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Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation

Parsons, Jeffrey Ta,b,c; Schrimshaw, Eric Wb; Wolitski, Richard Jd; Halkitis, Perry Nc,e; Purcell, David Wd; Hoff, Colleen Cf; Gómez, Cynthia Af

doi: 10.1097/01.aids.0000167348.15750.9a
Original papers

Objective: This study assessed unprotected anal and oral sex behaviors of HIV-positive gay and bisexual men in New York City and San Francisco with their main and non-main sexual partners. Here we focus on the use of three harm reduction strategies (serosorting, strategic positioning, and withdrawal before ejaculation) in order to decrease transmission risk.

Method: The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising and other techniques.

Results: City differences were identified, with more men in San Francisco reporting sexual risk behaviors across all partner types compared with men in New York City. Serosorting was identified, with men reporting significantly more oral and anal sex acts with other HIV-positive partners than with HIV-negative partners. However, men also reported more unprotected sex with partners of unknown status compared with their other partners. Some evidence of strategic positioning was identified, although differences were noted across cities and across different types of partners. Men in both cities reported more acts of oral sex without ejaculation than with ejaculation, but the use of withdrawal as a harm reduction strategy for anal sex was more common among men from San Francisco.

Conclusion: Overall, evidence for harm reduction was identified; however, significant differences across the two cities were found. The complicated nature of the sexual practices of gay and bisexual men are discussed, and the findings have important implications for prevention efforts and future research studies.

From the aHunter College of the City University of New York, New York, NY, USA

bGraduate Center of the City University of New York, New York, NY, USA

cCenter for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA

dCenters for Disease Control and Prevention, Atlanta, GA, USA

eNew York University, New York, NY, USA

fUniversity of California, San Francisco, CA, USA.

Correspondence to Jeffrey T. Parsons, Hunter College of the City University of New York, Department of Psychology, 695 Park Avenue, New York, NY 10021, USA. Tel: +1 212 772 5533; e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.