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RESEARCH ARTICLE
Contents Vol 8(2)

HIV serosorting among HIV-positive men who have sex with men is associated with increased self-reported incidence of bacterial sexually transmissible infections

Ulrich Marcus A B C , Axel J. Schmidt A B and Osamah Hamouda A
+ Author Affiliations
- Author Affiliations

A Robert Koch Institute, Post Box 650261, 13302 Berlin, Germany.

B These authors contributed equally to this work.

C Corresponding author. Email: marcusu@rki.de

Sexual Health 8(2) 184-193 https://doi.org/10.1071/SH10053
Submitted: 3 May 2010  Accepted: 20 August 2010   Published: 18 May 2011

Abstract

Background: We aimed to quantify the frequency of HIV serosorting among men who have sex with men (MSM) in Germany, and evaluate the association of serosorting with other sexual risk management approaches (RMA) and with the frequency of bacterial sexually transmissible infections (STI). Methods: An anonymous, self-administered questionnaire was distributed through German online sexual networking sites and medical practices in 2006. The analysis was based on 2985 respondents who reported an HIV test result. Based on two questions on RMA, serosorting was classified as tactical (an event-based decision) or strategic (a premeditated search for a seroconcordant partner). The analysis was stratified by HIV serostatus and seroconcordant partnership status. Results: HIV serosorting patterns were different for HIV-positive and HIV-negative participants. Tactical serosorting ranked second after RMA based on condom use (HIV-positive: 55.1%, HIV-negative: 45.1%; P < 0.001). While the overlap of strategic and tactical HIV serosorting among HIV-positive MSM was substantial (58.0%), HIV-negative strategic and tactical serosorting were more distinct (18.1% overlap). Among HIV-positive and HIV-negative respondents, tactical serosorting was associated with reduced condom use. Compared with respondents using RMA other than serosorting, HIV-positive men reporting serosorting had a three-fold increased risk for bacterial STI (strategic: odds ratio (OR) = 2.62; 95% confidence interval (CI): 1.76–3.89; tactical: OR = 3.19; 95% CI: 2.14–4.75; both for respondents without HIV seroconcordant partners). Conclusions: HIV serosorting has emerged as a common RMA among MSM. For HIV-positive MSM, it may contribute to high rates of bacterial STI that may lead to elevated per-contact risks for HIV transmission.

Graphical Abstract Image

Additional keywords: condom use, Germany, sexual risk management.


Acknowledgements

We would like to acknowledge the assistance of our colleagues at Robert Koch Institute who contributed to the study, particularly Claudia Kuecherer and her team; and the cooperation of the German MSM websites and private practices, without whom we would not have succeeded in recruiting so many participants; and, of course, the study participants who filled out the questionnaire. The study was financed by a grant from the German Federal Ministry of Health.


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A Safer sex has been a term used in national German prevention campaigns targeted at MSM since the mid-1980s. Safer sex essentially signified the use of condoms for anal intercourse.

B The estimated number of MSM living with HIV in Germany in 2006 was ~30 000; the estimated number of MSM in the adult male population (18–59 years), assuming a proportion of 2.9% MSM, is ~650 000.