Serosorting
Encyclopedia
Serosorting is the practice of using HIV
status as a decision-making point in choosing sexual behavior. Frequently the term is used to describe the behavior of a person who chooses a sexual partner assumed to be of the same HIV serostatus
for the purpose of engaging in unprotected sex
with the intent to reduce the risk of acquiring or transmitting HIV.
Knowledge of HIV status is based on the result of a person's HIV test
, with a positive result indicating that a person has HIV
and can transmit the disease to others during sexual contact in which body fluids are exchanged. There are many causes which lead to situations where one person who asks about the status of another cannot get accurate information, for example, the person asked might be truly ignorant about their status due to not having had a test since their last risky sexual encounter.
Because of difficulty in accurately determining serostatus outside of a clinical setting, serosorting has limited efficacy. As people typically do not engage in sex practices with the expectation of contracting or transmitting HIV, failed attempts at serosorting are a leading cause of people contracting HIV.
. Sorting refers to choosing partners based on HIV status, which can be determined from a blood test among other ways.
"Serodiscordant
" sex refers to sex between an HIV positive person and an HIV negative person. Typically persons practicing serosorting make an attempt to find someone with a matching HIV test result, otherwise known as "concordant serostatus
."
after a recent infection. Secondly, just because someone does not have HIV does not mean that they are free of other sexually transmitted disease
s such as syphilis
or hepatitis B. However, the largest experiment with serosorting has been conducted in the adult film industry by the Adult Industry Medical Healthcare Foundation. All actors in legitimate adult films are tested twice a year for Gonorrhea, Chlamydia, Syphilis, Hepatitis A/B/C, Herpes and HIV-and Monthly for HIV, Gonorrhea and Chlamydia. The AIM testing program eliminates virtually all possibility of lying and enforces a high frequency of testing-and involves testing for a variety of STD's that can make transmission of HIV more likely. Before this program of testing adult film actors had a very high rate of STD's-and now have a rate of STD's 20% that of the general public. There exists a service, STFree Certifications which allows the general public to anonymously and securely exchange STD test results-but few public health professionals are aware of this service-and its effectiveness and proper use haven't been thoroughly tested.
3.5% of the men he observed that did not use condoms or serosort became HIV+, 2.6% of the men he observed that serosorted became HIV+ as did 1.5% of the men who reported consistent condom use.
Golden's population differs from AIM's in that anal sex was a large portion of their sexual habits, their testing intervals were typically longer and less regular, there was no testing for other diseases like Chlamydia which can speed spread of HIV and there were no protections against false reporting of results. Golden's study did not cover the use of serosorting combined with condoms-which theoretically would be more effective than either precaution used alone.
will develop. Unprotected sex between two HIV+ individuals does risk that one with a less aggressive, drug susceptible strain of the virus who might have kept his infection well under the control of the available drugs, might find him or herself with an aggressively drug resistant strain. Furthermore, dual infection has been associated with more rapid progression to AIDS
.
who use it as an HIV risk reduction technique.
It has been seen as controversial for being used to engage in sexual activities without regard to safer sex practices as either participants were free of HIV or were already carriers. Although the practice has occurred informally since the AIDS pandemic
began, serosorting has become more prevalent with online social networking sites facilitating quick networking and even some health professionals citing harm reduction
concepts for gay
men as a measure to reduce the risk of acquiring HIV
infection.
, when first articulated in magazines such as POZ magazine
in 1995/6 as a practice taking place among HIV positive men, could be seen as an early articulation of serosorting.
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
status as a decision-making point in choosing sexual behavior. Frequently the term is used to describe the behavior of a person who chooses a sexual partner assumed to be of the same HIV serostatus
Serostatus
Serostatus is a term used to refer to the presence or absence of specific substances in the blood serum. Most commonly, this medical test is looking for specific antibodies in an effort to diagnose a particular disease....
for the purpose of engaging in unprotected sex
Safe sex
Safe sex is sexual activity engaged in by people who have taken precautions to protect themselves against sexually transmitted diseases such as AIDS. It is also referred to as safer sex or protected sex, while unsafe or unprotected sex is sexual activity engaged in without precautions...
with the intent to reduce the risk of acquiring or transmitting HIV.
Knowledge of HIV status is based on the result of a person's HIV test
HIV test
HIV tests are used to detect the presence of the human immunodeficiency virus , the virus that causes acquired immunodeficiency syndrome , in serum, saliva, or urine. Such tests may detect antibodies, antigens, or RNA.- Terminology :...
, with a positive result indicating that a person has HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
and can transmit the disease to others during sexual contact in which body fluids are exchanged. There are many causes which lead to situations where one person who asks about the status of another cannot get accurate information, for example, the person asked might be truly ignorant about their status due to not having had a test since their last risky sexual encounter.
Because of difficulty in accurately determining serostatus outside of a clinical setting, serosorting has limited efficacy. As people typically do not engage in sex practices with the expectation of contracting or transmitting HIV, failed attempts at serosorting are a leading cause of people contracting HIV.
Etymology
The word "serosorting" comes from the Latin word "serum," which refers to blood serumBlood serum
In blood, the serum is the component that is neither a blood cell nor a clotting factor; it is the blood plasma with the fibrinogens removed...
. Sorting refers to choosing partners based on HIV status, which can be determined from a blood test among other ways.
