[Presented at SÖDAK 2009: The German-Austrian-Swiss AIDS Congress, June 24-27 2009]
Marcus ULRICH and Axel J. SCHMIDT (Robert Koch Institut)
Objectives: We aimed to quantify the frequency and effectiveness of HIV risk management strategies and tactics other than condom use among men who have sex with men (MSM) in Germany and their impact on the frequency of sexually transmitted infections (STI).
Methods: For a cross-sectional survey a self-administered questionnaire was distributed via German MSM websites and medical practices in 2006. The majority (87%) of 6,833 analyzed participants were recruited online. We analyzed risk management of participants who reported HIVserosorting as a strategy (premeditated, planned) or as a tactic (depending on the situation) and explored the impact of HIV serosorting on the incidence of self-reported bacterial STIs by comparing serosorters with participants who reported other forms of risk management.
Results: HIV status has a large impact on the way how HIV serosorting is implemented. While HIV serosorting used strategically and tactically seems to be very similar in HIV positive MSM, there are distinct differences between HIV negative strategic and tactic serosorting. Except for HIV negative strategic serosorters, serosorting is associated with reduced condom use, higher partner numbers and a two to four fold increased risk of being diagnosed with bacterial STIs.
Discussion: HIV serosorting within primary relationships as well as with casual partners has emerged as a common risk management strategy and tactic in MSM. Apart from the problems of unambiguous communication about HIV status and the reliability of an HIV negative serostatus information, HIV serosorting as practiced currently by MSM in Germany is often used as an alternative to condoms, contributes to high incidences of STIs and hence elevated per-contact-risks for HIV transmission. Exclusive emphasis on HIV testing may encourage HIV serosorting, and thus may not solve the problems of HIV prevention, mainly because it lacks a comprehensive sexual risk reduction strategy for ART-naïve MSM diagnosed with HIV.
Slides from the presentation (in German)