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Safe Sex Serosorting.
Aug 5, 2008

So, I guess that by your comment: "What's important to note, even from the selective information in your post, is that people should not rely on serosorting to keep them safe! Nor is your conclusion, "serosorting has broken the cycle of new HIV transmissions and made safe sex safer," supported by sound scientific data.

For instance, the disconnect between rising rates of STDs and declining new HIV infections noted in some cities might be related to more effective antiretroviral therapy. We know that when HIV plasma viral load decreases to undetectable levels, the risk of HIV transmission decreases significantly. There have been marked improvements in antiretroviral therapy over recent years. This too may well account for the disconnect and declining HIV-infection rates.

The disclosure information you discuss really has nothing to do with serosorting."

What your are readly saying is that the researchers are liers, delibertaly publishing false and misleading information?

What Safe Sex Serosorting research projects have YOU published?

Robert

Response from Dr. Frascino

Robert,

Calm down! Jeez, just how big is that chip on your shoulder anyway???? As I mentioned, "sero-sorting may, in some cases, be an effective addition to other harm-reduction-and-prevention strategies . . . ." "But" (and this is a very big but), "folks certainly should not rely on it." This is the correct conclusion of the scientific studies conducted to date. I am presently in Mexico City, attending the World AIDS Conference. Consequently, I can assure you this information is extremely current! (The posters are still up and the presentations are still in progress!) If you read my previous responses carefully, you will see they not only conform to the current scientific data, but they also contain a potent dose of common sense.

Robert, it is important to critically examine scientific information and not jump to conclusions not supported by sound data. What may seem like a good idea doesn't always turn out that way. We have had to learn that lesson the hard way far too often during the HIV/AIDS pandemic. For instance, many folks felt that "strategic treatment interruptions" (structured treatment interruptions, drug holidays, etc.) were an excellent idea to decrease exposure to antiretroviral drugs and possibly even to boost immunity to HIV. These were very good theories; however, we know now that they didn't pan out. In fact, strategic treatment interruptions not only were not found to be helpful, but they actually were found to be harmful.

We had a similar experience with the recent promising HIV vaccine trials. Instead of being helpful and preventing HIV infection, the experimental vaccines may have actually increased the risk of infection. And remember what happened with nonoxynol-9? Initially, we felt nonoxynol-9 (N-9) would help prevent HIV infection. In reality, the opposite turned out to be true, because N-9 irritates delicate mucous membranes, making them more susceptible to HIV. This is only a partial list of seemingly good ideas that we all wanted to believe in and which, at first glance, seemed very plausible. However, closer examination and rigorous scientific scrutiny forced us to admit our optimism was misguided.

I'm not linking serosorting to N-9 or other failures. I'm merely making the point that "associations" are not the same thing as "cause and effect." What we have with serosorting is an association. There is no question that serosorting has increased as the rate of new infections has gone down in some areas. This is an association, but we can not claim it's a cause-and-effect relationship, because there are other factors that could have caused this same outcome (fewer infections), as I pointed out in my last response to you. (See below.) Let me give you one none-medical example of how easily it is to confuse association with cause-and-effect. In New England in the late fall every year, you will see birds flying south. It's quite a phenomenon that these birds do it every year at exactly the same time. Also of note is that three weeks after the birds fly south, it snows in New England. Every year! Therefore, you could make the case that birds flying south in New England causes snow to fall three weeks later in New England. It's a demonstrable fact, right? You can see it happens every year like clockwork. Hence, without a deeper scientific understanding, it would seem quite logical that south-flying birds in New England cause snow to fall every winter. Serosorting could be akin to south-flying birds when it comes to decreased HIV infection rates. Other factors could (and probably do) come into play, such as more effective antiretroviral therapies driving HIV plasma viral loads to undetectable levels. Scientifically, we do know this significantly decreases HIV-transmission risk. OK?

Continue to serosort if you wish. It may well decrease your chances of acquiring/transmitting the infection. However, please note it may well also decrease your chance of finding your Mr. (or Mrs.) Right if he (or she) happens to be of opposite serostatus! When it comes to HIV prevention, there is no silver bullet, including serosorting! HIV prevention in 2008 requires a combination of behavioral, structural and biomedical prevention paradigms and approaches adapted and prioritized to specific communities. Now can we be BBF (best boyfriends forever) again?

