Trends in Serosorting & the Association with HIV/STI Risk Over Time among Men Who Have Sex with Men
BACKGROUND:
Serosorting
among men who have sex with men (MSM) is common but recent data to describe
trends in serosorting are limited. How serosorting affects population-level
trends in HIV and other sexually transmitted infection (STI) risk is largely
unknown.
METHODS:
We
collected data as part of routine care from MSM attending an STD clinic (2002-2013)
and a community-based HIV/STD testing center (2004-2013) in Seattle,
Washington. MSM were asked about condom use with HIV-positive, HIV-negative and
unknown-status partners in the prior 12 months. We classified behaviors into
four mutually exclusive categories: no anal intercourse (AI); consistent condom
use (always used condoms for AI); serosorting (condomless anal intercourse
[CAI] only with HIV-concordant partners); and non-concordant CAI (CAI with
HIV-discordant/unknown-status partners; NCCAI).
RESULTS:
Behavioral
data were complete for 49,912 clinic visits. Serosorting increased
significantly among both HIV-positive and HIV-negative men over the study
period. This increase in serosorting was concurrent with a decrease in NCCAI
among HIV-negative MSM, but a decrease in consistent condom use among
HIV-positive MSM. Adjusting for time since last negative HIV test, the risk of
testing HIV positive during the study period decreased among MSM who reported
NCCAI (7.1% to 2.8%; P=0.02), serosorting (2.4% to 1.3%; P=0.17) and no CAI
(1.5% to 0.7%; P=0.01). Serosorting was associated with a 47% lower risk of
testing HIV positive compared to NCCAI (adjusted prevalence ratio=0.53; 95%
CI=0.45-0.62).
CONCLUSIONS:
Between
2002 and 2013, serosorting increased and NCCAI decreased among Seattle MSM.
These changes paralleled a decline in HIV test positivity among MSM.
- 1 Department of Epidemiology, University of Washington, Seattle, WA, USA
- 2 Department of Medicine, University of Washington, Seattle, WA, USA
- 3 Department of Biostatistics, University of Washington, Seattle, WA, USA
- 4 Department of Global Health, University of Washington, Seattle, WA, USA
- 5 Public Health - Seattle and King County HIV/STD Program, Seattle, WA, USA
- 6 Gay City Health Project, Seattle, WA, USA.
- J Acquir Immune Defic Syndr. 2016 Feb 13.
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