Gay men's current practice of HIV seroconcordant unprotected anal intercourse: serosorting or seroguessing?

Abstract

We explored seroguessing (serosorting based on the assumption of HIV seroconcordance) and casual unprotected anal intercourse (UAIC) associated with seroguessing. The ongoing Positive Health and Health in Men cohorts, Australia, provided data for trends in seroconcordant UAIC and HIV disclosure to sex partners. In event-level analyses, we used log-binomial regression adjusted for within-individual correlation and estimated prevalence rate ratios (PRRs) and 95% confidence intervals (95% CIs) for the association between the knowledge of a casual partner's seroconcordance and UAIC. UAIC and HIV disclosure significantly increased during 2001–2006. HIV-positive men knew partners were seroconcordant in 54% and assumed it in 13% of sex encounters (42 and 17% among HIV-negative men). Among HIV-positive men, the likelihood of UAIC was higher when a partner's status was known (Adjusted PRR = 5.17, 95% CI: 3.82–7.01) and assumed seroconcordant because of seroguessing (Adjusted PRR = 3.70, 95% CI: 2.56–5.35) compared with unknown. Among HIV-negative men, the likelihood of UAIC was also higher when a partner's status was known (Adjusted PRR = 1.88, 95% CI: 1.58–2.24) and assumed seroconcordant (Adjusted PRR = 2.12, 95% CI: 1.72–2.62) compared with unknown. As levels of UAIC remain high, seroguessing increasingly exposes gay men to the risk of HIV infection. Because both HIV-positive and HIV-negative men often seroguess, education and prevention programs should address the fact that HIV-negative men who engage in UAI due to this practice may be at high risk of HIV infection. HIV prevention should take into account these contemporary changes in behaviors, especially among HIV-negative gay men.

Keywords:

• gay men
• unprotected anal intercourse
• serosorting
• seroguessing
• HIV
• disclosure of serostatus

Acknowledgements

The authors would like to acknowledge the key community partners – the Australian Federation of AIDS Organisations (AFAO), the National Association of People Living with HIV/AIDS (NAPWA), the AIDS Council of New South Wales (ACON) and People Living with HIV/AIDS (PLWHA, NSW) for being instrumental in the establishment of the PH study. Many thanks go to all study participants for sharing their life experiences with the research team. We are also grateful for the financial support which made this study possible. The National Centre in HIV Epidemiology and Clinical Research and the National Centre in HIV Social Research are funded by the Australian Government Department of Health and Ageing. The HIM Cohort study was funded by the National Institutes of Health, a component of the US Department of Health and Human Services (NIH/NIAID/DAIDS: HVDDT Award N01-AI-05395), the National Health and Medical Research Council in Australia (Project grant # 400944), the Australian Government Department of Health and Ageing (Canberra), and the New South Wales Health Department (Sydney). The Sydney Gay Community Periodic Survey and the PH cohort study have been funded by the New South Wales Health Department (Sydney). Iryna B. Zablotska contributed to formulating the research issue and design of this analysis, assumed principal responsibility for data collection, analysis and preparation of the paper. John Imrie, Garrett Prestage, Patrick Rawstorne, June Crawford, Jeff Jin and Susan Kippax contributed to this paper at different stages of study design, data collection and analysis, and assisted with the interpretation of the results and the preparation of the paper. All authors have seen and approved the final version of this paper.