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):1.21–2.70) and bacterial STIs (1 study, OR: 1.62, 95% CI: 1.44–1.83). Compared to no condom use, serosorting was associated with reduced risk of HIV (3 studies, OR: 0.46, 95% CI: 0.25–0.83) and bacterial STIs (1 study, OR: 0.81, 95% CI: 0.73–0.91). 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 [2–4]. 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
References
[1]
L. A. Eaton, S. C. Kalichman, D. N. Cain et al., “Serosorting sexual partners and risk for HIV among men who have sex with men,” The American Journal of Preventive Medicine, vol. 33, no. 6, pp. 479–485, 2007.
[2]
J. Elford, “Changing patterns of sexual behaviour in the era of highly active antiretroviral therapy,” Current Opinion in Infectious Diseases, vol. 19, no. 1, pp. 26–32, 2006.
[3]
F. Jin, J. Crawford, G. P. Prestage et al., “Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men,” AIDS, vol. 23, no. 2, pp. 243–252, 2009.
[4]
J. M. Snowden, H. F. Raymond, and W. McFarland, “Prevalence of seroadaptive behaviours of men who have sex with men, San Francisco, 2004,” Sexually Transmitted Infections, vol. 85, no. 6, pp. 469–476, 2009.
[5]
D. P. Wilson, D. G. Regan, K. J. Heymer, F. Jin, G. P. Prestage, and A. E. Grulich, “Serosorting may increase the risk of HIV acquisition among men who have sex with men,” Sexually Transmitted Diseases, vol. 37, no. 1, pp. 13–17, 2010.
[6]
D. M. Butler and D. M. Smith, “Serosorting can potentially increase HIV transmissions,” AIDS, vol. 21, no. 9, pp. 1218–1220, 2007.
[7]
M. R. Golden, J. Stekler, J. P. Hughes, and R. W. Wood, “HIV serosorting in men who have sex with men: is it safe,” Journal of Acquired Immune Deficiency Syndromes, vol. 49, no. 2, pp. 212–218, 2008.
[8]
G. Marks, G. A. Millett, T. Bingham, J. Lauby, C. S. Murrill, and A. Stueve, “Prevalence and protective value of serosorting and strategic positioning among black and latino men who have sex with men,” Sexually Transmitted Diseases, vol. 37, no. 5, pp. 325–327, 2010.
[9]
S. S. Philip, X. Yu, D. Donnell, E. Vittinghoff, and S. Buchbinder, “Serosorting is associated with a decreased risk of HIV seroconversion in the EXPLORE study cohort,” PLoS ONE, vol. 5, no. 9, Article ID e12662, 2010.
[10]
K. C. Poudel, K. Poudel-Tandukar, J. Yasuoka, and M. Jimba, “HIV superinfection: another reason to avoid serosorting practice,” The Lancet, vol. 370, no. 9581, p. 23, 2007.
[11]
D. E. Siconolfi and R. W. Moeller, “Serosorting,” BETA, vol. 19, no. 2, pp. 45–49, 2007.
[12]
H. H. M. Truong, T. Kellogg, J. D. Klausner et al., “Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting?” Sexually Transmitted Infections, vol. 82, no. 6, pp. 461–466, 2006.
[13]
World Health Organization, Prevention and Treatment of HIV and Other Sexually Transmitted Infections Among Men Who Have Sex with Men and Transgender People: Recommendations for a Public Health Approach, World Health Organization, Geneva, Switzerland, 2011.
[14]
D. Moher, A. Liberati, J. Tetzlaff, D. G. Altman, and PRISMA Group, “Preferred reporting items for systematic reviews and meta-analyses. The PRISMA statement,” Annals of Internal Medicine, vol. 151, no. 4, pp. 264–269, 2009.
[15]
J. A. Denison, K. R. O'Reilly, G. P. Schmid, C. E. Kennedy, and M. D. Sweat, “HIV voluntary counseling and testing and behavioral risk reduction in developing countries: a meta-analysis, 1990–2005,” AIDS and Behavior, vol. 12, no. 3, pp. 363–373, 2008.
[16]
C. Kennedy, K. O'Reilly, A. Medley, and M. Sweat, “The impact of HIV treatment on risk behaviour in developing countries: a systematic review,” AIDS Care, vol. 19, no. 6, pp. 707–720, 2007.
[17]
G. H. Guyatt, A. D. Oxman, G. Vist et al., “GRADE guidelines: 4. Rating the quality of evidence—study limitations (risk of bias),” Journal of Clinical Epidemiology, vol. 64, no. 4, pp. 407–415, 2011.
[18]
H. Cooper and L. V. Hedges, The Handbook of Research Synthesis, Russell Sage Foundation, New York, NY, USA, 1994.
[19]
J. P. T. Higgins and S. Green, Eds., Cochrane Handbook for Systematic Reviews of Interventions, John Wiley & Sons, Chichester, UK, 2008.
[20]
F. Jin, G. P. Prestage, D. J. Templeton et al., “The impact of HIV seroadaptive behaviors on sexually transmissible infections in HIV-negative homosexual men in Sydney, Australia,” Sexually Transmitted Diseases, vol. 39, no. 3, pp. 191–194, 2012.
