serosorting

{{Short description|Choosing sexual partners based on their HIV status}}

Serosorting, also known as serodiscrimination, is the practice of using HIV status as a decision-making point in choosing sexual behavior. The term is used to describe the behavior of a person who chooses a sexual partner assumed to be of the same HIV serostatus to engage in unprotected sex with them for a reduced risk of acquiring or transmitting HIV/AIDS.{{cite web |url=https://www.cdc.gov/hiv/topics/research/resources/other/serosorting.htm |title=Meeting Summary: "Consultation on Serosorting Practices among Men who Have Sex with Men" |date=31 March 2009 |publisher=Centers for Disease Control and Prevention |access-date=2010-12-26}}

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 potentially transmit the disease to others during any sexual contact involving an exchange of bodily fluids (e.g., unprotected anal or vaginal sex). There are many situations where determining their partner's serostatus outside clinical settings cannot be done with complete certainty, limiting the efficacy in mitigating the transmission of HIV/AIDS (or other STIs). As people do not typically engage in sex practices with the expectation of contracting or transmitting HIV, failed attempts at serosorting are a leading cause of the contraction of HIV among partners.{{cn|date=September 2022}}

Terms and 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 blood tests, among other methods.{{cite web |url=https://etymologeek.com/eng/serosorting/13417911 |title=Serosorting etymology |website=Etymologeek |access-date=2 June 2021}} Serodiscordant sex refers to sex between an HIV-positive person and an HIV-negative person.{{cite journal |title=Advances in HIV Prevention for Serodiscordant Couples |last1=Muessig |first1=Kathryn E |last2=Cohen |first2=Myron S |journal=Curr HIV/AIDS Rep |date=December 2014 |volume=11 |issue=4 |pages=434–446 |doi=10.1007/s11904-014-0225-9 |pmid=25145645 |pmc=4267973 }} Typically, partners practicing serosorting make an attempt to find someone with a matching HIV test result, otherwise known as a seroconcordant partner.{{citation needed|date=January 2021}}

Risks

=Failure to accurately determine HIV status=

Failure to accurately determine HIV status may stem from people not being sure of their true HIV status or not admitting to having HIV. A recent negative result from an HIV test may not be definitive of a person's serostatus, because if they are still within the window period following a recent infection, the antibodies that the blood tests measure will not be present yet. In addition, testing negative for HIV does not guarantee that they are free of other sexually transmitted infections (STIs) such as HPV or hepatitis B.{{citation needed|date=January 2021}}

The largest experiment with serosorting has been conducted in the adult film industry by the Adult Industry Medical Healthcare Foundation. The Adult Industry Medical testing program, or AIM, eliminates virtually all possibility of lying{{how|date=November 2013}} and enforces a high frequency of testing for a variety of STIs that can make the transmission of HIV more likely. All actors in legitimate adult films are tested twice a year for herpes, gonorrhea, chlamydia, syphilis, hepatitis types A, B and C, and HIV—as well as monthly for HIV, gonorrhea, and chlamydia. Before this program of testing, adult film actors had a very high rate of STIs, but now have only a 20% higher rate of STIs than the general public.{{Citation needed|date=February 2012}}

=Substitution for condom use=

Matthew Golden of King County Public Health, in Washington, conducted a study with sexually active West Coast men and concluded that the patient population demonstrated limited protection from HIV by serosorting. In his study, 3.5% of the men who used neither condoms nor serosorting became HIV-positive, as compared to 2.6% of the men that practiced serosorting alone, and 1.5% of the men who reported consistent condom use without serosorting.{{cite journal |url=https://dx.doi.org/10.1097/QAD.0b013e32834dcee9 |title=Population-based metrics for the timing of HIV diagnosis, engagement in HIV care, and virologic suppression |last1=Dombrowski |first1=Julia C |last2=Kent |first2=James B |last3=Buskin |first3=Susan E |last4=Stekler |first4=Joanne D |last5=Golden |first5=Mattew R |journal=AIDS |date=2 January 2012 |volume=26 |issue=1 |pages=77–86 |doi=10.1097/QAD.0b013e32834dcee9 |pmid=22008656 |access-date=2 June 2021|pmc=3434867 }}

Golden's population differs from AIM's in that anal sex made up a high proportion of the subjects' sexual habits, their testing intervals were typically longer and less regular, there were no tests for STIs other than HIV, such as chlamydia (an important factor considering other STIs may hasten the spread of the virus), and there were no protections against falsely reporting any of the results. Golden's study did not cover the use of serosorting combined with condoms—which, theoretically, would be more effective than either precaution used separately.{{cite journal |author1=Golden, MR |author2=Stekler, J |author3=Hughes, JP |author4=Wood, RW |year=2008 |title=HIV serosorting in men who have sex with men: is it safe? |journal=Journal of Acquired Immune Deficiency Syndromes |volume=49 |issue=2 |pages=212–8 |doi=10.1097/QAI.0b013e31818455e8 |pmid=18769346|s2cid=24007691 |doi-access=free }}

