Safer sex strategies as risk reduction: Use of Latent Class Analysis approach to examine use of safe sex strategies among gay, bisexual and men who have sex with men in Toronto, Canada

Background: Safe sex strategies such as refusing condomless anal sex (CAS), serostatus disclosure, and strategic positioning, have been identified as HIV prevention strategies among men who have sex with men (MSM). Using Latent Class Analysis (LCA), we examined patterns of strategies used and factors associated with these.

Methods: Using data from 470 MSM recruited in Toronto, we calculated posterior probability of being in a class using 5 different strategies. Simultaneously, we fit a multinomial regression model to differentiate MSM within each class by personal, psychological and behavioral characteristics. We used Entropy, the Bayesian information criterion and the Lo-Mendel-Rubin likelihood ratio test to identify the best fit model.

Results: Fit indices suggested a three class solution. Almost half (44%) the sample reported consistently low use of any strategy and 33% reported inconsistent use of strategies. Further, 23% reported higher probability of consistent use of: seeking information to avoid CAS, discussing HIV status, carrying condoms, and engaging in less risky sexual acts. Participants in the safest sex class were more likely to be younger and report higher hope. Conversely, they were less likely to be married/in a relationship and to use substances before/during sex compared to other class participants.  

Conclusion: LCA identified distinct classes of safe sex strategies used by MSM and factors characterizing these classes. Findings show the importance of tailoring interventions to an individual MSM’s pattern of safer sex strategies. Age-specific, substance use-centered, and couples-based tailored interventions focusing on adoption of, and consistent utilization of safer sex strategies are needed.