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(2018). Reducing Risk: Counseling HIV-Infected Men Who Have Sex With

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(2018). Reducing Risk: Counseling HIV-Infected Men Who Have Sex With Social Work in Public Health ISSN: 1937-1918 (Print) 1937-190X (Online) Journal homepage: http://www.tandfonline.com/loi/whsp20 Reducing Risk: Counseling Men Infected with HIV Who Have Sex with Men on Safer Sex Practices with Seroconcordant Partners Christopher W. Blackwell To cite this article: Christopher W. Blackwell (2018) Reducing Risk: Counseling Men Infected with HIV Who Have Sex with Men on Safer Sex Practices with Seroconcordant Partners, Social Work in Public Health, 33:5, 271-279, DOI: 10.1080/19371918.2018.1454869 To link to this article: https://doi.org/10.1080/19371918.2018.1454869 Published online: 10 Apr 2018. Submit your article to this journal Article views: 32 View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=whsp20 SOCIAL WORK IN PUBLIC HEALTH 2018, VOL. 33, NO. 5, 271–279 https://doi.org/10.1080/19371918.2018.1454869 Reducing Risk: Counseling Men Infected with HIV Who Have Sex with Men on Safer Sex Practices with Seroconcordant Partners Christopher W. Blackwell College of Nursing, University of Central Florida, Orlando, Florida, USA ABSTRACT KEYWORDS The incidence of new HIV infections in the United States continues to be AIDS; bisexual; gay; HIV; greatest among men who have sex with men (MSM). MSM infected with HIV men who have sex with often seek seroconcordant sexual partners based on intent to limit psychoso- men; risk; seroconcordant; cial, legal, and health risks they perceive as higher with serodiscordant sexual sexually transmitted disease; superinfection partners. However, the rationales for limiting sexual relationships exclusively with other MSM infected with HIV may be rooted in misinformation or mis- perception. Thus, these clients may have a unique sexual health knowledge deficit that nurses, social workers, and other clinicians need to address to help them reduce risk. This article focuses on sexually related health risks that are distinct to MSM infected with HIV seroconcordant partners. Data on the most recent HIV-infection incidence rates in MSM in the United States is provided. Discussion concentrates on the risk these individuals may have in communi- cating and acquiring sexually transmitted diseases other than HIV, the risk of HIV superinfection, and how sexually transmitted diseases affect persons who are immunocompromised differently than those who are immunocompetent. Finally, recommendations for healthcare professionals who counsel MSM infected with HIV in sexual decision making is provided. Introduction Incidence rates of new HIV infections among men who have sex with men in the United States The most recent data from the Centers for Disease Control and Prevention (CDC; 2017b) indicate men who have sex with men (MSM) continue to supply the greatest number of new HIV infections in the United States. These data, compiled in 2015, emphasize that HIV remains a major health disparity in MSM. MSM constituted 82% of all new infections of HIV in males; and MSM made up 67% of total new diagnoses (CDC, 2017b). Male-to-male sexual contact was identified as the mode of transmission among 26,375 adult and adolescent males who are newly infected, with an additional 1,202 cases in MSM who also reported injection drug use (CDC, 2017b). In addition to the higher risk of HIV infection among these sexual minorities, race has also been found to be a major confounding variable. Although new infections in White MSM dropped by 18% between 2005 and 2014, rates in Latino MSM rose by 24% during this same time period (CDC, 2017b). In African American (AA) MSM, rates increased by 22%, though by only 1%, over the last 5 years of the data collection period, suggesting a leveling off of new infections in AA MSM (CDC, 2017b). These statistics stress that interventions aimed at reducing transmission of HIV in MSM should remain a high public health priority. Preexposure prophylactic therapy (PrEP) is a new emerging prevention strategy involving daily use of emtricitabine/tenofovir (Truvada®) by MSM who are HIV seronegative as a regimen to prevent infection (Blackwell, 2014). Clinical studies suggest this can decrease chances of infection CONTACT Christopher W. Blackwell [email protected] College of Nursing, University of Central Florida, 12001 Research Parkway #300, Orlando, FL 32826-2210. © 2018 Taylor & Francis 272 C. W. BLACKWELL in these men by up to 90% (Blackwell, 2014; CDC, 2017c). Although there are longstanding public health campaigns focusing on the reduction of transmission of HIV by accentuating safer sexual behaviors by MSM, social science literature is largely void of information about serosorting of partners by MSM to reduce risk of