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The Role of Intent in Serosorting Behaviors Among Men Who Have Sex With Men Sexual Partnerships

Siegler, Aaron J. PhD, MHS*; Sullivan, Patrick S. DVM, PhD*; Khosropour, Christine M. MPH; Rosenberg, Eli S. PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1st, 2013 - Volume 64 - Issue 3 - p 307–314
doi: 10.1097/QAI.0b013e3182a0e880
Epidemiology and Prevention

Background: Serosorting is increasingly assessed in studies of men who have sex with men (MSM). Most research studies have measured serosorting by combining reported unprotected anal intercourse (UAI) and the occurrence of participant and partner same HIV status (seroconcordance). The Centers for Disease Control and Prevention’s definition of serosorting also incorporates intent to be in such a partnership, although few studies incorporate both intent and behavior into their measures.

Methods: Using data from a national, online survey of 3519 US MSM, we assessed the role of intention in seroconcordant partnerships, as measured by participant rating of the importance of shared serostatus when selecting a sex partner.

Results: For HIV+ men, 30% partnerships were seroconcordant; of these, 48% reported intent to be in such a partnership (intentional seroconcordance). For HIV− men, 64% partnerships were seroconcordant; of these, 80% reported intentional seroconcordance. Intentional seroconcordance was associated with UAI for HIV+ partnerships [odds ratio (OR): 1.9; 95% confidence interval (CI): 1.3 to 2.9] but not significant for HIV− partnerships (OR: 1.1; CI: 0.99 to 1.3). In separate models where intent was not considered, seroconcordance was associated with UAI for HIV+ partnerships (OR: 3.2; 95% CI: 2.2 to 4.6) and for HIV− partnerships (OR: 1.2; 95% CI: 1.0 to 1.3; P = 0.03).

Conclusions: Regardless of intentionality, seroconcordance was strongly associated with UAI for HIV+ men and weakly associated with UAI for HIV− men. Intentional seroconcordance was not associated with UAI more strongly than was seroconcordance in absence of consideration of intent. Intentionality may not be a critical element of the relationship between seroconcordance and UAI.

*Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; and

Department of Epidemiology, University of Washington, Seattle, WA.

Correspondence to: Aaron J. Siegler, PhD, MHS, Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA (e-mail:

Supported by the National Institute on Minority Health and Health Disparities RC1MD004370, National Institute of Mental Health R01MH085600, Eunice Kennedy Shriver National Institute for Child Health and Human Development R01HD067111, and was facilitated by the Emory Center for AIDS Research P30AI050409. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Presented in part at the 2011 National HIV Prevention Conference, August 14–17, Atlanta, GA.

The authors have no conflicts of interest to disclose.

Received February 26, 2013

Accepted June 12, 2013

© 2013 by Lippincott Williams & Wilkins