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

Khosropour, Christine M. PhD, MPH*; Dombrowski, Julia C. MD, MPH†‡; Katz, David A. PhD, MPH†‡; Golden, Matthew R. MD, MPH*†‡

doi: 10.1097/OLQ.0000000000000677
Original Studies

Background 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.

Methods 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.

Results 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).

Conclusions 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.

A study of sexually transmitted disease male patients who have sex with men in Seattle used a novel, single-question seroadaptive behaviors assessment and found a high risk of HIV among men who reported no seroadaptive behaviors.

From the Departments of *Epidemiology and †Medicine, University of Washington, Seattle, WA; and ‡Public Health–Seattle and King County HIV/STD Program, Seattle, WA

Acknowledgments: The authors thank the men who participated in this study and the front desk staff and clinic staff at the Public Health–Seattle & King County STD clinic. They also thank Shirley Zhang for survey programming support and data management support.

Conflict of Interest and Sources of Funding: M.R.G. has conducted studies unrelated to this work funded by grants from Cempra and Melinta. J.C.D. has conducted studies unrelated to this work funded by grants to the University of Washington from ELITech, Melinta Therapeutics, and Genentech. All other authors declare that they have no conflict of interest. This work was supported by the National Institutes of Health (NIH; Grant R21 AI098497, Grant T32 AI07140 trainee support to C.M.K., and Grants K23MH090923 and L30 MH095060 to J.C.D.) and the University of Washington Center for AIDS Research, an NIH-funded program (Grant P30 AI027757) that is supported by the following NIH institutes and centers: National Institute of Allergy and Infectious Diseases; National Cancer Institute; National Institutes of Mental Health; National Institute on Drug Abuse; National Institute of Child Health and Human Development; National Heart, Lung, and Blood Institute; and National Institute on Aging.

Presentation at meetings: These data were presented in part at the 2015 National HIV Prevention Conference in Atlanta, GA; December 6–9, 2015.

Correspondence: Christine M. Khosropour, PhD, MPH, Department of Epidemiology, Harborview Medical Center, Box 359777, 325 Ninth Ave, Seattle, WA 98104. E-mail:

Received for publication December 23, 2016, and accepted June 15, 2017.

© Copyright 2017 American Sexually Transmitted Diseases Association