Serosorting is alive and well among gay and bisexual men living with HIV, according to a study published in the journal AIDS and Behavior. For HIV-negative men, pre-exposure prophylaxis (PrEP) was associated with a greater likelihood of both dating men living with HIV and having condomless sex with them.

The findings support what some gay and bi men have reported anecdotally: Access to PrEP and new information about how well HIV treatment not only controls the virus but also prevents onward transmission are opening conversations about sex and intimacy between HIV-positive and HIV-negative men. And it conforms with international studiesshowing that PrEP has opened the door for many men to connect across HIV status.

Steven Goodreau, PhD, of the University of Washington in Seattle, and colleagues used data from the web-based ARTnet study, which gathered data on HIV status, dating, serosorting, PrEP use and viral suppression from 4,512 gay and bisexual men during 2017 and 2018. Participants were at least 15 years old and self-identified as gay or bisexual cisgender men; 72% were non-Hispanic white, 14% were Latino and only 5% were Black. The median age was 34, and most had at least a college education. PrEP and antiretroviral (ARV) treatment use was self-reported.

One in 10 of the men said they were living with HIV, and 87% of them reported being on antiretrovirals for the duration of their relationships; 17% didn’t know their HIV status. A quarter of the HIV-negative men had ever taken PrEP, amounting to more than 2,000 men.

The men had rich love lives, with 13,800 relationships reported among the 4,512 participants—about three each over the past year. Half of those were one-off hookups, 34% were ongoing but casual relationships and 15% were long-term and committed relationships.

The researchers looked at what they called the four stages of HIV status and relationships:

  • HIV status: 84% of participants had ever taken an HIV test, but that overall number is deceiving—only 15% of young people knew their status, but HIV testing rose to near universal levels by age 30. The men living with HIV were no longer tested, for obvious reasons, and 92% of men taking PrEP (which requires regular HIV tests) had been tested in the last two years.
  • Status disclosure: 68% of respondents said they knew their partners’ HIV status. But people in more casual relationships were less likely to know their partners’ status, whether they were taking PrEP or whether they were on ARVs. The researchers said they thought HIV-negative men on PrEP would be less likely to talk about HIV status with partners than men not on PrEP, but they were wrong: Men on PrEP still disclosed their status and knew their partners’ status. Men who didn’t know their own status still knew their partners’ status half the time.
  • Serosorting: Gay and bisexual men living with HIV appeared to continue the practice of serosorting, or having sex with people of the same HIV status. But HIV-negative men taking PrEP were more than two and a half times as likely to be dating someone diagnosed with HIV than those not on PrEP.
  • Sexual behavior: Men on PrEP were more likely to have condomless anal sex with HIV-positive or HIV-negative partners. In this way, they were more like their peers living with HIV than they were like HIV-negative men who weren’t on PrEP. What’s more, men not using PrEP were about as likely to have sex without a condom with HIV-positive partners on ARVs (about 57% of the time) as they were with HIV-positive men who were not taking ARVs (about 53% of the time).

“We note a consistent trend that we did not predict; for all types of respondents, regardless of status or PrEP use, condomless anal sex was most likely to occur with HIV-positive partners,” wrote Goodreau and colleagues. “Of course, the implications for this differ for HIV-positive versus HIV-negative men on or off PrEP.”

Click here to read the study abstract.

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