The Effect of Disclosure of HIV Serostatus on Condom Use Among MSM in Serodiscordant Relationships Open Access

Dunlevy, Megan (Spring 2019)

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Introduction: Men who have sex with men (MSM) are disproportionally affected by the HIV epidemic and 73% of HIV cases diagnosed in 2015 were attributed to male-to-male sexual contact. Reports of condomless anal intercourse reported by MSM are increasing and MSM are less likely than other groups to disclose their HIV status to sexual partners.

Methods: The Engag[ment]t study enrolled 400 HIV-positive men living in Atlanta, Georgia. Participants were enrolled using a modified venue-day-time sampling approach and via advertisements on web platforms frequently used by MSM. Participants completed computer assisted interviews to report number of partners and partner type, number and type of sexual encounters within 6 months of interview, age, marital status, stigma, and other demographics upon enrollment into the study. Laboratory testing was conducted to determine participant viral load. Generalized linear models were used to estimate the association between disclosure of serostatus and condom usage controlling for stigma, exclusive relationships, age, race, avoiding disclosure due to fear of prosecution, level of education, and suppression of viral load using a Poisson regression with generalized estimating equations to account for multiple partnerships for each participant.

Results: This analysis had a sample size of 108 participants with a total of 195 partners after exclusions for HIV-positive status of partners or non-male natal sex of partners. 108 (91.5%) participants reported disclosing to at least one sexual partner and 173 (88.7%) of the partners were disclosed to. Nonexclusive partnerships and participants of African American/Black race were significantly less likely to report condom use for receptive anal intercourse.

Conclusions: Decreased condom use during receptive anal intercourse was associated with serostatus disclosure, higher stigma, nonexclusive partnerships, African American/Black race, avoiding disclosure due to fear of prosecution, and having a suppressed viral load. Age, African American/Black race and avoiding disclosure due to fear of prosecution were associated with decreased condom use during insertive anal intercourse. Higher stigma, nonexclusive partnerships, African American/ Black race and avoiding disclosure due to fear of prosecution were associated with decreased condom use during any type of anal intercourse. 

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