Is Serosorting Effective in Reducing the Risk of HIV Infection Among Men Who Have Sex With Men With Casual Sex Partners?

van den Boom, Wijnand MSc*; Konings, Roos MSc*; Davidovich, Udi PhD*; Sandfort, Theo PhD; Prins, Maria PhD*,‡; Stolte, Ineke G. PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000051
Epidemiology and Prevention

Background: We investigated the prevalence and protective value of serosorting [ie, establishing HIV concordance in advance to practice unprotected anal intercourse (UAI)] with casual partners (CP) among HIV-negative men who have sex with men (MSM) using longitudinal data from 2007 to 2011.

Methods: Men of the Amsterdam Cohort Studies were tested biannually for HIV-1 antibodies and filled in questionnaires about sexual behavior in the preceding 6 months. HIV incidence was examined among men who practiced UAI, UAI with serosorting, or consistent condom use, using Poisson regression.

Results: Of 445 MSM with CPs, 31 seroconverted for HIV during a total follow-up of 1107 person-years. Overall observed HIV incidence rate was 2.8/100 person-years. Consistent condom use was reported in 64%, UAI in 25%, and UAI with serosorting in 11% of the 2137 follow-up visits. MSM who practiced serosorting were less likely to seroconvert [adjusted incidence rate ratio (aIRR) = 0.46; 95% confidence interval (CI): 0.13 to 1.59] than MSM who had UAI, but more likely to seroconvert than MSM who consistently used condoms (aIRR = 1.32; 95% CI: 0.37 to 4.62), although differences in both directions were not statistically significant. MSM who consistently used condoms were less likely to seroconvert than MSM who had UAI (aIRR = 0.37; 95% CI: 0.18 to 0.77).

Discussion: The protective effect for serosorting we found was not statistically significant. Consistent condom use was found to be most protective against HIV infection. Larger studies are needed to demonstrate whether serosorting with CPs offers sufficient protection against HIV infection, and if not, why it fails to do so.

Author Information

*Department of Research, Cluster of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands;

Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY; and

Department of Infectious Diseases, Tropical Medicine and AIDS, CINIMA, Academic Medical Center, Amsterdam, the Netherlands.

Correspondence to: Wijnand van den Boom, MSc, Department of Research, Cluster of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018 WT Amsterdam, the Netherlands (e-mail:

W.v.d.B. and R.K. contributed equally to this article.

Supported by the AIDS Fonds Grant 2008025. Dr Sandfort's contribution was supported by NIHM Center Grant P30-MH43520.

The authors have no conflicts of interest to disclose.

W.v.d.B. and R.K. analyzed and interpreted the data and wrote the draft article. T.S. and M.P. gave substantial contributions to the analyses and interpretation of the data. U.D. and I.S. designed and supervised the overall study and contributed to the analyses and interpretation of the data. All authors contributed to subsequent drafts and approved the final version of the article.

Received October 25, 2013

Accepted October 25, 2013

© 2014 by Lippincott Williams & Wilkins