%0 Journal Article
%T Serosorting and HIV/STI Infection among HIV-Negative MSM and Transgender People: A Systematic Review and Meta-Analysis to Inform WHO Guidelines
%A Caitlin E. Kennedy
%A Laura J. Bernard
%A Kathryn E. Muessig
%A Kelika A. Konda
%A Elie A. Akl
%A Ying-Ru Lo
%A Antonio Gerbase
%A Kevin R. O＊Reilly
%J Journal of Sexually Transmitted Diseases
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/583627
%X We conducted a systematic review and meta-analysis to assess the association between serosorting and HIV infection, sexually transmitted infections (STIs), and quality of life among men who have sex with men (MSM) and transgender people. Two reviewers independently screened abstracts and abstracted data. Meta-analyses were conducted using random effects models. Of 310 citations reviewed, 4 observational studies, all with MSM, met inclusion criteria. Compared to consistent condom use, serosorting was associated with increased risk of HIV (3 studies, odds ratio (OR): 1.80, 95% confidence interval (CI):1.21每2.70) and bacterial STIs (1 study, OR: 1.62, 95% CI: 1.44每1.83). Compared to no condom use, serosorting was associated with reduced risk of HIV (3 studies, OR: 0.46, 95% CI: 0.25每0.83) and bacterial STIs (1 study, OR: 0.81, 95% CI: 0.73每0.91). Among HIV-negative MSM, condom use appears to be more protective against HIV and STIs than serosorting and should be encouraged. However, serosorting may be better than no condom use as a harm reduction strategy. 1. Introduction Serosorting occurs when individuals limit their sexual partners to those with the same HIV status as themselves [1]. Generally, individuals seek out seroconcordant partners in order to forgo condom use while still reducing the risk of HIV [2每4]. This is known as partner serosorting or pure serosorting, while condom serosorting refers to the selective use of condoms with HIV serodiscordant partners [4]. Serosorting is one of a variety of seroadaptive behaviors, also called sexual harm reduction strategies. Seroadaptive behaviors occur when individuals alter their sexual behaviors based on knowledge or suspected knowledge of HIV serostatus of their partners to reduce, but not eliminate, the risk of HIV transmission or acquisition within a known or suspected serodiscordant couple. Seroadaptive behaviors include serosorting, seropositioning, withdrawal before ejaculation, and negotiation around viral load and may include other behaviors not yet identified. Serosorting and seroadaptive behaviors have received wider attention in recent years as expansion in HIV testing and treatment worldwide has meant that more people living with HIV know their status, are living longer and healthier lives, and resume or continue sexual activity. At the same time, there has been continued debate on the protective effect of serosorting on HIV and sexually transmitted infection (STI) acquisition among HIV-negative individuals. While serosorting may contribute to reducing transmission of HIV, modeling suggests
%U http://www.hindawi.com/journals/jstd/2013/583627/