Gay men's current practice of HIV seroconcordant unprotected anal intercourse: serosorting or seroguessing?

Abstract

We explored seroguessing (serosorting based on the assumption of HIV seroconcordance) and casual unprotected anal intercourse (UAIC) associated with seroguessing. The ongoing Positive Health and Health in Men cohorts, Australia, provided data for trends in seroconcordant UAIC and HIV disclosure to sex partners. In event-level analyses, we used log-binomial regression adjusted for within-individual correlation and estimated prevalence rate ratios (PRRs) and 95% confidence intervals (95% CIs) for the association between the knowledge of a casual partner's seroconcordance and UAIC. UAIC and HIV disclosure significantly increased during 2001-2006. HIV-positive men knew partners were seroconcordant in 54% and assumed it in 13% of sex encounters (42 and 17% among HIV-negative men). Among HIV-positive men, the likelihood of UAIC was higher when a partner's status was known (Adjusted PRR = 5.17, 95% CI: 3.82-7.01) and assumed seroconcordant because of seroguessing (Adjusted PRR = 3.70, 95% CI: 2.56-5.35) compared with unknown. Among HIV-negative men, the likelihood of UAIC was also higher when a partner's status was known (Adjusted PRR = 1.88, 95% CI: 1.58-2.24) and assumed seroconcordant (Adjusted PRR = 2.12, 95% CI: 1.72-2.62) compared with unknown. As levels of UAIC remain high, seroguessing increasingly exposes gay men to the risk of HIV infection. Because both HIV-positive and HIV-negative men often seroguess, education and prevention programs should address the fact that HIV-negative men who engage in UAI due to this practice may be at high risk of HIV infection. HIV prevention should take into account these contemporary changes in behaviors, especially among HIV-negative gay men.

Do men who have sex with men use serosorting with casual partners in France? Results of a nationwide survey (ANRS-EN17-Presse Gay 2004)

“…It requires for users of this strategy to obtain accurate information on the HIV serostatus of each casual partner before engaging in unprotected sex, without assuming serological concordance from the outlook or seroguessing [22]. This issue may be relatively simple to discuss with partners in established relationships, but direct discussion may be more problematic with casual partners encountered in anonymous venues.…”

“…Likewise, no data contributed to evaluate whether the knowledge of partners' serostatus was the respondent's assumption or the result of direct discussion between partners. Similarly to some other researchers, the implementation of negotiated safety practices in regular partnerships, especially by HIV-negative men, was not taken into account in our definition of serosorting [21,22,25].…”

“…Osmond et al showed that this strategy was used most frequently by the 18-29-year-olds [17]. This practice has also been described among HIV-negative men [11,[19][20][21][22]. To date, serosorting with casual partners has never been studied in France.…”

Relationship Dynamics and Sexual Risk Reduction Strategies Among Heterosexual Young Adults: A Qualitative Study of Sexually Transmitted Infection Clinic Attendees at an Urban Chicago Health Center

“…[8][9][10] Negotiated safety agreements have been described among men who have sex with men (MSM) as strategies for selectively practicing condomless anal intercourse (CAI) while maintaining sexual pleasure and intimacy within relationships. [11][12][13][14][15][16][17] While intended to reduce HIV risk, such strategies may fail in practice due to factors such as inaccurate assessment of individual and partner serostatus, infrequent testing, failure to maintain the agreement, and lack of protection against STIs. [18][19][20][21] Shortcomings in assessing partner HIV risk have also been reported among heterosexuals.…”

Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys

“…12,23 Serosorting has become much more commonly practised by GBM in the last decade, 12,40 but it is does not protect HIVnegative men if HIV status is incorrectly assumed or a partner has undiagnosed HIV. 24,41,42 In fact, the greater reliance on serosorting may have increased the exposure of HIV-negative men to undiagnosed HIV, which may explain why other positive changes (such as the increase in HIV treatment and undetectable viral load) have had limited effect. 12,37 Based on current trends, we expect CAI between casual partners to become more common over time and for HIV notifications to continue to rise if additional protective strategies are not deployed.…”