Seroadaptive Strategies of Vancouver Gay and Bisexual Men in a Treatment as Prevention Environment




Roth, Eric A.
Cui, Zishan
Rich, Ashleigh
Lachowsky, Nathan J.
Sereda, Paul
Card, Kiffer
Jollimore, Jody
Howard, Terry
Armstrong, Heather L.
Moore, David

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Journal of Homosexuality


British Columbia’s Treatment as Prevention policy has provided free access to Highly Active Antiretroviral Therapy (HAART) to all HIV-positive provincial residents since 1996. One outcome is an increase in HIV-positive gay and bisexual men (GBM) with suppressed viral loads. Previous cross-sectional analyses indicated that some Vancouver GBM now recognize condomless anal sex with men on HAART who report a suppressed viral load as a sero-adaptive strategy. To test the hypothesis that this new strategy, termed viral load sorting (VLS), is recognized and used among by GBM in the Momentum Health Study, we analyzed longitudinal data for HIV-negative/unknown (n=556) and HIV-positive (n=218) sero-status participants. Analyses indicated that both groups reported VLS, and that sero-status and Treatment Optimism Scale scores were significant determinants in frequency and use. Results exemplify the medicalization of sex and Rogers Diffusion of Preventative Innovations, and have important implications for HIV research and GBM sexual decision-making.


We thank our community colleagues at the Health Initiative for Men, YouthCO HIV & HepC Society of BC, Positive Living BC, for their support, as well as research participants for sharing their important life history data with the Momentum Health Study.


Treatment as Prevention, seroadaptation, Treatment Optimism, Diffusion of Preventative Innovations


Roth, E. A., Cui, Z., Rich, A., Lachowsky, N., Sereda, P., Card, K. G., Jollimore, J., Howard, T., Armstrong, H., Moore, D., & Hogg, R. (2018). “Seroadaptive Strategies of Vancouver Gay and Bisexual Men in a Treatment as Prevention Environment.” Journal of Homosexuality, 65(4), 524–539.