Some gay men in Toronto are having unprotected sex while believing they are not risking transmission of HIV/AIDS.
Serosorting is the controversial practice of men having unprotected anal sex with someone they believe to have the same HIV status — negatives having sex only with negatives, positives only with positives — in order to avoid new HIV infections.
“What we found, really, was the whole area around serosorting is just fraught with assumptions,” says Rui Pires, the gay men’s community education coordinator for the AIDS Committee Of Toronto (ACT). “A lot of it is based on assumptions about a person’s HIV status, and not really talking about it, but trying to second guess it. People don’t usually go that far to find out in conversations because they’re afraid of making it seem like they’re interrogating the other person.”
Studies in Europe, the US and Australia suggest the practice is becoming more widespread, though a recent study in London, England suggests that the percentage of men having unprotected anal sex has not increased there for the last five years.
Studies like one last year in San Francisco that suggested that serosorting has had some effect on reducing HIV-infection rates have been hotly contested. Even the researchers behind that study admit that there are many other factors. For example, gay men in San Francisco tend to get tested frequently. As well, the city has a high percentage of HIV-positive people, who can be more confident of their status than people who were negative at their last test or who merely assume they are negative.
“There are some people out there that don’t acknowledge or don’t actively find out about their status,” says Pires. “They don’t know, don’t want to know or just assume they’re not. Many people just assume that they are HIV-negative, but they haven’t gone out and had the test. So serosorting is based on the premise that everyone knows their HIV status, when in fact they don’t, and that’s a major problem.”
In a Toronto study conducted during 2005 Pride festivities, 947 men were asked whether they engaged in protected or unprotected sex.
“The info that we got is that the majority of gay men in Toronto are practising safe sex,” says Barry Adam, a doctor at the University Of Windsor who specializes in risk behaviour among gay men.
Adam conducted follow-up interviews with both positive and negative men over the next year. The findings up to this point (final results will be available later in the winter) show that a lot of men admitted to pratising serosorting — but many weren’t actually verbally confirming their HIV status to their partners. Instead, many men relied on communication through gestures or cues to disclose their status.
“For HIV-positive guys, it’s very hard to disclose,” says Adam. “There’s a few who make it a personal policy of saying “Hi, I’m HIV-positive.” And that’s hard to do…. For a lot of positive guys, what they start doing is resorting to kind of indirect messaging and they drop hints…. There’s a lot of slippage that can occur because I don’t think that both sides of the interaction know what’s going on.”
Some of the hints or cues HIV-positive participants revealed to researchers include: “I told him I was on such-and-such drug,” “I told him I lived at this address” (a building where there was a lot of subsidized housing for HIV-positive men) or “I volunteer for this organization.” For some negative men these cues “went right over the heads,” says Adam.
Gay men’s healthcare workers believe serosorting is a lot more prevalent on-line. Many gay dating services or cruising sites include a box users can tick off to indicate their HIV status. These sites often don’t mention the risk of contracting other diseases from unprotected anal sex such as syphilis, chlamydia, gonorrhea, hepatitis B and C, HPV and herpes.
“So when we talk about sero-sorting, we tend to think of a very rational process, almost like a contract,” says Adam. “It may happen a lot in places like San Francisco where the positive rate is so high there. But in Toronto where the rate runs about 12 percent, if you’re positive you’re really in the minority. In Toronto, men don’t need to serosort. If you practise safe sex all the time, it doesn’t have to come up.”