Seroadaptive practices by partner gender and HIV serostatus among Black men who have sex with men and women (BMSMW)

Background:  Seroadaptive behaviors are used by some MSM/W to reduce HIV risk.

Methods:  Baseline data from a randomized trial of an HIV-prevention intervention for BMSMW were analyzed.  Participants reported HIV serostatus, ascertainment method and sexual practices with up to 2 main male, female, and transgender partners.  Associations were estimated from mixed-effects logistic regression.

Results:  Of 211 participants, 192 (122 HIV-positive, 63 HIV-negative, 7 HIV-unknown status) had ≥ 1 main partner (median 2; IQR 2-4) and reported on 522 partners (242 male, 209 female, 71 transgender).  HIV status was known for 406 (78%) of the partners.  Among known serostatus partners, serostatus was determined by direct assessment (testing together, direct discussion) for 76%; indirect assessment (situational factors, appearance) for 9%; and other/unknown methods for 15%.  HIV-negative men were more likely than HIV-positive men to report seroconcordant partners (OR 2.25; 95% CI 1.24-4.06) and direct methods of serostatus ascertainment (OR 2.34; 95% CI 1.02-5.37), though 40% of HIV-negative men had not been tested in > 6 months. Among HIV-positive men, seroconcordance was associated with unprotected insertive anal intercourse with male (OR 3.17; 95% CI 1.47-6.81) and female (OR 4.17; 95% CI 1.68-10.4) partners.  Unprotected vaginal intercourse was not significantly associated with female partner seroconcordance (OR 2.51; 95% CI 0.79-7.96). Among HIV-negative men, sexual practices did not vary by partner serostatus.

Conclusions:  Strategic positioning with male partners appears among HIV-positive BMSMW.  Infrequent testing among HIV-negative men and indirect assessment of partner serostatus may limit the effectiveness of risk-reduction strategies, even with main partners.