CDC Meeting Summary: “Consultation on Serosorting Practices among Men who Have Sex with Men”

Here is a link to the full (short and sweet) summary.

[NOTE: Jim Pickett of LifeLube attended this CDC consultation, held Dec 2 - 3, 2008. He is delighted to finally see this summary published, and will be active in pushing this important conversation forward.]

Select highlights:

- "Serosorting is most often defined as a person choosing a sexual partner known to be of the same HIV serostatus, often to engage in unprotected sex, in order to reduce the risk of acquiring or transmitting HIV."

- "The consultants perceived seroadaptation to be a broader and more inclusive term than serosorting and, more consistent with the broader goal of improving the sexual health of gay and bisexual men in the United States. Discussions also focused on possible ways to frame prevention messages, including breadth and content of the messages as well as specific messages for partnerships in which both members are infected with HIV, partnerships in which both partners are not infected with HIV, and partnerships in which the members are serodiscordant or serostatus is unknown."

- "Regarding superinfection, the consultant noted that few cases have been reported in the literature and that the risk appears highest soon after seroconversion and may decline over the course of infection. Some data discussed by the consultants also indicate limited clinical consequences of superinfection. However, the consultants noted the lack of research among African American and Latino men and on superinfection in general."

- "The consultation highlighted the need to clearly define seroadaptation practices, and particularly serosorting, among MSM, and to understand the differing risks based on a variety of contextual factors. Several areas for future research were recommended. The information obtained in this consultation will inform potential future CDC activities, the development of prevention messages or guidance documents, and the creation of future funding announcements. As follow-up to this consultation, CDC will develop a fact sheet on serosorting among MSM that will include definitions of various seroadaptation practices, the state of the science with regard to behavioral patterns and their potential HIV risk under different situations and with different types of partners, and recommendations for future research. The fact sheet will be released later this year."

Read the whole thing.

The plague is over, let's party

by Elizabeth Pisani in Prospect

Pisani is an epidemiologist and the author of The Wisdom of Whores. Check out her blog by the same name here.

She has been stirring the pot on a number of listservs that LifeLube is on - we thought we'd let you lick the spoon on this provocative essay about HIV/AIDS and gay men in Britian.

Taste good?

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An HIV diagnosis in Britain is no longer a death sentence—
thanks to costly new drugs.
But as the spectre of death fades, so do the
most visible reasons to avoid risky behaviour.

Now the Aids prevention industry has a whole new set of problems .

I'm in a bar in Soho. A message flashes up on the plasma screen on the wall behind me: "Tom, I want to nibble your biltong." A guy leaning against the banisters makes a show of putting his mobile phone away while making eye contact with a cute blond boy at the bar. Cute blond blushes. Soon, they're smooching in a corner. How Tom's biltong fared that night I don't know, but I can guess.

This is London's gay scene in a world without Aids. Since treatment for HIV became available in the mid-1990s, Aids has all but evaporated in rich countries. Annual deaths among gay men in Britain have crashed from a peak of over 1,162 in 1994 to just 153 in 2007. "Aids? I've never met anyone with Aids," says Tim, an engineering undergraduate who's sitting under the plasma screen, nursing a nasty pre-mixed drink. When I ask how many of the guys around us might be infected with HIV, he looks shocked. "That's not a nice thing to talk about. I don't know, 4 or 5 per cent?" Actually, the government estimates that around 9 per cent of gay men in London are HIV-infected, against 5 per cent elsewhere. But we're not looking at all gay men in London. We're looking at guys in a pick-up bar at 1am on Friday night; I'm probably the only person here who will leave without being propositioned. Many of the men eyeing each other up are in their 30s; they've had plenty of time to get infected. My guess is that 25 per cent of the men in this room have HIV, possibly a lot more. In 2006, 2,640 gay men were diagnosed with HIV—making up nearly two thirds of the total diagnoses of HIV infections that were acquired in Britain.

You don't have to be an epidemiologist to work out that if 2,640 people are diagnosed with an incurable disease and only 153 die, the number of people known to be living with the disease will rise. The number of gay men living with HIV in Britain is probably around 31,000.

But these days you never see a cadaverous looking 35 year old in an armchair surrounded by friends trying not to notice that his face is covered by the black splotches of Kaposi's sarcoma, a cancer that feeds on people weakened by HIV. And as Aids disappears, so does the most visible reason to avoid unprotected sex. Just under half of gay men say they had some unprotected anal sex in the last year, up from under a third in 1996, when treatment became widespread. But if HIV isn't fatal any more, does it really matter if lots more people get infected?

The relationship between HIV treatment and prevention in the gay community is not straightforward. Virology, psychology, drugs and gay activist ideology play their part. Let's start with the virology. HIV is not very infectious. It is only easily transmitted when there's a high "viral load"—lots of free virus in the blood or genital fluids—and that is usually only for the first couple of months after a person gets infected, and then, years later, once they get sick. That means that people who have unprotected sex with several people in a three-month period are far more likely both to contract and spread HIV than people who have the same number of partners over a longer period. And gay men are far more likely than straight people to have lots of partners at once. A recent study of people who go drinking and clubbing in nine European cities found that gay or bisexual men were four times more likely than even out-to-have-fun heterosexuals to have had five or more recent partners.

Read the rest.

When serosorting is seroguessing

by Gus Cairns for aidsmap

Gay men attempt to reduce their risks of acquiring or transmitting HIV using information about HIV status, the Eighth AIDS Impact Conference in Marseille heard last week, but use a complex, fallible and sometime contradictory mix of guessing and rationalisation to do so.

As a result, said Peter Keogh of Sigma Research in London, who was one of the presenters in the session on ‘Risk Perception’: “The notion of who should be responsible for safer sex, and what responsibility consists of, becomes ever more fraught.”

Over the past few years there has been increasing interest in understanding what gay men do to avoid HIV infection and transmission when they know their own and their partner’s HIV status. This behaviour has been dubbed `serosorting` by some researchers, because it often involves choosing to have unprotected anal intercourse only with partners of the same HIV status.

Seroguessing in Australia

At last week’s conference Iryna Zablotska of the University of New South Wales in Australia introduced a new term – ‘seroguessing’ – for what a lot of gay men actually do.

She said that the proportion of Australian gay men, both with and without HIV, who both had unprotected sex and who attempted to serosort, in other words restrict it to men of the same HIV status, had increased between 2001 and 2006.

Read the rest here.