Pretty smart?
This site has been so full of discussion about sero-discordant sex that it’s kind of odd that we’ve only talked a little about its opposite. Namely sero-sorting.
So that we’re all on the same page, sero-sorting is the practice of guys seeking to have sex with partners of the same HIV status. We’re talking neg-on-neg sex here, or poz-on-poz.
Sounds like a pretty smart harm reduction strategy? Or not?
Sounds like a way to avoid stigma, or perhaps the reverse - a way to propagate it?
Much of the first debate - that harm reduction one - is complicated. Sex usually is. But for guys who are interested in how effective sero-sorting is as a prevention methodology, there’s an interesting piece of research out - a large scale study from Seattle - the results of which you can read here: http://www.medscape.com/viewarticle/584616
Wade through the legalese - or research-ese - and you’ll find that sero-sorting seems to be on the rise, certainly in terms of poz-on-poz sex. BUT for negs it’s a strategy only partially effective in limiting HIV transmissions, largely because of those highly infectious “neg” guys who don’t realize they are positive, that we’ve discussed many times here. Assumptions gone wrong, in other words. The bottom line seems to be that sero-sorting is a safer strategy than non-concordant unprotected fucking, less desirable than consistent condom use. In other words, proceed at your own risk.
Without sounding too much like a wet blanket - we need to acknowledge that the research doesn’t entirely dismiss the efficacy of sero-sorting, however limited - risk of HIV infection isn’t of course the only issue. The opprtunity to catch up with other STI’s is problematic for sero-sorting poz and neg guys alike, poz guys even more so, actually. (Aside from the viral implications, what poz guy wants a run-in with Public Health when those folks hear even a hint of unprotected poz sex. That can be nasty, I hear.)
For sero-sorting poz guys, there’s all that talk about super-infection too, getting a different strain of the virus on top of your own. Sounds nasty, but want to know what’s the latest on that? Read about it here: http://www.poz.com/articles/hiv_superinfection_couples_761_15984.shtml
All this clinical stuff can be quite daunting to wade through, right? But as they say in the infomercials, “but wait - there’s more“. The other part of the sero-sorting predicament is the stigma angle. By preferring to sero-sort, are you saying something negative about positives?
Is sero-sorting just about avoiding transmission? Or is there more to it? Is it stigma to seek out partners of the same status, or is it just being realistic? If poz guys hate being rejected because of their status, or just want to play safe, is it bowing to stigma to seek out only poz guys for sex? Similarly, is it OK for mr. neg to be looking for mr. right (for tonight) solely in the neg pool?. David talked a little about that already a while back, in a dating context, but I wanted to see if we have any kind of consensus on that as applied to fucking around generally
Tricky business, this sero-sorting thing, isn’t it?
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April 20, 2009 12:54 PM
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February 7, 2009 08:58 PM
Hey Rodger. Thanks for your additional thoughts. Remember I ended my post with these words: “Tricky business, this sero-sorting thing, isn’t it?” And the more I think about it - and it sounds like you have a similar problem - the trickier it becomes. The two layers of sero-sorting issues - the political ones (is this behaviour stigmatizing?) and the clinicall ones (is this behaviour effective or dangerous) both present challenges to us all, even those of us who are relatively well-informed.
From a poz guy’s perspective, poz sero-sorting leading to barebacking must often be mighty attractive on a fairly basic level. I’ve alway thought it hot, in fact, with not much thought on my part to how stigmatizing it is. I admit that in the back of my mind, there is a notion that this behaviour perpetuates stigma, but it’s not a deal-breaker. As to the dangers of poz sero-sorting, we don’t always approach those rationally but the prospect of superinfection increasingly seems something I’m not going to get hung up about. Other STI’s scare me though, to the point that worry-free barebacking doesn’t seem somethings that’s a reality!
By the way, Rodger, notice the next live chat on this site scheduled for next Tuesday night (details below). Sounds like somethng you might be interested in?
February 7, 2009 07:42 PM
In my message early this morning, I failed to distinguish between sero-sorting (choosing sex partners based on concordant HIV status), and sero-sorting plus unprotected sex. I think there are important distinctions.
In the neg-neg context, I think general sero-sorting is stigmatizing in the extreme, and that many neg guys don’t get this and think it is just logical. As for sero-sorting plus unprotected sex for neg guys, it could be considered a form of harm reduction but it has potential risks.
When it comes to poz guys, I understand why some guys would want to steer clear of sero-discordant sex in general. In what ways is that similar to, or different from, what happens when neg guys do that same thing? I don’t think it’s exactly the same. In truth, I want to give that some more thought. There may be more parallels than I realize. If you really believe safer sex is low-risk, then don’t you deserve to have sex in responsible ways with anyone? Lots to think about.
As for neg guys assailing poz “barebackers” as irresponsible, I’ve heard people say the kinds of things I mentioned. I don’t know that it is widespread though. I do think neg support for poz sero-sorting fits into their general logic about neg sero-sorting. In fact, I sometimes feel like many people would prefer this, thinking we would all die off and then the rest of them can have a more idyllic sex life and a return to the unprotected sex that HIV took away from them. Reality is a bit trickier than that.
For me as a poz guy, I can see the value of some unprotected poz-on-poz sex in some contexts. At the same time, widespread raw fucking (even sero-sorted) makes me a bit nervous. I’m really conscious about not getting other conditions that could make life a lot harder, like Hep C co-infection. And, for poz or neg guys, I think unprotected sex can be easy to get into the habit of, in negotiated contexts — and that this could make it easier to fall into it in riskier contexts too. I worry about that.
