Marseille 2007
| Abstract #324 - Whats Happened to Negotiated Safety: the Virtues and Vices of Serosorting | ||||
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Session: 25.3: Couples (Parallel) on Monday @ 16.30-18.30 in PR Chaired by Jose Catalan, Giovanna Meystre-Agustone Authors: Presenting Author: Prof Susan Kippax - The University of New South Wales, Australia |
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| Aim: This paper addresses the recent move to serosorting. It asks whether serosorting is a strategy or a practice, and investigates its prevalence, and the context of its use. | ||||
| Method / Issue: Data are drawn from a number of ongoing studies, both cross sectional (twice-yearly Gay Periodic Surveys) and cohort (Health in Men cohort of HIV-negative men and the Positive Health cohort of HIV-positive men) studies of Sydney gay mens sexual practice. | ||||
| Results / Comments: Findings from repeat cross sectional studies indicate that around 44% of gay mens regular relationships are seroconcordant. There have been no significant changes in these figures since 2001. Of those men in seroconcordant relationships, around 80% engage in unprotected anal intercourse with their regular partner. Findings from the cohort studies confirm this and also indicate that negotiated safety agreements (strict definition) are in place in 75% of seroconcordant relationships of six months or more duration and in which UAI is practised. In regular relationships therefore, one can assume that the practice of serosorting (i.e. unprotected anal intercourse within a seroconcordant relationship) has been negotiated in at least 75% of them (i.e. a safe sex strategy has been agreed on the basis of mutual disclosure of HIV status and a discussion of agreements to have only safe sex outside the relationship. Findings from the same repeat cross sectional studies indicate that around 50% of men disclose their status to at least some of their casual partners and/or are disclosed to by at least some of their casual partners. These data also indicate that this pattern of disclosure has increased over time, especially among HIV-positive men. There is a significant association between disclosure and unprotected anal intercourse with casual partners (UAIC) with around 40% of those engaging in UAIC reporting disclosure to some of their casual partners and 39% to all their casual partners. Such disclosure is not only limited but also very uncertain as HIV-negative men can never be absolutely sure of their own or their casual partners HIV status. The cohort studies with reference to last casual encounter support this conclusion. For 25% of HIV-positive men and 40% of HIV-negative men, the seroconcordance is assumed or guessed, i.e. not discussed. | ||||
| Discussion: Negotiated safety is a strategy for engaging in unprotected anal intercourse within relationships that involves disclosure of HIV serostatus and the reaching of an agreement about safe sex outside that relationship. On the other hand, the available data from these studies indicates that serosorting in the context of casual encounters is not a strategy but a practice (from which we, researchers, have inferred a strategy) in which disclosure is implicated but in a very uncertain manner, particularly for HIV-negative men. Some of this disclosure is spoken but some of it is not. Furthermore some seroconcordance is simply assumed. Serosorting as a practice for HIV-negative (as opposed to negotiated safety strategy) has inherent limitations for minimising HIV transmission risk. | ||||
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