Santa Fe 2011 Santa Fe, USA 2011
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Abstract #172  -  Viral sorting as a frequently practiced HIV risk reduction strategy among HIV-positive MSM with HIV-positive and HIV-negative and status unknown partners
  Presenting Author:   Mr Wijnand Van den Boom - Public Health Service Amsterdam
  Additional Authors:  Dr. Udi Davidovich, Mr. Robert Witlox, Dr. Ineke Stolte,  
We defined ‘viral sorting’ as a risk reduction strategy based on the perception that an undetectable viral load reduces the risk for HIV transmission during unprotected anal intercourse (UAI). We examined how frequently HIV-positive men who have sex with men (MSM) consciously practice viral sorting as an HIV risk reduction strategy with HIV-positive and HIV-negative or status unknown casual sex partners, sex buddies and steady partners.
  Method / Issue:
In total, 212/307 HIV-positive men who were part of an online panel of the Netherlands HIV Association, completed our online questionnaire measuring UAI and viral sorting practices. We included only men who reported sex with men and had an undetectable viral load (N=177; median age 48; IQR=42–55). Viral sorting was defined as the conscious decision to engage in UAI in two contexts, (1) both the participant and an HIV-positive partner had undetectable viral load levels, or (2) the participant himself had an undetectable viral load level with an HIV-negative or status unknown partner. In addition, we distinguished between three partner types, (1) the casual sex partner (“met by chance and had sex with only once or on several occasions”), (2) the sex buddy (“contacted on a regular basis for sex but not considered a steady partner”), and (3) the steady partner. Viral sorting was assessed in two ways: ever since HIV diagnosis with any HIV-positive or HIV-negative/unknown sexual partner, and during recent UAI with a casual sex partner, a sex buddy, or a steady partner.
  Results / Comments:
We found that of all participants, 68% (120/177) ever had UAI with any partner since HIV diagnosis. Of those, 44% (53/120) ever practiced viral sorting with an HIV-positive partner and 38% (46/120) with an HIV-negative/unknown partner. In total, 20% (24/120) reported viral sorting with both HIV-positive and HIV-negative partners. Among men who had recent UAI with an HIV-positive partner (n=63), proportions of viral sorting were 20% (3/15) with a casual sex partner, 58% (11/19) with a sex buddy, and 45% (13/29) with a steady partner. Among men who had recent UAI with an HIV-negative/unknown partner (n=60), proportions of viral sorting were 57% (16/28) with a casual sex partner, 40% (4/10) with a sex buddy, and 64% (14/22) with a steady partner.
We conclude that viral sorting as a risk reduction strategy is consciously practiced relatively frequently among HIV-positive MSM with both HIV-positive and HIV-negative/unknown partners. The high proportion of viral sorting with HIV-negative/unknown partners suggests that HIV-positive men engage in UAI while taking in consideration the reduction of transmission risk to others. The results also suggest that viral sorting is implemented to a different degree between different types of HIV-positive and HIV-negative/unknown partners, and therefore more research is required to investigate the underlying dynamics. Further, since most of the available data on viral load and HIV transmission risk is derived from studies on heterosexuals, future investigation should provide evidence on the effectiveness of viral sorting as an HIV risk reduction strategy in lowering HIV transmission among MSM.
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