Men who have sex with men who know their HIV

Men who have sex with men who know their HIV-positive status may practice harm reduction approaches such as serosorting (only engaging in unprotected sex with seropositive partners) and strategic positioning (selectively engaging in unprotected receptive, rather than unprotected insertive anal intercourse because the per-act risk of transmission is lower. This meta-analysis quantitatively synthesized US literature, excluding studies recruiting male sex workers, methamphetamine users, and men with clinically diagnosed alcohol dependency, as well as those that recruited entirely from high-risk settings (gay brothels, sex parties, and barebacking websites). With the behavioural recall window ranging from last sex to the past 12 months (median 3 months), the study found no support for the hypothesis that clinical variables (treatment status, medication adherence, and viral load) were associated with unprotected anal intercourse. Rather, serosorting and strategic positioning appear to be intentional and deliberate HIV-related harm-reduction behaviours chosen by some HIV-positive men, The relative safety of such strategies deserves urgent investigation given that there was a 26% increase in estimated male HIV cases among American men who have sex with men over the period 2004 to 2007. In 2007, 72% of male HIV cases from 38 US areas were attributed to male-to-male sexual activity.