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HIV serosorting as a harm reduction strategy: evidence from Seattle, Washington

Cassels, Susana; Menza, Timothy Wb; Goodreau, Steven Mc; Golden, Matthew Rb

doi: 10.1097/QAD.0b013e328330ed8a
Epidemiology and social

Objective: We sought to estimate how serosorting may affect HIV prevalence and individual risk among men who have sex with men in Seattle, Washington, and how the results vary under different assumptions of HIV testing frequency, heterogeneity in sexual behavior, and condom use.

Methods: We developed a deterministic mathematical model of HIV transmission dynamics. Data from the 2003 random digit dial study of men who have sex with men conducted in Seattle, Washington (n = 400) are used to parameterize the model.

Results: Predicted population-level HIV prevalence as well as an individual's risk of HIV acquisition decreases when the odds of serosorting are increased in the mathematical model. In our model based on observed levels of serosorting, we predict an HIV prevalence of 16%. In contrast, if serosorting were eliminated in the population, we predict that HIV prevalence would increase to 24.5%. However, our findings depend on rates of condom use, mean anal sex contact rates, and HIV testing in the population.

Conclusion: Under realistic scenarios of sexual behavior and testing frequency for men who have sex with men in the United States, serosorting can be an effective harm reduction strategy.

aCenter for Studies in Demography and Ecology, USA

bDepartments of Medicine and Epidemiology, USA

cDepartment of Anthropology, University of Washington, Seattle, Washington, USA.

Received 20 March, 2009

Revised 9 July, 2009

Accepted 16 July, 2009

Correspondence to Susan Cassels, Center for Studies in Demography and Ecology, Box 353412, University of Washington, Seattle, WA 98195, USA. Tel: +1 206 616 2507; fax: +1 206 616 8135; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.