16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

HIV SEROSORTING? INCREASES IN SEXUALLY TRANSMITTED INFECTIONS AND RISK BEHAVIOR WITHOUT CONCURRENT INCREASE IN HIV INCIDENCE AMONG MEN WHO HAVE SEX WITH MEN IN SAN FRANCISCO

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. MoAc0105

Truong H.M.¹, Kellogg T.², Klausner J.², Katz M.², Dilley J.², Knapper K.³, Chen S.², Prabhu R.², Grant R.⁴, Louie B.², Mc Farland W.^2
1University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, United States, ²San Francisco Department of Public Health, San Francisco, United States, ³The STOP AIDS Project, San Francisco, United States, ⁴Gladstone Institute of Virology and Immunology, San Francisco, United States

BACKGROUND: Sexually transmitted infections (STI) and unprotected anal intercourse (UAI) have been increasing among men who have sex with men (MSM) in San Francisco. However, HIV incidence has stabilized. We evaluated recent trends in sexual risk behavior, STI, and HIV incidence to assess whether increases in HIV serosorting (i.e., selective unprotected sex with partners of the same HIV serostatus) may contribute to preventing further expansion of the epidemic.

METHODS: The study applies an ecological approach and follows the principles of Second Generation HIV Surveillance. Temporal trends in biological and behavioral measures were assessed using multiple pre-existing data sources: STI case reporting, prevention outreach programmatic data, and voluntary HIV counseling and testing data.

RESULTS: Reported STI cases rose from 1998 through 2003. Rectal gonorrhea cases increased from 158 to 311 while early syphilis increased from 8 to 314. UAI increased overall from 1998 to 2004 (p<0.001) in community-based surveys; however, UAI with partners of unknown HIV serostatus decreased overall (p<0.001) among HIV-negative MSM, and among HIV-positive MSM declined from 30.7% in 2001 to a low of 21.0% in 2004 (p<0.001). UAI (any, receptive, insertive) with a known HIV-positive partner decreased overall from 1998 to 2004 (p<0.001) among MSM at HIV testing programs. HIV incidence using the serological testing algorithm for recent HIV seroconversion (STARHS) peaked in 1999 at anonymous testing sites (4.1%) and the STI clinic confidential testing program (4.8%), with rates leveling off through 2004.

CONCLUSIONS: HIV incidence among MSM appears to have stabilized at a plateau following several years of resurgence. Increases in the selection of sexual partners of concordant HIV serostatus may be contributing to the stabilization of the epidemic. However, current incidence rates of STI and HIV remain high. Moreover, a strategy of risk reduction by HIV serosorting can be severely limited by imperfect knowledge of one´s own and one´s partners´ serostatus.

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2006-08-13
MoAc0105

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