Objectives: To define and measure the prevalence of HIV seroadaptive behaviors among men who have sex with men (MSM).
Methods: A community-based, cross-sectional sample of 1,211 HIV-negative and 251 HIV-positive MSM was recruited in San Francisco in 2004 by time-location sampling. Seroadaptive behaviors were defined by enumerating and characterizing all episodes of anal intercourse by partner type, partner HIV serostatus, sexual position, and condom use for up to five partners in the preceding six months.
Results: Among HIV-negative MSM, 37.6% engaged in some form of apparent seroadaptive behavior, predominantly pure serosorting (24.7%), followed by seropositioning (5.9%), condom serosorting (3.9%), and negotiated safety (3.1%). Among HIV-positive men, 43.4% engaged in some form of seroadaptation, including pure serosorting (19.5%), seropositioning (14.3%), and condom serosorting (9.6%). Consistent condom use was reported by 37.1% of HIV-negative and 20.7% of HIV-positive MSM.
Conclusions: In aggregate, seroadaptive behaviors appear to be the most common HIV prevention strategy adopted by MSM in San Francisco as of 2004. Surveillance and epidemiological studies need to precisely measure seroadaptive behaviors in order to gauge and track the true level of HIV risk in populations. Rigorous prevention research is needed to assess the efficacy of seroadaptive behaviors on individuals’ risk and on the epidemic.
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