title: Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation.
abstract: OBJECTIVE
  This study assessed unprotected anal and oral sex behaviors of HIV-positive gay and bisexual men in New York City and San Francisco with their main and non-main sexual partners. Here we focus on the use of three harm reduction strategies (serosorting, strategic positioning, and withdrawal before ejaculation) in order to decrease transmission risk.
  
  
  METHODS
  The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising and other techniques.
  
  
  RESULTS
  City differences were identified, with more men in San Francisco reporting sexual risk behaviors across all partner types compared with men in New York City. Serosorting was identified, with men reporting significantly more oral and anal sex acts with other HIV-positive partners than with HIV-negative partners. However, men also reported more unprotected sex with partners of unknown status compared with their other partners. Some evidence of strategic positioning was identified, although differences were noted across cities and across different types of partners. Men in both cities reported more acts of oral sex without ejaculation than with ejaculation, but the use of withdrawal as a harm reduction strategy for anal sex was more common among men from San Francisco.
  
  
  CONCLUSIONS
  Overall, evidence for harm reduction was identified; however, significant differences across the two cities were found. The complicated nature of the sexual practices of gay and bisexual men are discussed, and the findings have important implications for prevention efforts and future research studies.
authors.affiliation: Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY 10021, USA. jeffrey.parsons@hunter.cuny.edu
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Parsons
authors.forename: Eric W
authors.initials: EW
authors.lastname: Schrimshaw
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wolitski
authors.forename: Perry N
authors.initials: PN
authors.lastname: Halkitis
authors.forename: David W
authors.initials: DW
authors.lastname: Purcell
authors.forename: Colleen C
authors.initials: CC
authors.lastname: Hoff
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Gómez
mesh_terms: D000328:Adult; D001727:Bisexuality / Q000523:psychology / Q000706:statistics & numerical data; D004542:Ejaculation; D006679:HIV Seropositivity / Q000523:psychology*; D040261:Harm Reduction; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009519:New York City; D021841:Safe Sex / Q000523:psychology / Q000706:statistics & numerical data; D012495:San Francisco; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D012747:Sexual Partners; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data