"Serodiscordant
Serodiscordant
Serodiscordant is a term used to describe a couple in which one partner is HIV positive and the other is HIV negative. Serodiscordant relationships are also referred to as "magnetic". The term seroconcordant is its antonym, used to describe a couple in which both partners are of the same HIV...
" sex refers to sex between an HIV positive person and an HIV negative person. Typically persons practicing serosorting make an attempt to find someone with a matching HIV test result, otherwise known as "concordant serostatus
Serostatus
Serostatus is a term used to refer to the presence or absence of specific substances in the blood serum. Most commonly, this medical test is looking for specific antibodies in an effort to diagnose a particular disease....
."
Failure to accurately authenticate another person's true HIV status
Firstly, some people may not be sure of their true HIV status, or lie about it. Even a recent negative HIV test may not be definitive, if they are still within the window periodWindow period
In medicine, the window period for a test designed to detect a specific disease is the time between first infection and when the test can reliably detect that infection...
after a recent infection. Secondly, just because someone does not have HIV does not mean that they are free of other sexually transmitted disease
Sexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
s such as syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
or hepatitis B. However, the largest experiment with serosorting has been conducted in the adult film industry by the Adult Industry Medical Healthcare Foundation. All actors in legitimate adult films are tested twice a year for Gonorrhea, Chlamydia, Syphilis, Hepatitis A/B/C, Herpes and HIV-and Monthly for HIV, Gonorrhea and Chlamydia. The AIM testing program eliminates virtually all possibility of lying and enforces a high frequency of testing-and involves testing for a variety of STD's that can make transmission of HIV more likely. Before this program of testing adult film actors had a very high rate of STD's-and now have a rate of STD's 20% that of the general public. There exists a service, STFree Certifications which allows the general public to anonymously and securely exchange STD test results-but few public health professionals are aware of this service-and its effectiveness and proper use haven't been thoroughly tested.
Haphazard Serosorting as substitution for condom use offers limited protection
Dr. Matthew Golden of King County Public Health conducted a study of West Coast serosorting men. He concluded that the men he observed got limited protection from HIV via serosorting.3.5% of the men he observed that did not use condoms or serosort became HIV+, 2.6% of the men he observed that serosorted became HIV+ as did 1.5% of the men who reported consistent condom use.
Golden's population differs from AIM's in that anal sex was a large portion of their sexual habits, their testing intervals were typically longer and less regular, there was no testing for other diseases like Chlamydia which can speed spread of HIV and there were no protections against false reporting of results. Golden's study did not cover the use of serosorting combined with condoms-which theoretically would be more effective than either precaution used alone.
Seroconcordant people can still exchange diseases other than HIV
Thirdly, unprotected sex between two HIV+ people is not free of risk. Infection with one strain of HIV does not preclude later infection with another. There is a great deal of genetic variability within individual HIV populations and this variability is shuffled and mutated every time the virus reproduces inside a cell in the body. There are millions of viruses in the body of an infected person. Modern drug cocktails keep virus and mutation levels low but eventually drug resistanceDrug resistance
Drug resistance is the reduction in effectiveness of a drug such as an antimicrobial or an antineoplastic in curing a disease or condition. When the drug is not intended to kill or inhibit a pathogen, then the term is equivalent to dosage failure or drug tolerance. More commonly, the term is used...
will develop. Unprotected sex between two HIV+ individuals does risk that one with a less aggressive, drug susceptible strain of the virus who might have kept his infection well under the control of the available drugs, might find him or herself with an aggressively drug resistant strain. Furthermore, dual infection has been associated with more rapid progression to AIDS
.
Seroconcordant persons will not change each other's serostatus
Studies have shown that serosorting provides some limited decrease in risk of contracting HIV among MSMsMen who have sex with men
Men who have sex with men are male persons who engage in sexual activity with members of the same sex, regardless of how they identify themselves; many men choose not to accept sexual identities of homosexual or bisexual...
who use it as an HIV risk reduction technique.
It has been seen as controversial for being used to engage in sexual activities without regard to safer sex practices as either participants were free of HIV or were already carriers. Although the practice has occurred informally since the AIDS pandemic
AIDS pandemic
The acquired immune deficiency syndrome pandemic is a widespread disease caused by the human immunodeficiency virus .Since AIDS was first recognized in 1981, it has led to the deaths of more than 25 million people, making it one of the most destructive diseases in recorded history.Despite recent...
began, serosorting has become more prevalent with online social networking sites facilitating quick networking and even some health professionals citing harm reduction
Harm reduction
Harm reduction refers to a range of public health policies designed to reduce the harmful consequences associated with recreational drug use and other high risk activities...
concepts for gay
Gay
Gay is a word that refers to a homosexual person, especially a homosexual male. For homosexual women the specific term is "lesbian"....
men as a measure to reduce the risk of acquiring HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
infection.
Sex without condoms perceived as desirable
BarebackingBarebacking
Bareback is a slang term to describe acts of sexual penetration without the use of a condom.The term comes from the equestrian term bareback, which refers to the practice of riding a horse without a saddle...
, when first articulated in magazines such as POZ magazine
POZ (magazine)
POZ is a monthly magazine that chronicles the lives of people affected by HIV/AIDS. Its website, Poz.com, has daily HIV/AIDS news, treatment information, forums, blogs and personals....
in 1995/6 as a practice taking place among HIV positive men, could be seen as an early articulation of serosorting.