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’HIV-Negative Only Party’ Promoter Stirs Controversy Over Serosorting

by Ambrose Aban

EDGE Media Network Contributor

Wednesday November 14, 2007

An HIV activist has gone off on a limb that has alienated him from AIDS researchers, activists and organizations by advocating "self-serosorting" by HIV-positive and--and this is the controversial part--HIV-negative gay men. Even if his methods are unconventional and his rhetoric off-putting to many, he's raising points that have been discussed for years. Just not in the open--until now.

Some 25 years into the AIDS epidemic, gay men are debating serosorting more than ever before. Part of that is due to an "unstoppable protagonist" as he has been called, Robert Brandon Sandor. Bolstered by reports that suggest serosorting brings either psychological relief or danger to gay men, Sandor has embarked on a crusade to keep "pozzies" and "neggies" out of each other's bedrooms.

Sandor doesn't exactly shy away from controversy. He calls HIV-negative men the future and invites them (and only them) to "HIV-UB2" parties via his new site, . HIV-positive men have been vocal in their complaints of "sero-apartheid." Sandor points to a study of gay men in San Francisco that reports serosorting resulted in a reduction of HIV infection among gay men there.

According to reports like that one, serosorting may be effective for positive and negative couples. For positive men, they don't have to worry about HIV transmission to somebody who is negative, although they still have to worry about other STDs. Serosorting brings psychological relief, for HIV negative men. But, experts say, serosorting cannot obviate the issue of trust as the foundation--and fundamental problem--of any effective serosorting. Why? Because HIV-negative gay men may assume their partners are also negative and STD-free.

"This is the reason why I have decided to start a series of sex parties exclusively for HIV-negative men so that HIV infection among them can be reduced, if not stopped totally, via a safer version of serosorting," Sandor says.

But serosorting does not necessarily protect anyone from HIV or other STDs. "As we all know, it is a very big mistake to trust anyone when it comes to their HIV status as most of them don't even know their own status," notes one HIV-negative man who is in a long term relationship with an HIV-positive partner in New York City. "Under such circumstances, serosorting becomes an indirect way of spreading the HIV virus among HIV-negative gay men because serosorting seems to say that it is ok to bareback based on a simple foundation: trust,"

While Sandor (who is himself self-declared as HIV-positive) agrees that condoms are still the way to go to reduce HIV infection regardless of who has sex with whom, he believes "serosorting is a trend we all should have considered long time ago to save HIV-negative men who are really our future if we want to reduce or stop HIV infection."

The issue came to a head recently when Sandor applied to New York's LGBT Center to organize series of activities exclusively for HIV-negative men there. Robert A. Woodworth wrote back via an email rejecting the application without explanation.

Center spokesperson David Henderson told EDGE that fostering health and wellness for LGBT people, including prevention of HIV transmission, has been a core component of the Center's mission since its founding in 1983. In the realm of HIV/AIDS prevention, serosorting is a controversial subject. As a community concern it warrants discussion. Sandor conducted seminars at the Center in September 2006 and April 2007 on the subject. The Center rejected the application for a social event, Henderson said, "because the Center shares widely held concerns about risks associated with serosorting."

Sandor branded email "hate mail" and made it public. He's never shied away from controversy.

Poz-on-Poz: How Risky?

For a decade, he's been actively expressing opposition or hostility toward established activists, including Brad Becker of the LGBT National Help Center, Ken Fornataro of The Network, and Dan O'Connell of the NYSDOH-AIDS Institute. None of these leaders have been willing to debate this controversial issue openly in public, Sandor says.

Ten years ago Brandon created a series of social and sexual parties for pozzies in various cities). He says many positive men thanked him for a sex party without any reservations. HIV advocacy groups, however, weren't so pleased. They questioned whether the participants were all telling the truth about their HIV status. Sandor did ask participants to use condoms.

The success of these parties led him into the uncharted waters of HIV-negative parties. Advocacy groups didn't think the message was clear enough and that Sandor had failed to note that HIV can be transmitted in other ways than sexually, and that there was the possibility of other nasty (if not fatal) STDs.

Ken Fornataro, executive director of The Network, says he supports people having safe sex with whomever they want (except for minors), but accuses Sandor of advocating safe or unsafe sex between two HIV seronegative gay men, tacitly at least "That's very unlikely to stop the spread of HIV or anything else, including selfish disrespect for others," Fornataro says.

Sandor maintains that "the general public is not aware of the resources available out there and some gay men don't even know what serosorting means," despite its possible benefits. Indeed, some experts have praised serosorting as a way to prevent the spread of HIV between partners who choose not to use condoms. But many others won't endorse any unprotected sex.