February 7, 2009 03:43 PM
Eliiot. What can I say? I think of myself as a bit of a moderate (though some would differ on this) If I could sum up my position, I suppose it’s that the politics of sero-sorting kind of stink, but take away that aspect, and we have guys trying to do something - however innefectively at times - to avoid transmission.
Having said that, your last line makes a lot of sense. “With a few small precautions there is nothing preventing healthy sero-discordant relationships and the inverse is a very slippery slope indeed.” To that I can only respond that perhaps that reflects a more perfcect world than we live in now, As long as people tend to shy away from sero-discordant relatiionships - and we know some tend to - I think we have to acknowledge their efforts at preventing transmission, while pointing out their limiitations and by making the kind of arguments that you have in your last sentence.
Or is my thinking too convoluted to make sense, even for me?
February 7, 2009 12:44 PM
Dear Bob,
My bullshit meter has been off the roof lately too so forgive my rather blunt assessment of the situation. I feel the entire thing is escapist and nonsensical on either front. The neg-neg sorting is completely discriminatory and an ineffective way of harm reduction. The harm becomes greater considering the one third of us that don’t know we are on your “do not fuck” list. And considering we all fuck up there is bound to be increased risk. It just doesn’t make sense to me at all. As for the poz-poz sorting, I don’t know why we would want to paint ourselves into that type of corner. What message does that send? Are we really the rejectees that can only be with our own kind? I don’t like the messaging and I don’t like the stigmatization that goes with it. I hate to go back to the cliché but we are all humans and should be treated thusly. With a few small precautions there is nothing preventing healthy sero-discordant relationships and the inverse is a very slippery slope indeed.
Cheers,
E
February 7, 2009 10:35 AM
Roger. Halfway through writing this entry, I came to the same conclusion as you. Namely that poz-poz and neg-neg serosorting, even though they are often lumped together, raise entirely different issues. But I plodded on regardless. You did a good job in sorting out the jumbled threads. Thanks!
Anyway, I’m glad you don’t entirely diss neg-neg serosorting. Take away the stigmatizing aspect - and that’s a big leap I know - and it seems to me there remains a harm reduction strategy that, while far from perfect (few strategies are) - is at least an attempt to avoid HIV infection. That’s way better than not trying. And there are ways to make it even more effective, by rigorous testing routines etc.,as you know. Hopefully neg guys know what they are doing though - and understand the risks.
Poz-poz serosorting brings up entirely different issues, it’s true. I’m not sure about the argument that it tends to paint poz guys as people who just can’t stop being irresponsible. In fact, I think the world, if asked, would approve of poz guys “sticking with their own kind”; that latter mindset sounds more likely, in fact. I take it for what it is - one way that poz guys try to limit passing on the virus. Again, though, there are some dangers - some real, some perceived.
On the super-infection issue, though, my bullshit detector has been going off for some time now. Certainly it doesn’t surprise me that the new research I quoted seems to indicate it’s quite possible we’ve been eagerly touting the dangers of super-infection without enough foundation; clearly we still need to know more.
February 7, 2009 06:09 AM
Poz sero-sorting and neg sero-sorting are not the same thing.
Neg sero-sorting is a flawed strategy, but it might work for some people some of the time. Still they need to go into it eyes wide open and there needs to be community education as to what the risks are. But I don’t see that happening.
When “neg” two guys engage in “negotiated safety” and are both pretty certain they are neg and sure of what activities they will engage in inside and outside the relationship, that is one thing (and if they do anything outside the relationship, they have to acknowledge there is a certain level of risk).
But “ad hoc” sero-sorting where a neg guy automatically excludes any known poz guy as a potential sexual partner? Yes it is absolutely stigmatizing and it is not justifiable. There are neg guys who disagree on this point. I believe they are wrong. We should talk to them and try to help them understand the reasons that this won’t protect them and, just as important, why it replicates a damaging caste system of “untouchables” for reasons that are essentially not valid.
Then when you look at poz sero-sorting. There are two things to sort out here. First is the hype, next is the reality. The hype is how poz sero-sorting is used against us by the community at large. It is seen as evidence that poz men just can’t stop being irresponsible. “Look what you have done!” they say. “You have ruined your own future and your medical bills are threatening our health-care system’s stability. But still! You just can’t keep that greedy thing of yours out of a wet raw hole, can you? You are spreading syphilis and LGV and Hep C to everyone — and creating a super-strain of HIV that future generations won’t survive. WHY can’t you grow up and control your urges?!?”
My point is that this is hyperbolic and hysterical, and fits into a moral framework held by many neg folks who are determined to bash us and feel legitimate in their anger. On one hand, it is moralistic, off-the-rails bullshit. But, on the other hand, when we strip away the misguided and inapprpropriate anger, there are a few kernels of truth here. Unprotected sex does lead to increases in other STDs, and that affects all of us. My own sex life is pretty low-risk for HIV transmission but I still got syphilis once from a blowjob, and it was brutal. If there was less unprotected sex there would be less STDs. No easy answers on this.
That said, more and more studies are showing that superinfection is a low risk and that it may not have serious implications most of the time. Still, the super-infection you-are-the-architects-of-doom-for-barebacking argument is wielded against us like a blunt tool by certain negative folks in a smug and self-righteous way — and it is not validated by the science at this point.