communication of HIV. A 2015 article by Blackwell did describe the positive and negative implications of this risk avoidance strategy in HIV seronegative MSM. The goal of this work is to expand this discussion to include an examination of the pros and cons of serosorting among MSM who are HIV seropo- sitive. These MSM often engage in limiting their sexual relationships to other MSM who are seropositive with the intent to limit psychosocial, legal, and health risks they perceive as higher with sexual partners who are serodiscordant. Data suggest MSM who are HIV seropositive use CD4 counts and HIV-RNA levels as determi- nants for use of condoms during anal intercourse (Halkitis, Wilton, Parsons, & Hoff, 2004). Suzan- Monti and associates (2011) also found MSM who are HIV seropositive who experience virologic success were more likely to have a steady serodiscordant sexual partner. Lower perceived risk of HIV reinfection, lower behavioral intentions for condom use, and higher CD4 counts were predictive of MSM who are HIV seropositive engaging in unprotected anal intercourse with a primary sex partner infected with HIV(Halkitis et al., 2004). To achieve the objectives of this article, an extensive literature review was completed, concentrat- ing on data that examined the risks seroconcordant MSM infected with HIV may have during sexual activity. These studies examined communication and acquisition of sexually transmitted diseases other than HIV, the risk of HIV superinfection, and how sexually transmitted diseases affect persons who are immunocompromised differently than those who are immunocompetent. Finally, the literature was appraised to determine specific, evidence-based strategies for healthcare professionals to utilize when counseling MSM infected with HIV in sexual decision making. Characteristics of sexual decision making in seroconcordant MSM infected with HIV Research suggests MSM who are HIV seropositive have different health risks, based on differing sexual behaviors, than those who are HIV seronegative. Serosorting (restricting sexual partners who share the same identified HIV serostatus) is one described risk reduction activity among seronegative and seropositive MSM who are affected by HIV . In addition, seropositioning differences have also been found. MSM who are HIV seropositive, for example, were more likely to engage in anal receptive behavior during anal intercourse with a partner self-reported as HIV seronegative than with one self-reported as HIV seropositive (Mcfarland et al., 2012). This seropositioning behavior in the MSM who are HIV seropositive was reported with greater consistency than condom use (Mcfarland et al., 2012). Because anal receptive intercourse has been identified as the highest sexual risk behavior for HIV acquisition, this study indicated avoidance of this activity during serodiscor- dant sex as a possible protective practice by MSM who are HIV seropositive. This same study also showed higher percentages of abstinence or sexual-avoidant behaviors in MSM who are HIV seroposositive compared to MSM who are HIV sereonegative(Mcfarland et al., 2012). An older (2003) study by Halkitis, Parsons, and Wilton showed a significantly higher proportion of inten- tional unprotected anal intercourse among mutually reported MSM who are HIV seropositive in New York City compared to those who mutually self-reported as HIV seronegative. Although different in setting, these findings were echoed in a more recent (2017) study by Card and colleagues. Their research, focusing on sexual behaviors in MSM who met in online environ- ments, showed MSM infected with HIV had substantially higher rates of condomless anal sex (CAS) when compared to non-MSM infected with HIV. Although 32.4% of the HIV seronegative partici- pants reported CAS when having sex with other MSM self-reported HIV seronegative or with MSM of unknown serostatus, this figure rose to 62.1% in MSM who are HIV seropositive who had sex with other MSM who are HIV seropositive (Card et al., 2017). An Australian-based study by Rawstrone and associates (2007) showed a large proportion of unprotected anal intercourse occurred among SOCIAL WORK IN PUBLIC HEALTH 273 seroconcordant partners infected with HIV; this dyad comprised almost 43% of all unprotected anal intercourse acts within their study. Research assessing minority MSM serosorting has also showed significantly higher unprotected anal intercourse among couples who are HIV seroconcordant, with data from Lo, Reisen, Poppen, Bianchi, and Zea (2011) highlighting this phenomenon among Latino MSM. Serostatus also impacts other areas of sexual decision making in MSM as well. Prestage, Hurley, and Brown (2013) found MSM who are HIV seropositive were much more likely to engage in receptive “cum play” (p. 1347), in which semen is ejaculated
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