Seroadaptation and condoms: what are MSM really doing sexually? Glenn de Swardt Programme Manager, Health4Men

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Emma Arnold
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1 Seroadaptation and condoms: what are MSM really doing sexually? Glenn de Swardt Programme Manager, Health4Men

2 Playing in the garden Significant progress made but the divides between HIV prevention and the realities of MSM sexual behaviours continue Biomedical emphasis > PEP, PReP, microbicides, early treatment, TasP, condoms and lubrication But what s really going on in the field in the context of HIV?

3 or is it a jungle out there? Importance of understanding psychosexual dynamics and behaviour What are MSM doing sexually and with whom? What motivates this behaviour? What do MSM want regarding prevention? How do we find out? Listen to clients utilising our different services Consult, focus groups Ask and create safe spaces for feedback

4 The semantics of sementics Getting our terms straight Serosorting Choosing a sexual partner of the same HIV serostatus, often to engage in unprotected sex, in order to reduce the risk of acquiring or transmitting HIV Seroadaptation Adapting sexual practices based on knowledge or perceptions about your own and your partner s (or partners ) HIV status

5 The semantics of sementics Getting our terms straight Serosorting Choosing a sexual partner of the same HIV serostatus, often to engage in unprotected sex, in order to reduce the risk of acquiring or transmitting HIV WHO WE HAVE SEX WITH Seroadaptation Adapting sexual practices based on knowledge or perceptions about your own and your partner s (or partners ) HIV status WHAT SEX WE HAVE

6 The semantics of sementics Getting our terms straight Top / bottom / versatile fucking Barebacking Cruising Viral Load versus Cum Load Anonymous & opportunistic sex Superinfection

7 A peepshow a few initial results Health4Men s current online survey regarding SA MSM sexual health: A safe space for MSM to inform us, augmenting what we already hear from our clients Sexual identity, relationship status, sexual behaviours, group sex, venues, condom use, cruising online, serosorting and seroadaptation, drug use, transactional sex, HCT A few very initial results based on first responses, raw data

8 Last sexual encounter Playing in the jungle

9 A peepshow a few initial results Condom use over previous 6 months: Condom use previous 6/12 (%) Top (%) Btm Every time Most of the time About half the time A few times Never Didn t top / NA 13.5 Didn t bottom / NA 13.5 No answer

10 A peepshow a few initial results Condom use over previous 6 months: Condom use previous 6/12 (%) Top (%) Btm Every time Most of the time About half the time A few times % Never Didn t top / NA 13.5 Didn t bottom / NA 13.5 No answer

11 A peepshow a few initial results Avoided oral exposure to semen: (%) HIV Negative HIV Positive

4 25 Withdrew before ejaculation Did not

12 A peepshow a few initial results Tops withdrawing: (%) HIV Negative HIV Positive Withdrew before ejaculation Did not withdraw Withdrew before ejaculation Did not withdraw

13 A peepshow a few initial results Reported serosorting: (%) HIV Negative HIV Positive

A peepshow a few initial results Cruising online: (%) 100 90 80 70 60 50 Did not use Internet to cruise 40 Did use

14 A peepshow a few initial results Cruising online: (%) Did not use Internet to cruise 40 Did use internet to cruise Single In a relationship with one person In a relationship with more than one person

16 Concerns about serosorting and adaptation strategies Both dependent on knowing 1 your own and 2 your partner s (or partners ) HIV status What % of MSM really know their own status? Most infections occur between a negative partner and a newly infected HIV positive partner who will have a very elevated VL is unlikely to know his own HIV status The viral load in anal fluid (Fuchs E.J et al. J Infect Dis. 2008) Is serosorting a valid strategy for HIV negative MSM?

17 Concerns about serosorting and adaptation strategies Is serosorting a valid strategy for HIV positive MSM? Superinfection the consultants noted that few cases have been reported in the literature and that the risk appears highest soon after seroconversion and may decline over the course of infection indicate limited clinical consequences of superinfection noted the lack of research felt that there is a great deal of public confusion on the risks, and expressed the belief that the medical and prevention communities may have overemphasized the likely risk of superinfections, as well as the severity of its consequences Meeting Summary: Consultation on Serosorting Practices among Men who Have Sex with Men, Centres for Disease Control and Prevention, 2009

18 Consequences of barebacking? Increased rates of unprotected sex among undiagnosed gay men wipe out benefits of diagnosis and HIV treatment van Sighem A et al. Increasing sexual risk behaviour amongst Dutch MSM: mathematical model versus prospective cohort data. AIDS 26, online edition. DOI: 10/1097/QAD.0b013e df9, Higher rates of risky sex, especially among undiagnosed MSM and men who are not taking anti HIV drugs, are offsetting the benefits provided by testing and antiretroviral treatment.

19 Closing comments Prevention initiatives must be based on the reality of MSM s sexual behaviour Biomedical interventions can only be successful if they take account of MSM s complex psychosexual and behavioural dynamics MSM (gay men in particular) are very resourceful explore and capitalise on prevention strategies that have evolved on a grassroots level Should we shift our paradigm from prevention to harm reduction?

20 And finally Health4Men has introduced larger condoms, available in both natural and black following community consultation with MSM

21 Finally Health4Men has introduced larger condoms, available in both natural and black following community consultation with MSM Over the period 1 January 15 August 2012 the Health4Men office in Green Point, Cape Town, distributed condoms and a similar number of water based lubricant sachets to gay venues, shebeens, community clinics, SAPS, municipal staff, tertiary institutions, SWEAT and other NGOs, often via our Ambassadors

22 To participate in the survey or join Health4Men on Facebook

Revised MEN S ATTITUDE SURVEY (the RMAS)

Revised MEN S ATTITUDE SURVEY (the RMAS) VISIT #: Visit Date: As before, this questionnaire is intended to assess and track your attitudes, beliefs and other factors that might influence your sexual and other risky or risk-reduction practices