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Op-Ed

On unprotected sex between HIV-neg top and poz bottom

An HIV-negative Filipino asks if it’s okay to have unprotected sex with an HIV-positive bottom; and Dr. Jose Narciso Melchor Sescon answers.

Dr. Jose Narciso Melchor Sescon – president of the AIDS Society of the Philippines and current Chief of Clinics of Sta. Ana Hospital – answers all your HIV-related inquiries. For all your questions, email josescon1@gmail.com or info@outragemag.com.

Dear Doc,

I’m HIV-negative, and my partner is HIV-positive. His viral load is undetectable. We have been in a monogamous relationship. I read somewhere about seropositioning – that because I’m top and his viral load is undetectable, we can have sex without using condom because my risk to get infected is marginally low. Is this true?

Curious Top

Allow me to introduce two community-driven HIV seroadaptive strategies, namely: serosorting and seropositioning. These harm reduction/harm minimizing strategy has become popular in recent years.

For years now, men having sex with men (MSM) in the developed countries like USA and Europe have been reported to choose their sexual partners based on their HIV status (i.e. serosorting). There is another selection approach, which is in choosing sexual roles and activities (i.e. seropositioning), though this is similarly based on one’s partners’ HIV status.

Several MSM studies in the US and in Europe revealed the following findings:

        • For those who play the receptive part when seropositioning, viral load method and sero-guessing was rated with the highest risk of acquiring HIV.
        • Seropositioning may not be very effective because serodiscordant unprotected anal intercourse (UAI) still poses some risk to an insertive HIV-negative partner.
        • EXPLORE study, a randomized trial conducted among HIV-negative MSM with data obtained from more than 3,000 participants, ascertained that a sizable minority of MSM in all demographic categories do in fact engage in these practices. EXPLORE study revealed that the most common of the two practices among those surveyed was serosorting (as defined in this study as the preferential use of condoms with partners whose HIV status was either positive or unknown). Serosorting was associated with a 12% decrease in risk for HIV seroconversion, even in those reporting having 10 or more sex partners. Seropositioning (as defined in the study is the practice of insertive rather than receptive anal sex with a partner whose HIV status is either positive or unknown; and which may or may not include the use of condoms), was less common and significantly less effective. In fact, researchers found no evidence that seropositioning had any effect against HIV acquisition. Susan Philip of the San Francisco Department of Public Health, who presented the EXPLORE study data, shared this take-home message: “To continue to promote condom use among MSM”, in support of serosorting as an effective HIV prevention strategy. Philip also pointed out that promoting frequent HIV testing among MSM and ensuring that access to the most advanced testing technology is available is also critical.

Now, after having presented these available evidence-based research studies on seroadaptive behaviors (serosorting or seropositioning), the final decision belongs to the consenting adults whether to proceed or not. But at the end of the day, we recommend that at all times, do no further harm.

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