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Serosorting

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Serosorting is the practice of using HIV status as a decision-making point in choosing sexual behavior. Frequently the term is used to describe the behavior of a person who chooses a sexual partner assumed to be of the same HIV serostatus for the purpose of engaging in unprotected sex with the intent to reduce the risk of acquiring or transmitting HIV.[1]

Knowledge of HIV status is based on the result of a person's HIV test, with a positive result indicating that a person has HIV and can transmit the disease to others during sexual contact in which body fluids are exchanged. There are many causes which lead to situations where one person who asks about the status of another cannot get accurate information, for example, the person asked might be truly ignorant about their status due to not having had a test since their last risky sexual encounter.

Because of difficulty in accurately determining serostatus outside of a clinical setting, serosorting has limited efficacy. As people typically do not engage in sex practices with the expectation of contracting or transmitting HIV, failed attempts at serosorting are a leading cause of people contracting HIV.

Etymology

The word "serosorting" comes from the Latin word "serum," which refers to blood serum. Sorting refers to choosing partners based on HIV status, which can be determined from a blood test among other ways.

"Serodiscordant" sex refers to sex between an HIV positive person and an HIV negative person. Typically persons practicing serosorting make an attempt to find someone with a matching HIV test result, otherwise known as "concordant serostatus."

Risks associated with serosorting

Failure to accurately authenticate another person's true HIV status

Firstly, some people may not be sure of their true HIV status, or lie about it. Even a recent negative HIV test may not be definitive, if they are still within the window period after a recent infection. Secondly, just because someone does not have HIV does not mean that they are free of other sexually transmitted diseases such as syphilis or hepatitis B. However, the largest experiment with serosorting has been conducted in the adult film industry by the Adult Industry Medical Healthcare Foundation. All actors in legitimate adult films are tested twice a year for Gonorrhea, Chlamydia, Syphilis, Hepatitis A/B/C, Herpes and HIV-and Monthly for HIV, Gonorrhea and Chlamydia. The AIM testing program eliminates virtually all possibility of lying and enforces a high frequency of testing-and involves testing for a variety of STD's that can make transmission of HIV more likely. Before this program of testing adult film actors had a very high rate of STD's-and now have a rate of STD's 20% that of the general public. There exists a service, STFree Certifications which allows the general public to anonymously and securely exchange STD test results-but few public health professionals are aware of this service-and its effectiveness and proper use haven't been thoroughly tested. Home Bio Tests sells inexpensive tests that two potential partners can take in front of each other(thus eliminating the possibility of lying about test results and reducing potential of a false negative test result). The Home Bio Test Kits have not been FDA approved for home use or over the counter sales by the FDA (though some of their test kits are used by US clinics).

Haphazard Serosorting as substitution for condom use offers limited protection

Dr. Matthew Golden of King County Public Health conducted a study of West Coast serosorting men. He concluded that the men he observed got limited protection from HIV via serosorting. 3.5% of the men he observed that did not use condoms or serosort became HIV+, 2.6% of the men he observed that serosorted became HIV+ as did 1.5% of the men who reported consistent condom use. Golden's population differs from AIM's in that anal sex was a large portion of their sexual habits, their testing intervals were typically longer and less regular, there was no testing for other diseases like Chlamydia which can speed spread of HIV and there were no protections against false reporting of results. Golden's study did not cover the use of serosorting combined with condoms-which theoretically would be more effective than either precaution used alone. [2]

Seroconcordant people can still exchange diseases other than HIV

Thirdly, unprotected sex between two HIV+ people is not free of risk. Infection with one strain of HIV does not preclude later infection with another. There is a great deal of genetic variability within individual HIV virus populations and this variability is shuffled and mutated every time the virus reproduces inside a cell in the body. There are millions of viruses in the body of an infected person. Modern drug cocktails keep virus and mutation levels low but eventually drug resistance will develop. Unprotected sex between two HIV+ individuals does risk that one with a less aggressive, drug susceptible strain of the virus who might have kept his infection well under the control of the available drugs, might find him or herself with an aggressively drug resistant strain[3]. Furthermore, dual infection has been associated with more rapid progression to AIDS [4].

