title: Examining levels of risk behaviors among black men who have sex with Men (MSM) and the association with HIV acquisition.
abstract: Seroadaptation is defined as the practice of modifying sexual behavior based on one's own HIV serostatus, the perceived HIV serostatus of sexual partners, and differences in risk of HIV transmission by sexual acts. Because this definition implies intent, we use the term "seroprotection" to describe HIV negative participants reporting condomless anal sex (CAS) either exclusively with seronegative partners, or only as the insertive partner with HIV positive or unknown serostatus partners. Little is known about seroprotection in Black men who have sex with men (MSM). We evaluated the independent association of seroprotection and HIV acquisition among the 1144 HIV-negative Black MSM enrolled in HPTN 061 using Cox models; we stratified by city of enrollment, and controlled for number of partners, age, and drug use. Behaviors reported at 0, 6, and 12 months were assigned to three mutually exclusive categories: (1) No CAS; (2) Seroprotection; and (3) CAS without seroprotection. In 2,861 six-month intervals; 28 HIV seroconversions occurred. No CAS was reported at 33.3% of visits, seroprotection at 46.6% of visits, and CAS without seroprotection at 20.1% of visits. The seroconversion rate per 100 person-years for no CAS was 0.98 (95% CI: 0.27, 2.51), compared with 2.39 (95% CI: 1.03, 4.71) and 13.33 (95% CI: 7.62, 21.66) for seroprotection and CAS without seroprotection, respectively. Compared to CAS without seroprotection, intervals without CAS were associated with an 87% reduction (aHR: 0.13, 95% CI: 0.03-0.46) in HIV acquisition and intervals with seroprotection with a 78% reduction (aHR: 0.22, 95% CI: 0.09-0.57). No CAS is the safest behavior to prevent HIV acquisition. Seroprotective behaviors significantly reduced risk, but HIV incidence was still >2/100 person-years, suggesting that additional strategies, such as pre-exposure prophylaxis, are warranted for this population.
authors: Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, United States of America; Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America.
authors: Risha
authors: R
authors: Irvin
authors: Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America.
authors: Snigdha
authors: S
authors: Vallabhaneni
authors: Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America.
authors: Hyman
authors: H
authors: Scott
authors: Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles (UCLA), Los Angeles, California, United States of America.
authors: John K
authors: JK
authors: Williams
authors: Department of Human Development, Binghamton University, Binghamton, New York, United States of America; Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa.
authors: Leo
authors: L
authors: Wilton
authors: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America.
authors: Xin
authors: X
authors: Li
authors: Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America.
authors: Susan
authors: S
authors: Buchbinder
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012309:Risk-Taking; D055815:Young Adult