Marseille 2007
Marseille 2007
Abstract book
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Abstract #282  -  PRACTICE OF SEROSORTING: WILL IT MINIMISE HIV TRANSMISSION RISK?
Session:
  18.5: Risk Perception (Parallel) on Monday @ 14.00-16.00 in CP Chaired by Elizabeth Brown, Yusef Azad
Authors:
  Presenting Author:   Dr Iryna Zablotska Manos - UNSW, Australia
 
  Additional Authors:  Dr Garrett  Prestage, Dr Patrick Rawstorne, Dr John  Imrie, Dr Andrew  Grulich, Dr John Kaldor, Dr Susan  Kippax,  
Aim:
Background: Serosorting is increasingly described in the literature as a strategy used by gay men for reducing sexual HIV risk in the context of unprotected sex. To be effective, serosorting requires knowledge and open discussion of a sexual partners HIV status.
 
Method / Issue:
Methods: Using the 2001-2006 data from the Australian Positive Health (HIV-positive gay men) and Health in Men (HIV-negative gay men) cohort studies, we explored the following trends in casual relationships: proportion of HIV positive partners, negative and of unknown status in the past 6 months, unprotected sex, and HIV disclosure. Significance of findings was assessed using 2 tests for heterogeneity and for trend as appropriate. In a subsample of 178 and 249 interviews, when HIV positive and negative men reported that on the last occasion of unprotected anal intercourse their casual partner was of the same HIV status, we assessed what that statement was based on: open HIV status discussion or assumptions.Using the 2001-2006 data from the Australian Positive Health (HIV-positive gay men) and Health in Men (HIV-negative gay men) cohort studies, we explored the following trends in casual relationships: proportion of HIV positive partners, negative and of unknown status in the past 6 months, unprotected sex, and HIV disclosure. Significance of findings was assessed using 2 tests for heterogeneity and for trend as appropriate. In a subsample of 178 and 249 interviews, when HIV positive and negative men reported that on the last occasion of unprotected anal intercourse their casual partner was of the same HIV status, we assessed what that statement was based on: open HIV status discussion or assumptions.
 
Results / Comments:
Results: During 2001-2006 the prevalence of serosorting increased, especially among HIV positive gay men: the average proportion of their casual partners who were positive rose from 21% to 34%, a statistically significant trend (p<0.001). More than 80% of the casual partners of HIV negative men were of unknown status, but the proportion of negative partners increased from 9% to 15% (p <0.01). During the same time, there has been an obvious increase in unprotected anal intercourse in seroconcordant casual relationships. The proportion of seroconcordant partners with whom positive men had unprotected sex significantly increased from 57% to 93% (p<0.001), while the proportion of HIV negative men who reported unprotected seroconcordant sex increased insignificantly (about one third). HIV status disclosure in the context of unprotected casual sex increased among both HIV positive and negative men, but a substantial proportion did not know the HIV status of their last casual partner. 59% of HIV positive and 18% of the negative men reported that their last casual partner was seroconcordant. Among these men only 75% and 60%, respectively, reported knowing the status of that partner because they directly discussed it, while the rest made assumptions or conclusions based on indirect information. Also, on the last occasion of unprotected intercourse with casual partners, HIV positive men disclosed their status more often to HIV positive than to HIV negative men.
 
Discussion:
Discussion: The recent increase in unprotected anal intercourse in perceived seroconcordant relationships was not universally backed up by HIV disclosure and direct knowledge of the partners status. A high level of serosorting based on assumptions of partners status, especially among HIV negative men, raises concerns. Such practice is indeed seroguessing rather than serosorting. It has inherent limitations in minimising HIV transmission and may be a misleading strategy.
 
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