Seroadaptation refers to sexual harm reduction/HIV prevention strategies that primarily involve 1) serosorting (selecting sex partners based on HIV status), and 2) seropositioning (choosing sexual positions to mitigate HIV exposure). While used across populations, the term, “seroadaptation,” was developed with white gay men and may not apply to historically marginalized populations like Black men who have sex with men (BMSM) (which here encompasses Black gay and bisexual men and Black trans women).

Understanding how BMSM, who represent less than 1% of the U.S. population, but account for over one-third of new HIV infections annually, practice seroadaptation can inform new interventions to improve their engagement in HIV services. To this end, we conducted a qualitative study (called the “PhotoUStudy”), which was guided by a conceptual model, the BMSM Intersectional Identity Framework Over the Life Course (BMSM Identity Framework). Thirty-six BMSM who lived in/accessed health services in Washington, D.C., aged 18-65, were recruited into a five-day photovoice activity and follow-up interview. Using NVivo, participant photos and transcripts were analyzed. Findings indicated that BMSM sexual harm reduction focused on condom use and HIV testing, and was considered a small, though important, part of health practice focused on physical safety and social support. Younger BMSM reported greater access to larger support networks; older BMSM had smaller social circles and poorer health. Few participants were familiar with PrEP or U=U. More research is needed; however, BMSM HIV interventions may be best couched in discussions of overall health and safety, such as self-defense.