Thursday, December 6, 2007

Serosorting, Barebakers and +'s- %'s Oh My!

Have you ever read an article about the rise or fall of HIV infection rates and when you reach the end you're either scared shitless, angry or have no idea what the hell is going on? Yeah, me too. All. the. time.

After reading this incredibly muddy article by 365gay.com entitled: "Study Suggests Shift In Attitude Among Newly Infected Men With HIV Regarding Partners" I again had that, "uhh, what?" feeling. But lately, do to having some incredibly bright and educated people around me I've grown skeptical of the way percentages and statistics are reported and thus my post-article freak-outs have declined.

Here's the dilly:
The article is saying that some poz men are barebacking or men who happen to be barebacking, are positive, but in some cities (like SF) they're beginning to only bareback with other positive men. This is otherwise known as "serosorting."

Serosorting, as defined by wikipedia is "the practice of seeking to only engage in sexual activities with partners who are of the same HIV status as you. In April of 2006, the Los Angeles Times reported that the practice of positive-positive serosorting is partially responsible for the decline in new HIV infections in San Francisco.

Serosorting is the reason why it is possible to see a simultaneous increase of barebacking stats with the decrease of HIV infection rates. Men who choose to not use condoms aren't changing their sexual acts but they are changing their sexual partners, and that in itself is a way to avoid spreading HIV. The trend here is that positive men are barebacking each other and not negative men.

Now listen up and listen up real good. I'm not advocating unsafe sex. I'm not saying that it's a good thing that poz on poz men are choosing not to use condoms (there's a TON of other health related issues with that alone.) I'm simply clearing up a hard-to-decipher article before we start stigmatizing the entire positive community as barebacking orgy-fueled deviants. Trust me, as I've reported before, a lot of gay men, even myself at one time, came spring loaded with that defense. And, yes. Yes. Yes. Yes we can talk about how this trend might make barebacking seemingly more acceptable, that it isn't foolproof and that negative men might get caught up in this, but it is none-the-less, an interesting trend and attitude shift to note.

I feel as though this is neither good nor bad news and proves how complicated statistics, percentages and HIV reporting can be.
Case in point- the article states:

Two separate studies presented earlier in the week at the National HIV Prevention Conference, however, found that more than 35 percent of men who have sex with men continue to have unsafe sex.
Everybody freak out, right?

Hold on a second. As a friend of mine pointed out when discussing this article:
How many of those guys are poz guys who have unprotected sex with poz guys only? In terms of HIV prevention, those guys should be counted out of the equation.
How many of those guys are in monogamous longterm neg couples? In terms of HIV prevention, those guys should be counted out of the equation.
How many of those guys were having non-penetrative or oral sex? In terms of HIV prevention, those guys should be counted out of the equation.

The real question is: How many NEGATIVE men fail to use a condom when they have ANAL sex with someone whose status was uncertain or POSITIVE? But nobody ever asks that question.

See that's just the thing. In many of the safe-sex surveys I take or the questions I answer when getting tested, I'm always asked, "Did you use a condom the last time you had sex?" The answer is almost meaningless without a follow-up question: "Were you and your last partner both already poz? Were you and your last partner both neg men in a longterm monogamous relationship? Was the last time you had sex a strictly oral/J.O. encounter?"

Hell yes. Complicated! But important.

I'd like to be clear about something. You can disagree with me all you want but I feel it is tremendously important that we do not look at postive and negative like black and white cards or a pass/fail on a college exam or a yes/no answer. In order to really begin combating this virus we need the ability to acknowledge and comprehend everything it involves. With anger and sympathy being both important factors, it is simple understanding that will eventually be the key factor winning out.

12 comments:

Anonymous said...

what you're failing to realize, eric, is that the virus mutates repidly. rapidly as in A PERSON. in other words: two positive barebacker partners aren't safe. they are sharing with each other two DIFFERENT versions of the virus. THIS IS NOT A GOOD THING. i thought you were more intelligent than this. enough already.

mike
mdpowelson@yahoo.com

NewPrevTech said...

Actually, the jury is rather out when it comes to re-infection and what the consequences are. Look at the literature, or the lack thereof...

