Eric Leven

Serosorting, Barebackers and +'s- %'s Oh My!

Filed By Eric Leven | December 06, 2007 3:34 PM | comments

Filed in: Living
Tags: barebacking, HIV/AIDS, serosorting, sex ed

Have you ever read an article about the rise or fall of HIV infection rates and when you reach the end you're either scared out of your mind, angry or have no idea what the hell is going on? Yeah, me too. All. the. time.

After reading this incredibly muddy article by 365gay.com entitled: "Study Suggests Shift In Attitude Among Newly Infected Men With HIV Regarding Partners" I again had that, "uhh, what?" feeling. But lately, do to having some incredibly bright and educated people around me I've grown skeptical of the way percentages and statistics are reported and thus my post-article freak-outs have declined.

Here's the dilly:
The article is saying that some poz men are barebacking or men who happen to be barebacking, are positive, but in some cities (like SF) they're beginning to only bareback with other positive men. This is otherwise known as "serosorting."

Serosorting, as defined by wikipedia is "the practice of seeking to only engage in sexual activities with partners who are of the same HIV status as you. In April of 2006, the Los Angeles Times reported that the practice of positive-positive serosorting is partially responsible for the decline in new HIV infections in San Francisco."

Serosorting is the reason why it is possible to see a simultaneous increase of barebacking stats with the decrease of HIV infection rates. Men who choose to not use condoms aren't changing their sexual acts but they are changing their sexual partners, and that in itself is a way to avoid spreading HIV. The trend here is that positive men are barebacking each other and not negative men.

Now listen up and listen up real good. I'm not advocating unsafe sex. I'm not saying that it's a good thing that poz on poz men are choosing not to use condoms (there's a TON of other health related issues with that alone.) I'm simply clearing up a hard-to-decipher article before we start stigmatizing the entire positive community as barebacking orgy-fueled deviants. Trust me, as I've reported before, a lot of gay men, even myself at one time, came spring loaded with that defense. And, yes. Yes. Yes. Yes we can talk about how this trend might make barebacking seemingly more acceptable, that it isn't foolproof and that negative men might get caught up in this, but it is none-the-less, an interesting trend and attitude shift to note.

I feel as though this is neither good nor bad news and proves how complicated statistics, percentages and HIV reporting can be.
Case in point- the article states:

Two separate studies presented earlier in the week at the National HIV Prevention Conference, however, found that more than 35 percent of men who have sex with men continue to have unsafe sex.

Everybody freak out, right?

Hold on a second. As a friend of mine pointed out when discussing this article:
How many of those guys are poz guys who have unprotected sex with poz guys only? In terms of HIV prevention, those guys should be counted out of the equation.
How many of those guys are in monogamous longterm neg couples? In terms of HIV prevention, those guys should be counted out of the equation.
How many of those guys were having non-penetrative or oral sex? In terms of HIV prevention, those guys should be counted out of the equation.

The real question is: How many NEGATIVE men fail to use a condom when they have ANAL sex with someone whose status was uncertain or POSITIVE? But nobody ever asks that question.

See that's just the thing. In many of the safe-sex surveys I take or the questions I answer when getting tested, I'm always asked, "Did you use a condom the last time you had sex?" The answer is almost meaningless without a follow-up question: "Were you and your last partner both already poz? Were you and your last partner both neg men in a longterm monogamous relationship? Was the last time you had sex a strictly oral/J.O. encounter?"

Hell yes. Complicated! But important.

I'd like to be clear about something. You can disagree with me all you want but I feel it is tremendously important that we do not look at postive and negative like black and white cards or a pass/fail on a college exam or a yes/no answer. In order to really begin combating this virus we need the ability to acknowledge and comprehend everything it involves. With anger and sympathy being both important factors, it is simple understanding that will eventually be the key factor winning out.


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I have all these same questions when I read these articles. Good post.

And then there's an even more complicating factor to that 35%: What does "continue" mean? Like once almost never? All the time?

