Disclosure

There are two necessary conditions for serosorting. Men have to know their HIV status. And they have to reveal it.

Disclosure is not easy. To quote the authors of the Danish study cited above,¹ which found that 55% of HIV-positive men and 48% of HIV-negative men did not know the HIV status of their partners, “Disclosure is not as much in demand as we expect.”

In fact, disclosure is very much dependent on circumstance. On the one hand, an unpublished but influential online survey by GMFA² found that only 20% of 355 HIV-positive gay male respondents said they always disclosed their HIV status to a partner before they had sex. Forty per cent sometimes did and 40% never did. This formed the background to the ‘Why Won’t He Tell?’ campaign.

The men were also asked if they would disclose their HIV status if their partner had already disclosed HIV-positive status first. Only 42% always ‘returned the favour’, 37% sometimes did and 21% never did (and presumably rarely, if ever, disclosed to any sexual partner).

In one analysis of the ongoing survey of gay men attending London gyms,³ the authors detected two very different strategies being adopted by HIV-positive and HIV-negative gay men to avoid infection.

In HIV-negative men what the authors call ‘concordant UAI’ (serosorting definition ‘F’) happened mostly with main partners. Over one in four (28.6%) practised it with their primary partner, but only 5% with casual partners.

However, in HIV-positive men concordant UAI was equally practised with main partners (22.2%) and with casual partners (20.6%).

While negative men were a great deal more cautious about unprotected sex when it was casual, the positive men were almost as likely to have unprotected sex with casual as with primary partners. The difference can be explained, in part, by the fact that it is possible for HIV-positive men to disclose their status with certainty: “Seroconcordance among negative men can only be established with confidence if both men test for HIV together,” the authors write. “For this reason it is difficult for HIV-negative men to establish concordance with a casual partner…On the other hand, HIV-positive men can establish concordance, be it with a casual or regular partner, simply by mutual disclosure. This requires no confirmatory test.”