Serosorting vs Condom Use: HIV Prevention Among Men Who Have Sex With Men

Among men who have sex with men (MSM), an increased knowledge of HIV and preexposure prophylaxis (PrEP) was significantly associated with lower likelihood of condom use with partners with lower HIV transmission risk, according to study results published in AIDS Care.  Condom use was also associated with sociodemographic characteristics, such as age, race, and education.

From 2014 to 2018, more than 58.6% of new HIV cases in Florida were among MSM, and the largest burden of incidence was among racial or ethnic minorities. “Despite condom use efficacy, some sexually active MSM use serosorting as a method of HIV protection,” the study authors noted.

To address the need for additional information about prevention strategies, a team of investigators aimed to determine the differences between partner serostatus and likelihood of condom use, and to identify variables that influence condom use likelihood with carrying serostatus partners.

Study authors collected data via an online cross-sectional survey. Participation eligibility included being aged 18 years or older, assigned male at birth, previous PrEP awareness, sexual attraction to men, and Florida residency.

The final sample included 150 men (mean age, 31.1 years). Of the participants whose information were available, 71 men were non-Hispanic White, 10 men were non-Hispanic Black, and 45 men were Hispanic. Of the cohort, the majority of participants had either some college or a 2-year degree (41.3%), or a 4-year degree (37.3%). HIV status was categorized as either negative on PrEP (27.1%), negative not on PrEP (68.8%), or positive (4.2%); 6 participant responses were missing or unanswered. The majority of participants (69.0%) self-reported having 2 or more sex partners in the past 12 months.

Study results indicated that increased age was significantly associated with increased likelihood of condom use with a partner on PrEP vs a partner who is HIV-negative and not on PrEP (P =.014), a partner with unknown HIV status (P =.013), and a partner with HIV-positive status (P =.045).

The primary finding was that individuals were less likely to use condoms with partners on PrEP compared with any other serostatus; however, variations in condom use likelihood did not significantly vary by participant PrEP use. These findings may be influenced by partner PrEP use instead of participant’s self-PrEP use. 

Regardless of PrEP or viral load, condom use is still recommended, as it provides additional protection against HIV and other sexually transmitted infections.

“Future studies on serosorting behaviors should include partner-specific factors related to condom use likelihood. These results may provide insight for future condom

use and serosorting interventions,” the authors concluded.

Reference

Alagrin AB, Shrader CH, Hackworth BT, Ibanez GE. Condom use likelihood within the context of PrEP and TasP among men who have sex with men in Florida: a short report. AIDS Care. Published online February 10, 2021. doi:10.1080/09540121.2021.1883513