And as for sero-sorting, I prefer the term sero-adaptation, which goes beyond the idea of simply selecting sexual partners by sero-status and includes other harm reduction methods around positioning during sex.

We have posted a lot about sero-adaptation on LifeLube, all of which can be found at the following link, if you are interested:

http://lifelube.blogspot.com/search/label/sero-adaptation

We really need to stop reflexivley pathologizing men who want to have sex - natural sex - without a condom and seek to understand the motivations (not assume them) and find innovative ways to reduce the potential harms

We should not be satisfied with only the condom to protect ourselves during sex. We need other methods, other new prevention technologies, such as rectal microbicides (www.IRMWG.org), pre-exposure prophylaxis and vaccines...

And since we all seem to get so frickin'hung up on "barebacking" among gay men... When was the last time we read an article or a published study that looked at the intentional condom-free intercourse that occurs among heterosexuals? All those cute babies in their carriages and double-wides, after all, are a direct result of barebacking. And for heterosexuals, sex without condoms is a primary means of transmitting HIV...

Somehow, we don't automatically screech at them...

I, too, am not suggesting people ditch their condoms. If they are willing and able to use condoms, they are absolutely fantastic at preventing HIV, and other STD, transmission.

But we need to look outside of this very narrow box, meet people where they are at, and support the research and development of NEW prevention technologies that go beyond latex, as well as harm reduction techniques such as those found in sero-adaptation.

Thanks.

Jim de LifeLube
www.LifeLube.blogspot.com

Eric Leven said...

Hey Mike-
Did you READ the article I wrote, the part where I said I don't advocate safe sex nor do I think it's a good thing that poz on poz men are barebacking?

How about the fact that this isn't about the health of condomless poz on poz men but rather the SPREAD of HIV?

Or did you get angry and jump the gun?

NewPrevTech said...

Hey guys, lots of data suggest that actually, men are getting infected from their main partner, not from being wanton hussies necessarily. Many, many of us choose to not use condoms with our long-term partners (boyfriends, lovers, husbands, whatever you call them)... There is absolutely nothing utopian about trying to figure out new ways to reduce men's risk NOW in ways that don't include condoms - 50% of gay men are not using them regularly - and to look to the future for new prevention technologies.

A condom will likely ALWAYS BE OUR BEST BET. But they only work when used CONSISTENTLY and CORRECTLY.

Why is it that we demand choice in every other part of our lives (double-cupped extra hot soy latte with Splenda, anyone?) but don't do the same for something as important as protecting our health during sexual relations?

We don't only rely on seatbelts to protect us while driving - which is very dangerous, btw. We also have speed limits, stop lights, dividers on highways, etc...)

We need to address HIV prevention at not only the individual behavioral level, but at the community/societal and structural levels...

xxoo
Jim

Anonymous said...

Re-infection is a reality. So is inherited drug resistance via exposure to someone taking different meds.

Result? A virus which is effectively immune to any drug therapy currently available.

This is seriously current thinking. Two HIV+ men barebacking is just plain fucking dumb. For them. For me. For everyone.

NewPrevTech said...

Many people who contract drug resistant virus see their virus morph into "wild type" over time, and no longer resistant. Reistant virus is much less hardy than the "wild type."

This is also the case with re-infection, we have seen.

So, it is not as clear cut as you purport, craigf.

I am not advocating any type of behavior here - just stating the facts.

YOU may think two POZ guys barebacking is dumb. And your opinion is just that. It is not necessarily born out by the research/data/experience as of now.

theszak said...

Whole article good
http://www.newyorker.com/reporting/
2007/12/03/071203fa_fact_specter?currentPage=8

Anonymous said...

YOU may think two POZ guys barebacking is dumb. And your opinion is just that. It is not necessarily born out by the research/data/experience as of now.


Uh, I think the science bears out the widely held opinion that rampant unprotected sex among poz guys will lead to rapidly evolving, potentially drug-resist strains of HIV. Which is bad for everybody.

A good friend of mine here in Brooklyn recently contracted a strain of HIV (from topping his boyfriend, who had cheated on him) that turned into full blown AIDS within a month. And he's already had to change his drug cocktail multiple times. This is happening. NOW. TO US.