=Disease exchange between seroconcordant people=

Serosorting does not fully protect against all STIs during unprotected sex between two people infected with HIV. Infection with one strain of HIV does not preclude later infection with another strain. There is a great deal of genetic variability within individual HIV populations, because this variability is shuffled and mutated every time the virus (numbering in the millions) reproduces inside the infected person's body. Modern drug cocktails keep virus and mutation levels low but eventually drug resistance will develop. Unprotected sex between two HIV-positive individuals still presents the risk of one of them—with a relatively less aggressive strain of the virus—exchanging genetic sequences with their partner's more drug-resistant cousin, and becoming harder to treat.{{cite journal

|pmid=16052079

|title=HIV drug resistance acquired through superinfection

|journal=AIDS

|volume=19

|issue=12

|pages=1251–1256

|doi=10.1097/01.aids.0000180095.12276.ac

|year=2005

|last1=Smith

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|last7=Richman

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|last8=Little

|first8=SJ

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|display-authors=6

|doi-access=free

}} Furthermore, dual infection has been associated with a more rapid progression towards developing AIDS.

{{cite journal

|pmid=14987889

|title=Dual HIV-1 infection associated with rapid disease progression

|journal=Lancet

|year=2004

|volume=363

|issue=9049

|pages=619–622

|doi=10.1016/S0140-6736(04)15596-7

|last1=Gottlieb

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|first3=MA

|last4=Wong

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|last6=Li

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}}

Motivation

=Lower rates of changing each other's serostatus=

Studies have shown that serosorting provides some limited decrease in risk of contracting HIV among men who have sex with men (MSMs) who use it as an HIV risk reduction technique.{{cite journal |title=Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation |journal=AIDS |volume=19 |issue=1 |pages=S13–S25 |date=April 2005 |author1=Parsons, Jeffrey T |author2=Schrimshaw, Eric W |author3=Wolitski, Richard J |author4=Halkitis, Perry N |author5=Purcell, David W |author6=Hoff, Colleen C |author7=Gómez, Cynthia A |doi=10.1097/01.aids.0000167348.15750.9a |pmid=15838191 |s2cid=31629523 |doi-access=free }}{{cite web |url=http://www.aidsmap.com/en/news/E198EB3E-2EE3-48D6-BAC2-0C5EF17CE24A.asp |title=Is serosorting working, or even possible? |author=Gus Cairns |date=22 August 2006 |access-date=2008-06-02 |publisher=aidsmap}}

Although the practice has occurred informally since the AIDS pandemic began,{{cite journal | url=http://www.thebody.com/content/art40765.html | title=Serosorting | publisher=San Francisco AIDS Foundation | date=Winter 2007 | access-date=2010-12-23 |author1=Siconolfi, Daniel E |author2=Moeller, Robert W | journal=Beta: Bulletin of Experimental Treatments for AIDS | volume=19 | issue=2 | pages=45–9 | pmid=17489116 }} serosorting has become more prevalent with online social networking sites now facilitating interactions, and even some health professionals citing harm reduction concepts for gay men as a measure to reduce the risk of acquiring HIV infection.{{Cite journal |last=Race |first=Kane |year=2010 |title=Click Here for HIV Status: Shifting Templates of Sexual Negotiation |journal=Emotion Space & Society |pages=7–14 |volume=3 |issue=1 |doi=10.1016/j.emospa.2010.01.003}}

=Bareback sex=

Barebacking, or having male-to-male anal sex without using a condom, first became articulated in magazines such as POZ in 1995–96 as a practice taking place among HIV-positive men, and may be seen as an early articulation of serosorting.{{Cite journal |last=Race |first=Kane |year=2010 |title=Engaging in a Culture of Barebacking: Gay Men and the Risk of HIV Prevention |journal=HIV Treatment and Prevention Technologies in International Perspective |pages=144–166 |isbn=978-0-230-23819-0|doi=10.1057/9780230297050_8 }}

References

External links

{{cite web |url=http://www.prospect-magazine.co.uk/article_details.php?id=10184 |title=The plague is over, let's party |author=Elizabeth Pisani |date=June 2008 |publisher=prospect-magazine.co.uk |access-date=2008-06-02}}
{{cite web |url=http://www.sfaf.org/beta/2006_win/dual_infection.html |title=Dual Infection |publisher=San Francisco Aids Foundation |date=2006-01-01 | access-date=2008-07-25}}

Category:Prevention of HIV/AIDS

Category:HIV/AIDS

Category:LGBTQ terminology

Category:Serology

Category:Sexual acts

Category:Sexual slang