Be well Robert.

Dr. Bob

Safe Sex Serosorting works. Jul 29, 2008

Serosorting is NOT just for barebackers (Unsafe sex), as these scientific studies explain. Also, Safe Sex Serosorting is NOT just for gay men.

For more than a decade, Serosorting has broken the cycle of new HIV transmissions, has made safe sex safer, and has reunited mankind to achieve a single, common goal to reignite the excitement of HIV Prevention.

Serosorting Having sex with your own HIV status. There are three forms of Serosorting, and two involve safe sex. Serosorting began back in the mid 1990s as an HIV Prevention and Harm Reduction Strategy in New York City, NY and has now become an international phenomenon.

The serosorting behavior our participants have reported could have reduced the number of new infections caused by people having random sexual occurrences by 99%, says Jeff McConnell, project director of the Positive Partner Study at the University of California, San Franciscos J. David Gladstone Institutes.

"There are other reasons why people may choose partners of the same serostatus beyond the risk of HIV transmission," Dr. William McFarland from the San Francisco Department of Public Health, California explained. "For example, HIV-positive persons may find more support in a relationship with another HIV-positive person because they share many more of the challenging aspects of living with HIV."

The investigator concluded: "Our observations and studies of serosorting may simply be documenting the rise of a community-generated HIV prevention strategy that is happening whether we have any control over it or not." Dr. McFarland said. (Sex Transm Infect 2006;82:461-466.)

Does serosorting work? In some American cities, evidence of a disconnect between rising rates of sexually transmitted infections but steady or declining rates of HIV incidence has been seen as evidence that serosorting is working. Two things are necessary for serosorting:

1) A high rate of HIV testing and, 2) Disclosure of status.

A number of different posters looked at rates of disclosure by HIV-positive people all over the world. A poster from Uganda (King) found that of 1,092 HIV-positive clients of the countrys largest AIDS NGO, TASO, 45% of them men, 42% of them had been sexually active in the past three months and of these 69% had disclosed their HIV status to their partner. Encouragingly, higher rates of disclosure were associated with higher rates of condom use, showing that the two activities are linked.

Finally, in an upbeat presentation, Fiona Percy-de Korte reported on high rates of disclosure among recipients of antiretrovirals in the Botswana National Treatment Programme.

Among this cross-sectional survey of 275 patients in two districts, she said that 90% of ARV recipients had disclosed their HIV status to family members, 71% to their spouse or partner, 54% to friends, 26% to a church leader, and 20% to their employer.

Seventy-three per cent said they always used a condom during sex. And 48% said they had reduced their number of sexual partners since diagnosis.(1)

There is plenty of evidence that serosorting exists as a behaviour. Jonathan Elford presented a poster showing that serosorting was common not only among HIV-positive gay men in the UK but also among Africans.(2)

Investigators from Sydney therefore looked at the serosorting behaviour of gay men known to be HIV-negative between 2002 and 2005. Although these men were not explicitly asked if they had serosorted, this behaviour was inferred from information they provided.

The practice of deliberately selecting partners of the same HIV status often called serosorting has been well described amongst HIV-positive gay men and even been credited with contributing to a fall in HIV incidence in San Francisco. Most investigators have looked at the serosorting behaviours of HIV-positive men and there are limited data on serosorting amongst HIV-negative gay men. There is also some evidence from the United States that HIV-negative men are increasingly avoiding sex with men who know they are HIV-positive. They also suggest that the internet may have a role in the apparent increase in serosorting. (3)

(1) Percy-de Korte F. Experiences of people living with AIDS (PLWA) following enrollment in the Botswana National Treatment Programme (BNTP). Sixteenth International AIDS Conference, Toronto, abstract WEAC0102, 2006. (2) Elford J et al. Serosorting among Africans living with HIV in London. Sixteenth International AIDS Conference, Toronto, abstract WEPDC05, 2006 (3) Mao L et al. Serosorting in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia. AIDS 20: 1204-1206, 2006. Abelson J et al. HIV optimism does not explain increases in high-risk sexual behaviour among gay men of positive or negative HIV status in Sydney, Australia. AIDS 20: 1215-1216, 2006.