The San Francisco study mentioned above may buttress Sandor's claims. "Serosorting" became a buzzword early in 2006, when the San Francisco Department of Public Health officials and researchers proposed that serosorting might help explain a simultaneous increase in sexually transmitted infections (STIs) and decrease in new HIV infections.

Researchers have suggested that while the increase in STIs indicated either static or increasing rates of unprotected sex, rates of HIV infection were holding steady. So maybe negative guys were doing it with negative guys--giving each other clap maybe, but not HIV.

Nor do all gay men disagree with Brandon. Some HIV-negative men see his intentions as benign. But Sandor doesn't help his cause by branding anyone who disagrees with him as a "hate group" and calling their motives into question.

"My partner was infected because he trusted his ex-lover, says an HIV-negative man living with a positive man. "Safe sex is still the only way to go especially for us. Serosorting is based on trust and we cannot trust anyone--not even the ones we know personally because most of the people we know do not know their own HIV status and most of them don't go for a regular check up, because they 'always play it safe."

But experts and activists may not be tackling whether negative people think they are being safe because they think they know the serostatus of their partners and are not using protection. "You probably have also heard of some businesses that offer cards attesting to a person's negative status, but we think that these are being used by people to convince others that it's safe to have unprotected sex with them," warns Dan O'Connell, a director of the Division of HIV Prevention at NYSDOH-AIDS Institute.

The person may be unaware of his status even after being checked.

Unaware of Serostatus, Despite Testing

The body naturally produces the standard HIV antibody screening test checks for antibodies against HIV. However, the immune system typically takes one to three months--and in rare cases as long as six months--to develop detectable quantities of antibodies (the hallmark of seroconversion).

As people who have had an HIV test may recall hearing from a doctor or counselor, the antibody test will not detect HIV infection during this "window period." A supposedly HIV negative person who has, in fact, been recently infected with HIV may receive a negative test result but still be capable of transmitting the virus. Indeed, HIV viral load skyrockets during acute infection, as the body has yet to produce enough antibodies to keep the virus (relatively) in check, and researchers believe that newly infected individuals are more infectious during this period than they will be during long-term, chronic infection.

This presents a significant problem for HIV negative people who rely on serosorting in order to have unprotected sex.

A significant proportion of people practicing serosorting who think they are HIV negative or do not truly know their status may, in fact, be HIV positive. In the vast majority of studies in which investigators have asked participants for self-reported HIV status and then conducted follow-up blood screening, those who were unsure of their HIV status overwhelmingly tended to be positive.

Dr. Richard J. Wolitski, acting deputy director for Behavioral and Social Sciences, Division of the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, believes that serosorting is likely to further reduce the risk of HIV transmission. But only if it is practiced in conjunction with monogamy and condom use, "Serosorting as a substitute for other strategies may be problematic, particularly because studies have suggested that many HIV-infected men who have sex with men are mostly unaware of their infection," Wolitski says.

One recent study also found nearly half of HIV-infected men having sex with men did not know that they were infected. Additionally, a study of more than 4,000 of these men found that 22 percent of new HIV infections were attributed to unprotected receptive anal sex with a partner who was believed to be HIV-negative.

"Consider the facts that roughly 25 percent of people with HIV don't even know they're infected," says Tim Horn, senior editor of AIDSmeds.com. "Or that people with acute HIV infection--with very high levels of HIV in their body--are easily missed using antibody testing; or that many don't get tested for HIV as regularly as they should.

"Essentially, you end up dealing with a sizeable number of men who think they're negative but really aren't, and end up putting their partners at risk under the premise of serosorting," Horn says. "It's definitely a noteworthy extension of safer sex principles, but it hardly comes with guarantees."

Researchers have also begun to observe how HIV positive individuals are choosing specific roles and behaviors with their sexual partners based on serostatus, a practice known as "strategic positioning." For example, some studies report that HIV-positive gay and bisexual men are more likely to take a receptive role with HIV-negative partners during anal sex, as the virus is less likely to be transmitted from the receptive to the insertive partner.

Experts also say serosorting can be an active or passive strategy. For example, an HIV-positive person who seeks a sex partner through online chat rooms or bulletin boards may actively select seropositive partners and/or disclose serostatus in a personal profile, allowing potential partners to serosort and thereby reducing the odds of connecting with individuals who may react unfavorably upon learning that a potential partner has HIV.

Data gathered over the past few years indicate that HIV positive individuals tend to engage in risk-reduction strategies when they have sex with a partner they believed to be HIV negative.

