HIV

Assumed Risk

Experts have put forth all kinds of ideas to help reduce HIV transmissions, but a new study shows that one touted practice might well be creating even more harm.

By Benjamin Ryan

March 1, 2010

Since the beginning of the epidemic, gay men seeking unprotected intercourse have developed their own methods of attempting to prevent the spread of HIV -- namely, selecting only partners with the same HIV serostatus as themselves. On its face, the practice -- which the public-health sector has dubbed "serosorting" -- sounds like a no-brainer as a safety precaution. And researchers who've delved into the issue have found that the practice provides potential benefits, along with some risks, for HIV-positive men. But for HIV-negative men, it's a whole different -- and dangerous -- ball game.

"It's this paradoxical scenario where people believe they're safe but are taking risks at the same time," says Lisa A. Eaton, a postdoctoral fellow at the Yale School of Public Health and lead author of the study, whose results were published in the October issue of the journal AIDS Care.

Her study found that between 21% and 62% of both HIV-negative and -positive men report serosorting. HIV-negative men are often falsely reassured by the assumption that their partners are also free of the virus -- with many relying only on nonverbal cues to confirm another's HIV status. For those who do ask about HIV, the study points out that it may be impossible for men to test for HIV frequently enough to accurately know their own serostatus. Furthermore, untreated sexually transmitted diseases can help fuel the spread of HIV among serosorting sexual networks. So for these men, Eaton points out, their approach to the practice of serosorting is actually increasing their risk for infection.

Then there are some HIV-positive guys who, however, simply assume their partner is the same serostatus as themselves without actually having a conversation about HIV. As many as a third of seropositive gay men report having unprotected intercourse without ever disclosing their HIV status.

And some say the false sense of security that serosorting is creating is really doing more harm than good. Mark S. King, a blogger at TheBody.com, says that for HIV-negative men, "Serosorting is just a different name for the ignorance and lying we've been doing all along. Why call it ‘serosorting'? Call it '1985.' "

And though King doesn't think the practice is OK for people who are HIV-negative, the 49-year-old has seen value in it for himself and other HIVers. He says he got tired of the anxiety about potentially infecting his partners and began exclusively seeking out other HIV-positive men.

Among other reasons that many gay HIVers are motivated to serosort, Eaton's study finds, is the fear that disclosing will lead to stigma or personal rejection. They may also worry about state laws that criminalize HIV exposure.

Longtime AIDS activist and AIDSMeds.com founder Peter Staley agrees with King's approach: "I think serosorting for HIV-positive men, in my book, is a good thing. I actually consider it one of the perks of being HIV-positive -- that we have far fewer issues to deal with from unprotected sex between each other than HIV-negative men do."

"It's ironic," King points out, though. "Jesse Helms wanted to put us on an island and otherwise segregate us. And now that's exactly what we're doing for ourselves. Just because it does lower that anxiety."

But concerns aren't just about transmitting HIV. Unprotected sex outside of a mutually monogamous relationship in which both partners have been screened for STDs, experts point out, is always a risk. STDs can lower T-cell counts, raise viral loads, and generally put a body with a weakened immune system in a tailspin. Terry Smith, associate director of education at AIDS Project Los Angeles recommends that HIV-positive men with multiple partners get screened every three months for a range of STDs. And as for the much-debated potential for superinfection, Eaton's review states that this is a proven risk. However, it is rare and tends to happen only in people who are newly infected.