An Ineffective HIV Prevention Practice

Computer Artwork of HIV Virions. Science Photo Library - PASIEKA/Brand X Pictures/Getty Images

What is Serosorting?

Serosorting is a sexual practice. It involves choosing to practice safe sex based on whether a potential partner is thought to be HIV positive. Many people who practice serosorting would say that they make such decisions based on their partner's status. However, such statements are often based on mistaken beliefs about the accuracy of HIV testing. In particular, many individuals do not realize that testing is not always good at detecting new HIV infections.

Therefore, even if a potential sex partner has been tested in the past few days, and is open and honest about their test results, there's still a risk. Their results might not be accurate yet. If someone believes they are negative, but are newly infected,  unsafe sex can be a big risk. Newly infected people can have very high viral loads.

Serosorting & Home HIV Testing

Serosorting is one reason people have concerns about at-home HIV testing. However, several studies have suggested that men who use HIV home tests to facilitate serosorting are actually more likely to engage in safe sex. That's true regardless of the test results. In other words, just talking about risk and testing encourages them to be more careful. That's not true for everyone, of course. Still, people who don't practice safe sex after using a home test probably wouldn't have practiced safe sex before such tests became available.

In addition, there is some evidence that consistent condom use following home-testing is safer than inconsistent condom use without it. That's true even taking into account the problem of the window period. (The window period is the time where new HIV infections may go undetected, because the test is not yet effective.) That said, conflicting evidence also exists.

Some studies suggest that more home HIV testing could decrease conventional testing. That could potentially put more men at risk because of sex during that same window period. The data are not yet clear.

Who Uses Serosorting?

Serosorting is most commonly discussed as a practice of men who have sex with men (MSM). However, they are not the only individuals who engage in serosorting. Anyone who has chosen not to have safe sex with a partner because they assumed that partner couldn't possibly have a blood-borne STD has, in some way, engaged in serosorting. The reason that it is primarily discussed as an issue for MSM is their overall increased risk for HIV infection. There are also cultural norms and expectations about casual sex among gay men that increase both prejudice and discussion. This is similar to the reason that the "down low" is discussed as an issue for men of color. Realistically, men of any race can be on the "down low."

Is Unprotected Sex Risky if We're Both Positive?

Even if you're both HIV positive, you might want to have safe sex.

  After all, HIV isn't the only risk associated with sexual activity. You could also be exposing each other to other sexually transmitted infections, including Hepatitis C. There's also potentially the risk of superinfection. Superinfection is when you become infected with a second strain of HIV.

Word Origin

Serosorting is a portmanteau of the two words sero-, meaning blood, and sorting. It is not a term unique to HIV infection. That is just the domain in which the word is most commonly used. Sero refers to the fact that HIV is a blood-borne illness detected by serology - i.e. blood testing. Thus, people who engage in serosorting are categorizing their partners based on their blood test results

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