Conclusion: For more than a decade, Serosorting has not only broken the cycle of NEW HIV transmissions and has made safe sex safer, but, Serosorting is the largest word of mouth HIV Prevention and Harm Reduction Strategy on the planet to date. And the Internet has played a key role in its success.

Dr. Bob, WHY do American HIV Researchers censor Safe Sex Serosorting data?

Response from Dr. Frascino

Hello,

"Why do American HIV researchers censor safe sex serosorting data?" Actually, I'm not aware of any censorship of this data whatsoever. (If there was, you wouldn't be quoting it, right?)

What's important to note, even from the selective information in your post, is that people should not rely on serosorting to keep them safe! Nor is your conclusion, "serosorting has broken the cycle of new HIV transmissions and made safe sex safer," supported by sound scientific data.

For instance, the disconnect between rising rates of STDs and declining new HIV infections noted in some cities might be related to more effective antiretroviral therapy. We know that when HIV plasma viral load decreases to undetectable levels, the risk of HIV transmission decreases significantly. There have been marked improvements in antiretroviral therapy over recent years. This too may well account for the disconnect and declining HIV-infection rates.

The disclosure information you discuss really has nothing to do with serosorting. It merely documents what we've known for some time. That knowing one's status leads to decreased risk, including decreased numbers of partners and improved use of condoms.

I'm not dismissing serosorting. It may, in some cases, be an effective addition to other harm-reduction-and prevention strategies, but folks certainly should not rely on it.

Finally, I have to disagree with your comment that serosorting is the largest word-of-mouth prevention-and-harm-reduction strategy on the planet to date. That honor would be claimed by condoms. Hands down!

I'll reprint a recent post about serosorting below.

Dr. Bob

Safe Sex Serosorting. Jul 7, 2008

Dr. Bob;

Thank you for your reply: "As for your question, "Do HIV negative people have safe sex anymore?" the answer would be: Yes, the smart ones who wish to remain HIV negative do!

My advice is to play safe to be safe, whether you are poz or neggie."

For the past decade, I have always been receiving this type of a response to my question, regardless which HIV expert or professional I ask. However, the main question: WHY are the HIV researchers, "experts" and "professionals" delibertly REFUSING to support or encourage Safe Sex Serosorting? Is never answered. After all, you TOO agree that safe sex is best, so why not add Safe Sex Serosorting to the list of HIV prevention strategies.

So, please forgive me if I repeat my question: WHY are the HIV researchers, "experts" and "professionals" delibertly REFUSING to support or encourage Safe Sex Serosorting?

Robert

Response from Dr. Frascino

Hi Robert,

You report: "For the past decade, I have always been receiving this type of a response to my question, regardless which HIV expert or professional I ask." Well then, it's unanimous: We "HIV experts and professionals" all agree. In my initial response, I explained in detail exactly why it would be unwise and illogical for us to endorse barebacking for anyone and also why even a "negative" test may not mean your partner is truly HIV negative. (See below.) The only message that makes sense is "safer sex for all... no glove, no love, no exceptions." Think it through Robert. All "HIV experts, professionals, and researchers" wouldn't be of like mind if this strategy did not meet the standards of both scientific fact and common sense.

Dr. Bob

Safe Sex Serosorting Jul 5, 2008

With the universal success of Serosorting (As a Barebacking strategy)in breaking the cycle of NEW HIV transmissions, WHY are the HIV researchers, "experts" and "professionals" delibertly REFUSING to support or encourage Safe Sex Serosorting?

Do HIV-(negative) people have safe sex anymore?

Robert

Response from Dr. Frascino

Hello Robert,

The "universal success of serosorting"????? WHAT???? Whether serosorting has actually reduced the number of new HIV infections remains an open question. Barebacking, even with serosorting, remains a risky endeavor, due to the possibility of reinfection (superinfection, dual infection) as well as infection with other STDs that could affect the course of HIV disease for HIV pozitoids. As for the neggies, well, you're only as negative as your last HIV test and even that negative test might be a false negative if taken within the window period. Therefore, it would be irresponsible for the experts to support any type of barebacking.

As for your question, "Do HIV negative people have safe sex anymore?" the answer would be: Yes, the smart ones who wish to remain HIV negative do!

My advice is to play safe to be safe, whether you are poz or neggie.

Dr. Bob


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