Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation

Parsons, Jeffrey T.; Schrimshaw, Eric W.; Wolitski, Richard J.; Halkitis, Perry N.; Purcell, David W.; Hoff, Colleen C.; Gómez, Cynthia

doi:10.1097/01.aids.0000167348.15750.9a

Cited by 274 publications

(219 citation statements)

References 48 publications

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“…Strategic positioning is defined as an individual taking on the role of the insertive partner in an effort to reduce his risk of being infected with HIV. 29,30 For example, in HIV serodiscordant couples the HIV positive partner would be the receptive partner, while the HIV negative partner would be the insertive partner. Our findings suggest there is a relationship between engaging in serosorting, engaging in strategic positioning, and increased number of unprotected sexual partners.…”

Section: Discussionmentioning

confidence: 99%

Serosorting Sexual Partners and Risk for HIV Among Men Who Have Sex with Men

Eaton

Kalichman

Cain

et al. 2007

American Journal of Preventive Medicine

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Objective-The purpose of the current study was to assess whether or not men who have sex with men who limit their unprotected anal sexual partners to those who are of the same HIV status (serosort) differ in their risk for HIV transmission than MSM who do not serosort.Methods-Cross-sectional surveys administered at a large gay pride festival (80% response rate) were collected from MSM. Univariate and multivariate logistic regressions were used to identify predictors of serosorting.Results-Participants were self-identified as HIV negative MSM (N=628), about one third of whom engaged in serosorting (n=229). Men who serosort were more likely to believe that serosorting offered protection against HIV transmission, perceived themselves as being at no relatively higher risk for HIV transmission, and had more unprotected anal intercourse partners. Over half the sample reported their frequency of HIV testing as yearly or less frequently; this finding did not differ between serosorters and non-serosorters.Conclusions-Men who identify as HIV negative and serosort are no more likely to know their HIV status than men who do not serosort and are at higher risk for exposure to HIV. Interventions targeting MSM must address the limitations of serosorting.Human Immunodeficiency Virus (HIV) is the most destructive pandemic in history, with nearly 40 million people worldwide living with HIV 1 . In the US it is estimated that one million people are infected with HIV and there are over 40,000 new HIV infections in the US each year, the majority of which occur among men who have sex with men 2 . To reduce the likelihood of HIV transmission, many individuals seek out their own strategies of prevention. One such method is serosorting; the practice of limiting sexual partners to those who have the same HIV serostatus. Several studies have found that serosorting is commonly used among men who have sex with men 3-6 . For many HIV infected and uninfected persons, serosorting is believed to reduce concerns about HIV/AIDS and make condom use less necessary. Additionally, for various reasons, people tend to dislike using condoms [7][8][9] and practice behaviors they believe are protective, such as serosorting, to avoid condom use. Public health policy is also embracing serosorting as a viable alternative to condom use. 10 As a result, partner HIV serostatus is often a determining factor in sexual risk decision making. 11,12 Multiple caveats to serosorting do exist. For uninfected persons, the effectiveness of serosorting relies on complete and open HIV status disclosure among monogamous men. Unfortunately, fear of rejection, physical threat, alcohol or drug related impairment, and the lag between HIV tests can all affect the accuracy of knowing a sexual partner's HIV status. Moreover, HIV testing is not universal among men who have sex with men (MSM). 13 16 In light of these circumstances, serosorting may be limited for preventing HIV transmission.Beliefs about the protective benefits of serosorting are inextricably linked to risk per...

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Section: Discussionmentioning

confidence: 99%

Serosorting Sexual Partners and Risk for HIV Among Men Who Have Sex with Men

Eaton

Kalichman

Cain

et al. 2007

American Journal of Preventive Medicine

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“…3 Many studies on sexual behaviors of HIV-positive persons suggest that the HIV status of an HIV-positive person's sex partner is one of the factors that might influence their sexual behavior. [4][5][6][7][8][9][10][11][12][13][14][15] The findings from these studies suggest that in some populations, HIV-positive persons may be adopting serosorting, in which unprotected sexual encounters are limited to partners who have the same HIV status.…”

Section: Introductionmentioning

confidence: 89%

Is Injection Serosorting Occurring among HIV-Positive Injection Drug Users? Comparison by Injection Partner’s HIV Status

et al. 2011

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Research needs to build evidence for the roles that HIV status of injection partners may or may not play in injection risk behaviors of injection drug users (IDUs). Using baseline data collected from a randomized controlled study (INSPIRE) conducted in four cities (Baltimore, Miami, New York, and San Francisco) from 2001 to 2005, we categorized 759 primarily heterosexual HIV-positive IDUs into four groups based on HIV serostatus of drug injection partners. Thirty-two percent of the sample injected exclusively with HIV-positive partners in the past 3 months and more than 60% had risky injection behavior with these partners. Eight percent injected exclusively with HIV-negative partners and 49% injected with any unknown status partners. The remaining 11% reported having both HIV-positive and -negative injection partners, but no partners of unknown HIV status. Riskier injection behavior was found among the group with mixed status partners. The risk among the group with any unknown status partners appeared to be driven by the greater number of injection partners. No major group differences were observed in socio-demographic and psychosocial factors. Our analysis suggests that serosorting appeared to be occurring among some, but not an overwhelming majority of HIV-positive IDUs, and knowledge of HIV status of all injection partners per se did not appear to be as important as knowledge of sexual partner's HIV status in its association with risk behavior.

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“…Even in the presence of preserved overall CD4 counts (>500 cells/mm 3 ), massive irreversible damage already occurs to the mucosal tissues of the gastrointestinal immune system in the first weeks of HIV infection [36] which could facilitate HCV entry through the mucosa. Moreover, serosorting (engaging in sexual contact with partners of the same HIV serostatus), which is considered a risk reduction strategy for HIV transmission, might fuel the epidemic of other STI, including HCV [37].…”

Section: As Well As In the Unitedmentioning

confidence: 99%

Viral hepatitis among men who have sex with men, epidemiology and public health consequences

et al. 2009

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Viral hepatitis causes major disease burden worldwide, due to the chronic hepatitis sequelae: cirrhosis and primary liver cancer. Transmission of viral hepatitis is a problem not only in low-income countries, but also in high-income ones where viral hepatitis is a frequently occurring infection among men who have sex with men (MSM). Although the transmission routes of the three main hepatitis viruses, A, B and C, differ, MSM mainly acquire viral hepatitis during sexual contact. Vaccination programmes (only available for hepatitis A and B), raising awareness, and screening can be used to prevent transmission. However, despite the introduction of such methods in many high-income countries, the spread of viral hepatitis among MSM is still ongoing. This paper provides an overview of sexually acquired hepatitis A, B, and C among MSM in high-income countries, using recent insights obtained through molecular epidemiology, with the aim to raise awareness, improve vaccination coverage, and stimulate prevention programs.

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Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation

Cited by 274 publications

References 48 publications

Serosorting Sexual Partners and Risk for HIV Among Men Who Have Sex with Men

Serosorting Sexual Partners and Risk for HIV Among Men Who Have Sex with Men

Is Injection Serosorting Occurring among HIV-Positive Injection Drug Users? Comparison by Injection Partner’s HIV Status

Viral hepatitis among men who have sex with men, epidemiology and public health consequences

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