CALIFORNIA: San Francisco Serosorting May Explain Odd HIV Data: STDs Have Risen, but Not New HIV Infections

Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.

CALIFORNIA: San Francisco Serosorting May Explain Odd HIV Data: STDs Have Risen, but Not New HIV Infections

AIDS Alert (05.01.04) Vol. 19, No. 5, P. 55 - Monday, May 24, 2004

Documented increases in STDs among high-risk populations in San Francisco, including men who have sex with men (MSM) who use the Internet to find anonymous sex partners, did not lead to a widely expected synergetic rise in HIV incidence. In fact, using a detuned assay test, the same public health officials and researchers who uncovered the syphilis increase among MSM found that HIV incidence was leveling off for the past several years despite the STD increases.

Health officials also found that safe sex behavior increased since 1998 among HIV-negative MSM who reported having sex with an HIV-positive partner. So while sexual risk behavior is increasing, MSM are having sex with partners whom they know have the same serostatus, investigators concluded. One hypothesis is that MSM are serosorting through the Internet - the same venue that makes it more likely they will increase their sexual risk behaviors.

"If persons who are the same HIV serostatus are in the same networks so that positives are having unprotected sex with positives and negatives with negatives, then you could see an increase in syphilis transmission without an increase in HIV transmission," noted Willi McFarland, MD, PhD, director of HIV/AIDS Statistics and Epidemiology for the San Francisco Department of Public Health.

In addition, data collected by a Stop AIDS Project survey showed that from 2001 on, HIV-positive MSM were saying they knew their partner's serostatus, said McFarland. And HIV- negative MSM reported knowing their partner's serostatus in more recent years. The survey found people who were HIV- positive were having fewer partners they knew to be HIV- negative.

Though hard data are lacking, it is possible that the leveling off of HIV cases could be due to the city's prevention-for- positives campaign. That effort began in 2001 with media saturation featuring celebrities, and physicians trained to provide prevention in HIV care clinics, said McFarland. Additional research is needed to further test the hypothesis and discover how serosorting works. On the Internet, "people put in their serostatus and say they're looking for someone with the same serostatus, and we know that partnering on the Internet is becoming more common," he said.

"Part of me worries that this may be a little too optimistic," said McFarland. "It's a lot to ask that people know their own serostatus and ask partners about them." Serosorting depends on people knowing their status if they're positive and remaining negative if they're not, and then being honest about their status when negotiating sexual encounters, he said.
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