“Losing the Phobia:” Understanding How HIV Pre-exposure Prophylaxis Facilitates Bridging the Serodivide Among Men Who Have Sex With Men

Abstract

The use of HIV serostatus information has played a pivotal role in partner selection norms. A phenomenon known as <i>serosorting</i> is the practice of selecting a partner based on a perception that they are of the <i>same</i> HIV status in order to avoid transmission from one partner to the other. An understudied aspect of serosorting is that it has a divisive effect-one accepts or rejects a potential partner based on a singular characteristic, the partner's HIV status, and thus excludes all others. This division has been formally referred to as the HIV <i>serodivide</i>. In this study, we explored partner selection strategies among a group of HIV-negative, young men who have sex with men (<i>n</i> = 29) enrolled in a PrEP demonstration project in Northern California. We found that trends in serosorting were in fact shifting, and that a new and opposite phenomenon was emerging, something we labeled "seromixing" and that PrEP use played a part in why norms were changing. We present three orientations in this regard: (1) <i>maintaining the phobia</i>: in which men justified the continued vigilance and exclusion of people living with HIV as viable sex or romantic partners, (2) <i>loosening/relaxation of phobia</i>: among men who were reflecting on their stance on serosorting and its implications for future sexual and/or romantic partnerships, and (3) <i>losing the phobi</i>a: among men letting go of serosorting practices and reducing sentiments of HIV-related stigma. The majority of participants spoke of changing or changed attitudes about intentionally accepting rather than rejecting a person living with HIV as a sex partner. For those who maintained strict serosorting practices, their understandings of HIV risk were not erased as a result of PrEP use. These overarching themes help explain how PrEP use is contributing to a closing of the HIV serodivide.