Someone could consider themselves a part of that 65% because they're not having sex w/o a condom regularly. Or they could lie. People lie even on anonymous surveys.

I think that sero-sorting is probably one of the worst ideas ever for solving this problem (OK, abstinence-only education is even worse). How are neg men supposed to know that they're having sex with someone who's neg? That is the other side of sero-sorting, and a lot of guys think they're neg, swear they're neg, and they're not.

Also, what about other STD's for poz men? It's not like HIV is the only thing to worry about out there - there are lots of other STD's.

Then again, if people are going to bareback, and some people really do prefer it and have all the good reasons to bareback in the world, it's better if they're at least discussing status and risk than if they're not talking at all.

Just as an aside, even if you are poz and barebacking only with other poz guys, you are still spreading strains of HIV, and more people having more multistrain infections will make it that much harder to develop a vaccine or a cure, either one of which could conceivably only be effective against a subset of the strains available.

So, although I agree with separating these people out in the statistics, they are still not the same as safe-sex folk as far as spreading HIV.

Alex and Bitter make good points, I'll add one more. In addition to other strains of HIV, there are OTHER BLOODBOURN VIRUSES that will pop up eventually. Scientists knew in the 70s that anonymous sex with multiple partners could lead to a pandemic. Even if we cured HIV tomorrow, we can't go back to multiple, anonymous, unprotected partners, or in ten or twenty years, we'll end up spreading a whole new disease.

Barebacking with multiple partners is ultimately a very selfish, anti-social act. But hey, I agree if poz people are gonna do it, they should do it with each other.

(And are there really neg guys who have unprotected basically anonymous sex with other guys and think they WON'T get infected? Or do they think that HIV isn't that big a deal any more? Either way, this kinda boggles my mind. I mean, how does one maintain this level of self-delusion?)

How many of those guys are poz guys who have unprotected sex with poz guys only? In terms of HIV prevention, those guys should be counted out of the equation. How many of those guys are in monogamous longterm neg couples? In terms of HIV prevention, those guys should be counted out of the equation. How many of those guys were having non-penetrative or oral sex? In terms of HIV prevention, those guys should be counted out of the equation.

The real question is: How many NEGATIVE men fail to use a condom when they have ANAL sex with someone whose status was uncertain or POSITIVE? But nobody ever asks that question.

I don't know, Eric. I have a few concerns here...

How many of those guys are poz guys who have unprotected sex with poz guys only? In terms of HIV prevention, those guys should be counted out of the equation - How do they know they're only having sex with other poz guys? I mean, just like sex ed teaches, being able to tell definitively what your partner's HIV status is impossible. It's the whole "Why you shouldn't bareback" argument in the opposite way.

How many of those guys are in monogamous longterm neg couples? In terms of HIV prevention, those guys should be counted out of the equation. - This one I have a really big issue with... If I had a dollar for every friend that thought they were in a monogamous relationship only to find out they weren't...

How many of those guys were having non-penetrative or oral sex? In terms of HIV prevention, those guys should be counted out of the equation. - This one I'll give you. :)

The real question is: How many NEGATIVE men fail to use a condom when they have ANAL sex with someone whose status was uncertain or POSITIVE? But nobody ever asks that question. - I think a better question is how many men who don't know that they're positive have anal sex with other men without a condom?

Robert Sandor | July 27, 2008 7:40 AM

Your Serosorting comments are outdated, and needed revision. Here is some Safe Sex Serosorting scientific research findings. A question we gay Americans must ask ourselves is: Why are the HIV experts in America censoring the Safe Sex Serosorting data?


The findings:

For more than a decade, Serosorting has broken the cycle of new HIV transmissions, has made safe sex safer, and has reunited mankind to achieve a single, common goal – to reignite the excitement of HIV Prevention.

Serosorting – Having sex with your own HIV status. There are three forms of Serosorting, and two involve safe sex. Serosorting began back in the mid 1990’s as an HIV Prevention and Harm Reduction Strategy in New York City, NY and has now become an international phenomenon.

