A Single Question to Examine the Prevalence and Protective Effect of Seroadaptive Strategies Among Men Who Have Sex With Men.

Abstract

Seroadaptive behaviors among men who have sex with men (MSM) are common, but ascertaining behavioral information is challenging in clinical settings. To address this, we developed a single seroadaptive behavior question. Men who have sex with men 18 years or older attending a sexually transmitted disease clinic in Seattle, WA, from 2013 to 2015, were eligible for this cross-sectional study. Respondents completed a comprehensive seroadaptive behavior questionnaire which included a single question that asked HIV-negative MSM to indicate which of 12 strategies they used in the past year to reduce their HIV risk. HIV testing was performed per routine clinical care. We used the κ statistic to examine agreement between the comprehensive questionnaire and the single question. We enrolled HIV-negative MSM at 3341 (55%) of 6105 eligible visits. The agreement between the full questionnaire and single question for 5 behaviors was fair to moderate (κ values of 0.34-0.59). From the single question, the most commonly reported behaviors were as follows: avoiding sex with HIV-positive (66%) or unknown-status (52%) men and using condoms with unknown-status partners (53%); 8% of men reported no seroadaptive behavior. Men tested newly HIV positive at 38 (1.4%) of 2741 visits. HIV test positivity for the most commonly reported behaviors ranged from 0.8% to 1.3%. Men reporting no seroadaptive strategy had a significantly higher HIV test positivity (3.5%) compared with men who reported at least 1 strategy (1.3%; P = 0.02). The single question performed relatively well against a comprehensive seroadaptive behaviors assessment and may be useful in clinical settings to identify men at greatest risk for HIV.