Serosorting Is Associated with a Decreased Risk of HIV Seroconversion in the EXPLORE Study Cohort

Abstract

BackgroundSeroadaptation strategies such as serosorting and seropositioning originated within communities of men who have sex with men (MSM), but there are limited data about their effectiveness in preventing HIV transmission when utilized by HIV-negative men.Methodology/Principal FindingsData from the EXPLORE cohort of HIV-negative MSM who reported both seroconcordant and serodiscordant partners were used to evaluate serosorting and seropositioning. The association of serosorting and seropositioning with HIV seroconversion was evaluated in this cohort of high risk MSM from six U.S. cities. Serosorting was independently associated with a small decrease in risk of HIV seroconversion (OR = 0.88; 95%CI, 0.81–0.95), even among participants reporting ≥10 partners. Those who more consistently practiced serosorting were more likely to be white (p = 0.01), have completed college (p = <0.0002) and to have had 10 or more partners in the six months before the baseline visit (p = 0.01) but did not differ in age, reporting HIV-infected partners, or drug use. There was no evidence of a seroconversion effect with seropositioning (OR 1.02, 95%CI, 0.92–1.14).SignificanceIn high risk HIV uninfected MSM who report unprotected anal intercourse with both seroconcordant and serodiscordant partners, serosorting was associated with a modest decreased risk of HIV infection. To maximize any potential benefit, it will be important to increase accurate knowledge of HIV status, through increased testing frequency, improved test technology, and continued development of strategies to increase disclosure.

Rates of condom and non-condom-based anal intercourse practices among homosexually active men in Australia: deliberate HIV risk reduction?

“…In line with earlier research, however, our data suggest that they remain minority practices, with each being reported by approximately 10% of gay men overall 2 30. Compared with the popularity of serosorting in regular relationships among HIV-negative men and serosorting in casual encounters among HIV-positive men, our findings suggest that these two practices remain supplementary risk-reduction strategies.…”

"To Share or Not to Share?" Serosorting by Hepatitis C Status in the Sharing of Drug Injection Equipment Among NHBS-IDU2 Participants

“…Researchers focusing on the sexual choices of MSM [15, 16] have found serosorting is associated with decreased risk of HIV infection [17] and changes in the sexual behavior of MSM when it is employed as an HIV risk-reduction strategy [18]. Serosorting has also been documented among HIV-positive PWID [19].…”

Motivational Interviewing Targeting Risky Sex in HIV-Positive Young Thai Men Who Have Sex with Men

“…Seroadaptation has been proposed as a way to reduce HIV transmission risk among MSM; however, its effectiveness remains debatable (Cassels, Menza, Goodreau, & Golden, 2009; Philip, Yu, Donnell, Vittinghoff, & Buchbinder, 2010). Seroadaptation practices in our study population were uncommon.…”

“…The study revealed a high prevalence of serodiscordant partnership (69%) and a low rate (59–64%) of protected anal sex with serodiscordant partners, suggesting that serosorting, a form of seroadaptive behaviors, may be less common among HIV+ Asian MSM. For seroadaptive behaviors to be prevalent in a community, there must be frequent and accessible HIV testing, widespread knowledge of HIV transmission risk, and an existing culture of serostatus disclosure (Philip et al, 2010). Such factors are uncommon in the setting of MSM in Thailand.…”