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Sexually Transmitted Diseases
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Lester Gottesman, Christina Cellini
HIV-negative individuals who engage in ano-receptive intercourse are more prone to HIV infection in the presence of ulcerating anal STIs. In addition, recent data suggest that unprotected anal sex has become more common in all communities, and the incidence of sexually-transmitted proctitis and proctocolitis has increased in both the heterosexual and homosexual communities. In particular, HIV serosorting has emerged as a common sexual risk management approach amongst MSM. Serosorting is a term used to describe the behaviour of a person who chooses a sexual partner assumed to be of the same HIV serostatus in order to engage in unprotected sex with them with the intention of reducing the risk of acquiring or transmitting HIV/AIDS. For HIV-positive MSM, this behaviour may contribute to the high rates of self-reported bacterial and viral STIs.4
HIV/AIDS Prevention
Published in James Chin, Jeffrey Koplan, The AIDS Pandemic, 2018
Primary HIV prevention in MSM populations must target those who have multiple and concurrent sex partners since MSM with this pattern of risk behavior have the highest risk of acquiring HIV. HIV incidence in most MSM populations has been reduced from the very high rates present during the initial epidemic phase in the late 1970s and early 1980s to much lower “endemic” levels. Most of the observed decreases in annual HIV incidence by the mid-1980s can be attributed to saturation of infection in those with the highest level of risk behaviors. How much of this decreasing incidence can be attributed to public health prevention programs is not clear and this question will be addressed in the next section of this chapter. However, annual HIV incidence rates in MSM populations are still unacceptably high and currently range from about 1 to 5 percent or higher. Recent studies in the MSM population in San Francisco indicate that annual HIV incidence may now be as low as 1 percent. This decrease in annual incidence may be in part attributable to the new social phenomenon of serosorting, i.e., selecting sex partners based on their known HIV status and the lower viral load of infected persons who are receiving anti-HIV drug treatment (highly active anti-retroviral treatment – HAART). However, even a “low” annual incidence rate of 1 percent (1/100) is still unacceptably high for a severe infectious agent such as HIV.
Bridging the serodivide: attitudes of PrEP users towards sex partners living with HIV
Published in AIDS Care, 2022
Mart Van Dijk, John B. F. De Wit, Thomas E. Guadamuz, Joel E. Martinez, Kai J. Jonas
The division between HIV-positive and HIV-negative men who have sex with men (MSM) has been described as the “serodivide”; defined as the avoidance of sex with a partner of a serodiscordant HIV status (Koester et al., 2018). The serodivide is driven by concerns about HIV transmission and can result in serosorting, an HIV-risk reduction strategy of choosing same HIV status sex partners (Davis et al., 2006; Eaton et al., 2009; Golden et al., 2008). The introduction of biomedical HIV prevention, such as pre-exposure prophylaxis (PrEP) and treatment-as-prevention (TasP), holds the potential to overcome the serodivide and to reduce HIV stigma (Brisson & Nguyen, 2017; Grant & Koester, 2016; Haas et al., 2017; Jaspal & Daramilas, 2016; Malone et al., 2018; Persson, 2016). While there is initial evidence (Golub et al., 2018; Koester et al., 2018), more empirical research is needed to investigate the potential effect of PrEP on decreasing the serodivide and its temporal stability.
A serological divide: men who have sex with men’s attitudes on HIV risk reduction strategies
Published in AIDS Care, 2020
C. Den Daas, P. C. G. Adam, W. Zuilhof, J. B. F. de Wit
Some HIV risk reduction strategies, in particular withdrawal before ejaculation and serosorting (Dubois-Arber et al., 2012; Parsons et al., 2005; Vittinghoff et al., 1999), remain high-risk, with only a limited risk reduction benefit compared to not practicing any risk reduction at all (Vallabhaneni et al., 2012). Withdrawal entails potential high transmission risk because of the presence of HIV in pre-ejaculatory fluid and the possibility of not with-drawing soon enough (Ilaria et al., 1992). Serosorting (only having sex with someone who has the same HIV status) assumes that individuals are aware of their HIV status and disclose it. Moreover, if neither of the partners is on antiretroviral treatment (although unlikely in the Netherlands), serosorting does not take into account the possibility of reinfection with different (drug resistant) strains of HIV. In light of infrequent HIV testing, lack of HIV status disclosure, and acute HIV infections, serosorting might place HIV-negative MSM at risk of HIV (Eaton et al., 2009), and is not advocated as risk reduction strategy in the Netherlands (MantotMan, 2019).
Disparities Between HIV Testing Levels and the Self-Reported HIV-Negative Status of Sexually Active College Students
Published in The Journal of Sex Research, 2019
Edmond Pui Hang Choi, Janet Yuen Ha Wong, Daniel Yee Tak Fong
Furthermore, it is troubling to find a high prevalence of inaccurate disclosure of HIV infection status among sexually active MSM, who are disproportionately affected by HIV. Further studies are needed to explore whether inaccurate disclosure is common during sexual communication and sexual activities or unique only to research studies. The practice of serosorting is common among MSM (Mao et al., 2006). Serosorting is a sexual practice in which potential sexual partners discuss their HIV status and engage in risky sexual behaviors only with those they believe are of a similar serostatus (Suarez & Miller, 2001; Suarez et al., 2001). However, serosorting fails when people misreport their HIV status, either because they do not know they are infected or because they knowingly mislead their partners. Inaccurate disclosure of HIV infection status is dangerous and might help spread HIV to epidemic levels in this subgroup (Golden et al., 2007).