AIDS Behav

Men who have sex with men (MSM) often change sexual behaviors following HIV diagnosis. This systematic review examined such changes, including sero-adaptive behaviors (i.e., deliberate safer-sex practices to reduce transmission risk) to better understand the magnitude of their association with HIV diagnosis. We searched four databases (1996-2017) and reviewed references from other systematic reviews. We included studies conducted in the United States that compared sexual behavior among HIV-infected "aware" versus "unaware" MSM. We meta-analytically pooled RRs and associated 95% confidence intervals (CI) using random-effects models, and assessed risk of bias and evidence quality. Twenty studies reported k\u2009=\u2009131 effect sizes on sexual practices outcomes, most of which reported changes in unprotected sex (k\u2009=\u200985), and on sex with at-risk partners (k\u2009=\u200976); 11 reported sero-adaptive behaviors. Unprotected anal intercourse with an HIV-uninfected/unknown-status partner was less likely among aware MSM (insertive position: k\u2009=\u20092, RR 0.26, 95% CI 0.17, 0.41; receptive position: k\u2009=\u20092, RR 0.53, 95% CI 0.37, 0.77). Risk of not always serosorting among aware MSM (k\u2009=\u20093) was RR\u2009=\u20090.92 (0.83, 1.02). Existing evidence, although low-quality, suggests that HIV-infected MSM tend to adopt safer sexual practices once aware of their diagnosis. Variation in reporting of outcomes limits their comparability. Sero-adaptive behavior data are sparse.R37 DA015612/DA/NIDA NIH HHSUnited States/U38 PS004649/PS/NCHHSTP CDC HHSUnited States/5U38PS004649/national center for hiv/aids, viral hepatitis, std, and tb prevention