Association Between Serosorting and HIV Risk Differs by Race Among Men with Male Partners

Abstract

Among men who have sex with men, the level of protection against HIV associated with serosorting-the practice of considering a partner's serostatus in making one's decision to have sex or use a condom with that partner-may differ by race and ethnicity. According to an analysis of data collected during visits to a Seattle STD clinic by men who have sex with men, equal proportions of visits by whites, blacks and Hispanics who had not previously tested positive for HIV included reports of serosorting behavior (29- 30%); the proportion of visits during which clients who underwent testing received an HIV diagnosis was significantly lower among whites than among blacks or Hispanics (3% vs. 5% and 4%, respectively). In univariate analyses stratified by race and ethnicity, serosorting was associated with reduced odds of testing positive for HIV among whites (odds ratio, 0.5), but not among blacks or Hispanics. Data for the analysis came from electronic medical records of men who had visited the STD clinic for a new problem between October 1, 2001, and December 31, 2010, and reported having had a male sexual partner in the previous year. During each visit, men were asked about their race and ethnicity; their HIV testing history; their and their partners' HIV status; their sexual behavior, including the types of anal sex they had participated in during the prior two months (insertive, receptive, both or none); and their condom use. Overall, the sample included 22,370 clinic visits by 10,620 white, black and Hispanic men who had sex with men. Some 20,735 visits had complete serosorting data; of these, 17,972 were by men who had not previously tested positive for HIV, and 2,763 were by men who had. During 13,657 visits, men who had not previously tested positive for HIV underwent HIV testing. The authors highlight several limitations of their study, including low analytic power, and the possibility of social desirability bias and of variability in how clinicians surveyed clients. Even so, they conclude that serosorting "may not be protective against HIV" among black men who have sex with men, and suggest that their findings "prompt additional caution related to the promotion of serosorting among [black men who have sex with men] and highlight the need to increase HIV testing coverage and frequency in this critically important population." (PsycINFO Database Record (c) 2013 APA, all rights reserved)