Motivation for serosorting

Seroconcordant persons will not change each other's serostatus

Studies have shown that serosorting provides some limited decrease in risk of contracting HIV among MSMs who use it as an HIV risk reduction technique.[2][5]

It has been seen as controversial for being used to engage in sexual activities without regard to safer sex practices as either participants were free of HIV or were already carriers. Although the practice has occurred informally since the AIDS pandemic began,[6] serosorting has become more prevalent with online social networking sites facilitating quick networking and even some health professionals citing harm reduction concepts for gay men as a measure to reduce the risk of acquiring HIV infection.[7]

Sex without condoms perceived as desirable

Barebacking, when first articulated in magazines such as POZ magazine in 1995/6 as a practice taking place among HIV positive men, could be seen as an early articulation of serosorting.[8]

Doubts about Real World Effectiveness of Condoms

Estimates of the effectiveness of condoms vary widely. The Golden study suggested that condoms provided only a 60% reduction of risk compared to doing nothing at all. The claims that condoms are "highly effective" sometimes seem removed from the real world experience of populations seeking HIV protection.

See also

References

  1. ^ "Meeting Summary: "Consultation on Serosorting Practices among Men who Have Sex with Men"". http://www.cdc.gov/hiv/. Centers for Disease Control and Prevention. 31 March 2009. Retrieved 26 December 2010. {{cite web}}: External link in |work= (help)
  2. ^ a b Golden MR, Stekler J, Hughes JP, Wood RW. (2008). "HIV serosorting in men who have sex with men: is it safe?". Journal of Acquired Immune Deficiency Syndromes. 49 (2): 212–8. PMID 18769346. {{cite journal}}: |access-date= requires |url= (help)CS1 maint: multiple names: authors list (link)
  3. ^ Smith; Wong, JK; Hightower, GK; Ignacio, CC; Koelsch, KK; Petropoulos, CJ; Richman, DD; Little, SJ; et al. (2005). "HIV drug resistance acquired through superinfection". AIDS. 19 (12): 1251–1256. doi:10.1097/01.aids.0000180095.12276.ac. PMID 16052079. {{cite journal}}: Explicit use of et al. in: |author= (help)
  4. ^ Gottlieb; Nickle, DC; Jensen, MA; Wong, KG; Grobler, J; Li, F; Liu, SL; Rademeyer, C; Learn, GH; et al. (2004). "Dual HIV-1 infection associated with rapid disease progression". Lancet. 363 (9049): 619–622. doi:10.1016/S0140-6736(04)15596-7. PMID 14987889. {{cite journal}}: Explicit use of et al. in: |author= (help)
  5. ^ Parsons, Jeffrey T; Schrimshaw, Eric W; Wolitski, Richard J; Halkitis, Perry N,; Purcell, David W; Hoff, Colleen C; Gómez, Cynthia A (April 2005). "Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation". Volume 19 - Issue - p S13-S25. AIDS (journal). Retrieved 23 December 2010.{{cite web}}: CS1 maint: multiple names: authors list (link)
  6. ^ Daniel E. Siconolfi & Robert W. Moeller (winter 2007). "Serosorting". San Francisco AIDS Foundation. Retrieved 23 December 2010. {{cite web}}: Check date values in: |date= (help)
  7. ^ Race, Kane (2010), "Click Here for HIV Status: Shifting Templates of Sexual Negotiation", Emotion Space & Society, 3: 7–14 {{citation}}: Cite has empty unknown parameter: |1= (help)
  8. ^ Race, Kane (2010), "Engaging in a Culture of Barebacking: Gay Men and the Risk of HIV Prevention", HIV Treatment and Prevention Technologies in International Perspective, Palgrave Macmillan, ISBN 9780230238190 {{citation}}: Cite has empty unknown parameter: |1= (help)
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