It is not a wise public health strategy to back down on advocating condom use, even for poz-poz couplings (not that anyone on this blog has, thus far).

NewPrevTech said...

No one is suuggesting backing down on condom strategies. If there are gay men who are using them well, KEEP ON USING THEM.

But we have to provide more options for folks, because let's face it, about half of gay men are not using condoms consistently (much higher percentage than heteros, btw)...

Yelling and gnashing will not change that fact --- as good and superior as it makes you feel.

In these cases, harm reduction methods like sero-adaptation are worthy of exploration, and indeed have shown efficacy (of course, not at rates similar to condoms, but some level of efficacy and harm reduciton nonetheless) and for the future, new prevention technologies such as rectal microbicides, vaccines, and pre-exposure prophylaxis.

As for drug resistant HIV being passed, I am very sorry for your friend and what he is going through, but we do know that many folks who contract or acquire drug resistant HIV see their strain revert back to wild-type virus (which is much hardier than drug resistant) and therefore become treatable once more.

A story we NEVER hear about is the one about the guy in NY who was demonized a couple of years ago by the NY Dept of Health for being a crystal addict and contracting and possibly spreading a multiply drug resistant strain of HIV.... He had quickly progressed to AIDS after testing positive and there was much hysteria about him in press outlets and the general community across the country...

Well, he is now doing fine, did you know that? And he is being treated by a standard regimen of highly active anti-retroviral therapy... As the strain of HIV he acquired reverted back to the dominant wild-type...

Not as sexy a story, I guess. But reality.

Jim de LifeLube

NewPrevTech said...

No one is suuggesting backing down on condom strategies. If there are gay men who are using them well, KEEP ON USING THEM.

But we have to provide more options for folks, because let's face it, about half of gay men are not using condoms consistently (much higher percentage than heteros, btw)...

Yelling and gnashing will not change that fact --- as good and superior as it makes you feel.

In these cases, harm reduction methods like sero-adaptation are worthy of exploration, and indeed have shown efficacy (of course, not at rates similar to condoms, but some level of efficacy and harm reduciton nonetheless) and for the future, new prevention technologies such as rectal microbicides, vaccines, and pre-exposure prophylaxis.

As for drug resistant HIV being passed, I am very sorry for your friend and what he is going through, but we do know that many folks who contract or acquire drug resistant HIV see their strain revert back to wild-type virus (which is much hardier than drug resistant) and therefore become treatable once more.

A story we NEVER hear about is the one about the guy in NY who was demonized a couple of years ago by the NY Dept of Health for being a crystal addict and contracting and possibly spreading a multiply drug resistant strain of HIV.... He had quickly progressed to AIDS after testing positive and there was much hysteria about him in press outlets and the general community across the country...

Well, he is now doing fine, did you know that? And he is being treated by a standard regimen of highly active anti-retroviral therapy... As the strain of HIV he acquired reverted back to the dominant wild-type...

Not as sexy a story, I guess. But reality.

Jim de LifeLube

NewPrevTech said...

A little more on "super-infection" from an aidsmap.com story published in november... While not unheard of, it is relatively rare:

"Superinfection has been reported in over 20 HIV-positive individuals around the world. These cases show that infection with one strain of HIV does not always provide a protective immune response against the acquisition of a second strain. This has important implications for HIV vaccine development as most other viruses for which vaccines exist provide protective immunity against subsequent infection.

"It is still unclear how often HIV superinfection occurs, with studies providing contradictory findings regarding incidence. Nearly all the cases of superinfection reported to date involve individuals recently infected with HIV, but there has been a reported case of superinfection in a chronically-infected patient, meaning that it is uncertain if the risk of superinfection is restricted to the few years after primary HIV infection.

"In most of the cases reported so far, the superinfecting strain of HIV has been from a second distinct subtype. Detecting superinfecting strain of HIV from the same subtype can be much harder."

theszak said...

A thought experiment http://en.wikipedia.org/wiki/Thought_experiment
Two uninfected men are having anal sex. Is it true or false one or both of them could get infected?...

See also
http://notb4weknow.blogspot.com