PrEP status is a significant factor for HIV-negative men who have sex with men (MSM) when selecting sexual partners, but
not when choosing friends or romantic partners for dating, according to an
American study published in AIDS Care.
The authors investigated whether use of pre-exposure prophylaxis (PrEP)
influenced partner selection on an online dating application. PrEP status was
not a significant factor for HIV-positive men when it came to selecting sexual
partners.
The authors suggest that ‘PrEP sorting’ – selection based on PrEP status – may work in the same manner as HIV serosorting
works: men choose partners in a way they hope will reduce sexual infection risk.
PrEP usage has had divisive effects, either being seen as a responsible
preventative measure or an enabler of risky sexual behaviour amongst MSM. Some
men using dating apps may be pro-PrEP and thus see the benefits in terms of reduced
risk of HIV infection and PrEP users being regularly monitored for other STIs.
Other men may be anti-PrEP, believing that men who use PrEP are promiscuous, engage
in riskier behaviours with multiple partners and have more STIs.
The authors used vignettes in order to
assess social attitudes of MSM on a popular geo-location sex app. Participants
were presented with stories depicting gay male characters as either sexually
promiscuous or monogamous and either taking PrEP or not. None of the characters
used condoms. Participants were asked whether they would be friends, date, or
have sex with the characters.
A total of 339 men from nine US cities completed the
full survey (18-81 years old, average age 37) in July 2015. Of these, 258 were
HIV negative and not taking PrEP, 31 were HIV negative and taking PrEP, 25 were
living with HIV and the other 25 did not know their status or declined to
answer. Most of the men in the sample were white (52.5%) and single (68.7%),
with a wide range of annual incomes.
Most participants (over 70%) in all three
groups indicated that they would be friends with all the characters, regardless
of PrEP use and promiscuity.
In terms of romantic dating, HIV-negative
individuals not taking PrEP indicated that they preferred monogamous characters
(OR = .02, 95% CI .01-.05, p
<.0001) but PrEP use did not make a difference to preferences. PrEP users
also rejected promiscuous men for dating, and appeared to prefer to date men on
PrEP, but this difference was once again not significant. HIV-positive
participants showed a preference for dating monogamous men using PrEP. While
PrEP characters appeared to be preferred over those not taking PrEP (close to
80% said Yes to sex with monogamous
PrEP users), this difference was not significant.
In terms of sex, HIV-negative participants
not on PrEP preferred to have sex with men using PrEP (aOR = .18, 95% CI
.09-.37, p < .0001). Participants
taking PrEP preferred to have sex with those taking PrEP over those not taking
it (aOR = 0, 95% CI 0-0, p < .0001).
They largely rejected promiscuous characters not taking PrEP. While HIV-positive men preferred sex with monogamous PrEP characters, PrEP use was not
significant in this instance.
These results indicate that HIV-negative MSM – either on PrEP or not taking it – desired PrEP users as sexual partners and
thus shows evidence for sorting based on PrEP status. As this was a significant
finding for HIV-negative but not for HIV-positive individuals in terms of
sexual partner selection, it also is consistent with PrEP sorting being used as
a risk mitigating strategy.
The
authors caution that, as with HIV serosorting, a PrEP sorting strategy is only
as effective as each individual’s knowledge of their most current status. A
PrEP user (perhaps someone obtaining his medication informally) who does not
test for HIV regularly and who has lapses in adherence may have a false sense
of security about his HIV status.
An
interesting finding was that the HIV-negative men not taking PrEP indicated
that while PrEP usage was important for hook-ups, it was not important for
dating. For HIV-positive individuals, while characters’ PrEP use did not have
an effect on dating and sex in the statistical models, the most popular characters
were monogamous and using PrEP. This may be because the combination of monogamy
and PrEP use is seen as a more responsible way of having sex with HIV-negative
individuals, and HIV-positive men may not feel as pressurised to disclose their
status if they know their partner is on PrEP.
Another
recent study published in AIDS and
Behavior carried out with 104 MSM attending an STD clinic in Rhode Island
revealed that amongst those who used online apps to meet other men (86%), 53%
were more likely to contact a potential partner who disclosed being HIV negative,
and 48% were more likely to do so if the person disclosed being on PrEP. This
is further evidence for PrEP sorting while using online apps.
However,
it does raise questions for HIV-positive men who openly disclose their status
online, as 80% would be less likely to contact a man
for sex if he disclosed being HIV positive and 57% would be less likely to
contact an HIV-positive man who had an undetectable viral load. This highlights
stigma and rejection of men living with HIV and that messages such as U=U (undetectable equals untransmittable) have
not yet had a far-reaching effect.