HIV research and GBM sexual decision-making.

KEYWORDS:

• Treatment as prevention
• seroadaptation
• treatment optimism
• diffusion of preventative innovations

Acknowledgments

We thank our community colleagues at the Health Initiative for Men, YouthCO HIV & HepC Society of BC, Positive Living BC, for their support, as well as research participants for sharing their important life history data with the Momentum Health Study.

Funding

This work was supported by the Canadian Institutes for Health Research [#107544, #HHP134046]; National Institutes for Health, National Institute for Drug Abuse [1R01DA031055-01A1]. DMM is supported by a Scholar Award from the Michael Smith Foundation for Health Research.

Additional information

Funding

This work was supported by the Canadian Institutes for Health Research [#107544, #HHP134046]; National Institutes for Health, National Institute for Drug Abuse [1R01DA031055-01A1]. DMM is supported by a Scholar Award from the Michael Smith Foundation for Health Research.