title: Serosorting is associated with a decreased risk of HIV seroconversion in the EXPLORE Study Cohort.
abstract: BACKGROUND
  Seroadaptation strategies such as serosorting and seropositioning originated within communities of men who have sex with men (MSM), but there are limited data about their effectiveness in preventing HIV transmission when utilized by HIV-negative men.
  
  
  RESULTS
  Data from the EXPLORE cohort of HIV-negative MSM who reported both seroconcordant and serodiscordant partners were used to evaluate serosorting and seropositioning. The association of serosorting and seropositioning with HIV seroconversion was evaluated in this cohort of high risk MSM from six U.S. cities. Serosorting was independently associated with a small decrease in risk of HIV seroconversion (OR=0.88; 95%CI, 0.81-0.95), even among participants reporting ≥10 partners. Those who more consistently practiced serosorting were more likely to be white (p=0.01), have completed college (p=<0.0002) and to have had 10 or more partners in the six months before the baseline visit (p=0.01) but did not differ in age, reporting HIV-infected partners, or drug use. There was no evidence of a seroconversion effect with seropositioning (OR 1.02, 95%CI, 0.92-1.14).
  
  
  CONCLUSIONS
  In high risk HIV uninfected MSM who report unprotected anal intercourse with both seroconcordant and serodiscordant partners, serosorting was associated with a modest decreased risk of HIV infection. To maximize any potential benefit, it will be important to increase accurate knowledge of HIV status, through increased testing frequency, improved test technology, and continued development of strategies to increase disclosure.
authors.affiliation: San Francisco Department of Public Health, San Francisco, California, United States of America. Susan.Philip@sfdph.org
authors.forename: Susan S
authors.initials: SS
authors.lastname: Philip
authors.forename: Xuesong
authors.initials: X
authors.lastname: Yu
authors.forename: Deborah
authors.initials: D
authors.lastname: Donnell
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Susan
authors.initials: S
authors.lastname: Buchbinder
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D006679:HIV Seropositivity / Q000453:epidemiology / Q000276:immunology / Q000523:psychology*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D021841:Safe Sex; D012747:Sexual Partners / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D047568:Unsafe Sex; D055815:Young Adult