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HIV Serosorting's Impact on STI Rates Among MSM in San Francisco: An Analysis

This study examines the paradoxical rise in sexually transmitted infections (STIs) and risk behaviors among men who have sex with men (MSM) in San Francisco during the late 1990s to the early 2000s, despite stable HIV incidence rates. By analyzing various data sources, it suggests that increased HIV serosorting—selecting partners based on serostatus—may have contributed to the increase in STIs without a corresponding rise in HIV transmission. The findings highlight the dynamics of sexual practices within MSM communities and the need for tailored public health interventions.

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HIV Serosorting's Impact on STI Rates Among MSM in San Francisco: An Analysis

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  1. HIV Serosorting?Increases in Sexually Transmitted Diseases and Risk Behavior WithoutConcurrent Increases in HIV Incidence Among Men Who Have Sex With Menin San Francisco Hong-Ha M. Truong, PhD, MS, MPH Center for AIDS Prevention Studies Gladstone Institute of Virology & Immunology University of California, San Francisco

  2. MSM Communities • Men who have sex with men (MSM) during late 1990’s to early 2000’s had increasing rates of: • sexual risk behavior • sexually transmitted infections (STI) • HIV incidence • Trends observed worldwide • North America • Europe • Australia

  3. MSM in San Francisco • MSM seeking HIV testing (1995 – 1999) • concurrent increases • sexual risk behavior • male rectal gonorrhea • HIV incidence • Late 1990’s to early 2000’s • Syphilis cases increased exponentially (1997-2002) • No concomitant increase in recent HIV infection • Change in HIV epidemic among MSM?

  4. HIV Serosorting • HIV serosorting • selection of sexual partners by HIV serostatus • modifying sexual practices based on knowledge of • one’s own serostatus • serostatus of one’s partner • Increase in HIV serosorting may explain the paradoxical rise in STI transmission without a concurrent rise in HIV transmission

  5. Study Design • Secondary analysis of multiple data sources • Second Generation HIV Surveillance (UNAIDS/WHO) • multiple data sources to strengthen interpretation • combines biological and behavioral measures • flexible to different phases of epidemic • focus on temporal trends and changes

  6. Data Sources • STI surveillance • San Francisco Department of Public Health • STI registry: rectal gonorrhea and early syphilis • STOP AIDS Project • community-based organization • conducts serial cross-sectional surveys of MSM at gay-oriented venues • HIV testing programs • anonymous testing sites (ATS) • municipal STI clinic voluntary HIV testing (STI)

  7. Sample Size * Second half of 1998 only

  8. Age Age 40 and over at all sites (p<0.001)

  9. Race/Ethnicity White  at all sites (p<0.001) Asian-American at ATS & STI (p<0.001) Hispanic at STI (p<0.001) African-American at ATS (p<0.001)  at STI (p=0.02) & SAP (p=0.002)

  10. Early Syphilis & Rectal Gonorrhea Truong HM, et al. Sexually Transmitted Infections. in press

  11. Unprotected Anal IntercourseSAP  p<0.001  p<0.001  p<0.001 * Second half of 1998 only Truong HM, et al. Sexually Transmitted Infections. in press

  12. UAI With Known HIV+ PartnerATS  p<0.001  p<0.001  p<0.001 Truong HM, et al. Sexually Transmitted Infections. in press

  13. UAI With Known HIV+ PartnerSTI  p<0.001  p<0.001  p<0.001 Truong HM, et al. Sexually Transmitted Infections. in press

  14. HIV Incidence Truong HM, et al. Sexually Transmitted Infections. in press

  15. Summary • Syphilis and male rectal gonorrhea continued to rise even as HIV incidence leveled off • Behavioral data from SAP, ATS and STI support hypothesis that MSM are increasingly selecting HIV seroconcordant partners when engaging in UAI

  16. Summary • SAP • any UAI: overall increase • UAI with partners of unknown HIV serostatus • declined among HIV-positives • declined among HIV-negatives • ATS and STI • UAI with known HIV+ partner • overall decrease • similar prevalence: 11.6% ATS, 11.0% STI

  17. Discussion • Serosorting may prevent further increases in HIV transmission among MSM in San Francisco • HIV incidence remained at relative plateau through 2004 at two large testing programs • follows period of resurgent risk behavior, STI, and HIV incidence in late 1990’s • findings comparable to MSM studies in Sydney

  18. Discussion • New phase of HIV epidemic? • Increases in HIV serosorting may prevent further expansion of epidemic • “Prevention for Positives” • initiation & intensification - late 1990’s/early 2000’s • prevent secondary transmission from persons who know they are HIV-positive • Internet • may facilitate partner selection by HIV serostatus • provides semi-anonymous environment for disclosure of sensitive information

  19. Discussion • Vulnerabilities of such serosorting strategies • imperfect knowledge of one’s own HIV serostatus • uncertainty of partners’ HIV serostatus • transmission probabilities of certain sexual practices • Serosorting strategy may be more feasible in San Francisco than elsewhere • high level of HIV testing among MSM • 97% of MSM in San Francisco had ever tested • 34% had tested in the past 6 months

  20. Acknowledgements Gladstone Institute of Virology & Immunology • Robert Grant Stop AIDS Project • Karl Knapper San Francisco Department of Public Health • Willi McFarland • Jeffrey Klausner • Mitchell Katz • James Dilley • Timothy Kellogg • Sanny Chen • Roop Prabhu • Brian Louie

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