At your fingertips – informed sexual health practices
By: Aziel Gangerdine, HVTN Core, Seattle, WA, USA
The Personalized Sexual Health Promotion HIV Risk Prediction Model, known as SexPro, is a first of its kind and when used by physicians and men who have sex with men (MSM), predicts a person’s risk of HIV infection based on answering a few questions about sexual behavior and substance use. SexPro is a valuable tool to help MSM and providers target HIV prevention interventions such as Pre-Exposure Prophylaxis (PrEP).
To create SexPro, the creators used data from four large studies of MSM to develop and validate the tool, with the most recent study ending in 2013. SexPro was developed for use in clinical and non-clinical settings to determine HIV risk in MSM via a study called EXPLORE.
“We set out to develop an easy to use, data-driven tool that supported more accurate risk assessment,” said Dr. Hyman Scott, Bridge HIV (San Francisco) site investigator and HVTN RAMP Scholar Mentor. Via the EXPLORE study, the researchers “…developed and validated an HIV risk assessment tool for MSM, which showed good predictive ability, including among the largest cohort of HIV-uninfected Black MSM in the US.” (Scott et al., 2018)
Current HIV risk assessment tools historically used data from White MSM, without representation of Black and Latino MSM. Because of this, there was concern that the current tools may underestimate risk for Black and Latino MSM, and thus people from these racial and ethnic groups are less likely to receive recommendations for HIV prevention interventions.
“The increased HIV risk among Black and Latino MSM occurs despite similar or lower HIV risk behaviors compared with other groups. This is likely driven by social, structural, and sexual network factors experienced by Black and Latino MSM”, says Dr. Scott.
A granular examination by the study (Scott et al, 2018) revealed that social (higher prevalence among sexual networks) and structural (incarceration policies, poverty, etc.) factors that affect Black and Latino MSM in the US disproportionately impact their risk of HIV. The need to develop a model for risk assessment that accounts for race and ethnicity cannot be overstated given the racial and ethnic disparities in HIV risk in the United States. The lifetime risk for acquiring HIV among Black and Latino MSM in the US is 1 in 2 and 1 in 4, respectively.
“EXPLORE showed underserved populations wanted a self-directed tool”, said Wakefield, HVTN Director of External Relations and EXPLORE study team member.
A CDC survey approximated that one-third of MSM who had never been tested for HIV reported low perceived HIV risk as the reason for not being tested for HIV. On the contrary, 56% of the men reported having more than two male sex partners in the past 12 months, and 37% reported condomless anal intercourse. The CDC’s observation of low perceived risk for HIV acquisition was reinforced by the Young Men’s Study showing that nearly 75% of participants perceived themselves at low risk for HIV, despite 32% reporting four or more partners in the prior 6 months, and 21% having been diagnosed with a recent sexually transmitted infection.
SexPro is easily accessible via www.mysexpro.org and takes into account the recent findings about U=U (undetectable=untransmittable). It adjusts the risk associated with having sex with a virally suppressed HIV-positive partner to be equal to that of having an HIV-negative partner, the only risk tool to currently do so.
Aziel Gangerdine is the Director of Communications for the HVTN and is based in Seattle, Washington, USA.
Development and validation of the Personalized Sexual Health Promotion (SexPro) HIV Risk Prediction Model for Men Who Have Sex with Men in the United States
Reference: Scott, H., Vittinghoff, E., Irvin, R., Liu, A., Nelson, L., Del Rio, C., ... & Kuo, I. (2019). Development and Validation of the Personalized Sexual Health Promotion (SexPro) HIV Risk Prediction Model for Men Who Have Sex with Men in the United States. AIDS and behavior, 1-10.