“The serosorting behavior our participants have reported could have reduced the number of new infections caused by people having random sexual occurrences by 99%,” says Jeff McConnell, project director of the Positive Partner Study at the University of California, San Francisco’s J. David Gladstone Institutes.

"There are other reasons why people may choose partners of the same serostatus beyond the risk of HIV transmission," Dr. William McFarland from the San Francisco Department of Public Health, California explained. "For example, HIV-positive persons may find more support in a relationship with another HIV-positive person because they share many more of the challenging aspects of living with HIV."

The investigator concluded: "Our observations and studies of serosorting may simply be documenting the rise of a community-generated HIV prevention strategy that is happening whether we have any control over it or not." Dr. McFarland said. (Sex Transm Infect 2006;82:461-466.)

“Does serosorting work? In some American cities, evidence of a “disconnect” between rising rates of sexually transmitted infections but steady or declining rates of HIV incidence has been seen as evidence that serosorting is working. Two things are necessary for serosorting:

1) A high rate of HIV testing and,
2) Disclosure of status.

A number of different posters looked at rates of disclosure by HIV-positive people all over the world. A poster from Uganda (King) found that of 1,092 HIV-positive clients of the country’s largest AIDS NGO, TASO, 45% of them men, 42% of them had been sexually active in the past three months and of these 69% had disclosed their HIV status to their partner. Encouragingly, higher rates of disclosure were associated with higher rates of condom use, showing that the two activities are linked.

Finally, in an upbeat presentation, Fiona Percy-de Korte reported on high rates of disclosure among recipients of antiretrovirals in the Botswana National Treatment Programme.

Among this cross-sectional survey of 275 patients in two districts, she said that 90% of ARV recipients had disclosed their HIV status to family members, 71% to their spouse or partner, 54% to friends, 26% to a church leader, and 20% to their employer.

Seventy-three per cent said they always used a condom during sex. And 48% said they had reduced their number of sexual partners since diagnosis.”(1)

There is plenty of evidence that serosorting exists as a behaviour. Jonathan Elford presented a poster showing that serosorting was common not only among HIV-positive gay men in the UK but also among Africans.”(2)

“Investigators from Sydney therefore looked at the serosorting behaviour of gay men known to be HIV-negative between 2002 and 2005. Although these men were not explicitly asked if they had “serosorted,” this behaviour was inferred from information they provided.

The practice of deliberately selecting partners of the same HIV status – often called “serosorting” – has been well described amongst HIV-positive gay men and even been credited with contributing to a fall in HIV incidence in San Francisco. Most investigators have looked at the serosorting behaviours of HIV-positive men and there are limited data on serosorting amongst HIV-negative gay men. There is also some evidence from the United States that HIV-negative men are increasingly avoiding sex with men who know they are HIV-positive. They also suggest that the internet may have a role in the apparent increase in serosorting.” (3)

Conclusion: For more than a decade, Serosorting has not only broken the cycle of NEW HIV transmissions and has made safe sex safer, but, Serosorting is the largest “word of mouth” HIV Prevention and Harm Reduction Strategy on the planet to date. And the Internet has played a key role in it’s success.


(1) Percy-de Korte F. Experiences of people living with AIDS (PLWA) following enrollment in the Botswana National Treatment Programme (BNTP). Sixteenth International AIDS Conference, Toronto, abstract WEAC0102, 2006.
(2) Elford J et al. Serosorting among Africans living with HIV in London. Sixteenth International AIDS Conference, Toronto, abstract WEPDC05, 2006
(3) Mao L et al. ”Serosorting” in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia. AIDS 20: 1204-1206, 2006.
Abelson J et al. HIV optimism does not explain increases in high-risk sexual behaviour among gay men of positive or negative HIV status in Sydney, Australia. AIDS 20: 1215-1216, 2006.