According to Perry Halkitis, director of the Center for Health, Identity, Behavior and Prevention Studies at New York University, "research consistently documents that HIV positive (gay and bisexual) men deliberately partake in less risky transmission behaviors when their partners are known to be HIV negative. In my view, it is indicative of the sense of responsibility many HIV positive men have toward their partners and the gay community at large," he says.

Condoms Still Unpopular

What are the personal benefits of serosorting?

For many, condoms have significant shortcomings: they can be awkward and cumbersome to use, may dull the physical sensations of sex, often carry cultural stigma, and may create an emotional barrier between partners. Furthermore, 26 years into the HIV/AIDS epidemic, there is a sense of burn-out and fatigue with "use a condom every time" safer-sex messages.

HIV positive men (or anyone) who prefer to have sex without condoms may find that serosorting decreases their anxiety about transmitting HIV, allowing them to enjoy sex more fully, both physically and emotionally. Even for individuals who practice safer sex, serosorting can reduce anxiety about possible condom failure.

"From what I heard and know, serosorting can also be a way for HIV positive people to more readily find partners for a long-term relationship, as some seropositive individuals prefer to date others who understand the experience of living with HIV," says Marc Delany, a sexually active HIV-positive man in New York City who is familiar with the current showdown between Brandon and the HIV advocacy groups.

Chris Heredia, a reporter at San Francisco Chronicle, also thinks that HIV-positive individuals find that serosorting helps to alleviate the discomfort and potential rejection sometimes associated with disclosure, and seeking sexual partners through venues (such as websites) specifically designed for finding HIV positive peers dramatically decreases the likelihood of meeting partners who turn out to be HIV negative.

"However, relying on passive serosorting--providing information that allows potential partners to serosort--puts positive individuals at greater risk for the possible repercussions associated with being open about one's HIV status, such as loss of medical confidentiality and possible discrimination," Heredia explains.

While it is true that some people find that serosorting reinforces a sense of community and connectedness by helping them to meet others who intimately understand life with HIV, others point out that fostering community through serosorting may widen rifts between positive and negative people. Choosing to develop relationships or have sex exclusively with same-status people may dramatically limit an individual's pool of prospective partners and social contacts.

As serosorting becomes more commonplace, conversations in which a person discloses his or her HIV status before sex may become the norm. Perhaps individuals unsure of their status will be more likely to seek out HIV testing as peers and partners emphasize the need to know HIV status for certain.

Safe-Sex Campaigns' Implicit Serosorting Message

Serosorting has implicitly been a major component of prevention strategies over the past ten years to reduce the spread of HIV.

The "Knowing is Beautiful" campaign created not too long ago targeting gay men, which stressed the importance of testing and asking partners about their HIV status, carried an implicit message about serosorting. While this campaign and others like it do not suggest that individuals should only have relationships with people of the same serostatus, they do assume that if HIV-positive people are aware of a partner's negative status, they will take steps to ensure that the virus is not transmitted.

Another example can be seen in recent advertisements that show two men with the captions, "He'd tell me if he's positive" and "He'd tell me if he's negative."

Public health efforts that implicitly encourage serosorting, or suggest that HIV positive people can reduce the risk of spreading the virus by engaging in strategic sexual positioning, reflect what appears to be a shift in responsibility for HIV prevention.

The prevention messages of the 1980s and 1990s--which encouraged all individuals to "use a condom every time"--proved to be less realistic and effective than initially expected. Such efforts were followed by a focus on "secondary prevention," attempting to prevent new infections by empowering and shifting responsibility to HIV-positive people; this approach, too, may not have been as effective as originally anticipated.

At least serosorting distributes responsibility among all gay men. Serosorting appears to suggest that both partners are responsible in a way that "use a condom every time" and secondary prevention did not.

"As an HIV prevention strategy, I think serosorting is quite effective for positive and negative couples," said Dr. Mitch Katz, San Francisco's public health director. "For positive men, they don't have to worry about HIV transmission to somebody who is negative. You do still have to worry about [STDs]. But for many HIV-positive men, serosorting brings with it a tremendous psychological relief."

The Internet has also allowed dating profiles to make the issue of disclosure unambiguous, and there are many Web sites specifically for dating people who are HIV-positive. "But where are the parties or sites just for HIV-men?" Sandor asks. "I don't organize sex parties anymore but truly hope that others who do will copy the ideas from HIV-UB2.net site. This is a freedom of choice that we value so dearly, and freedom of choice is one of our liberties. Through serosorting then, a monumental goal is realized: behavioral change is possible, and new HIV transmission is stopped. If you are concerned about super infections or STIs, then use a condom and practice safe sex."

Sandor's reason is based on a research that many people who learn they have been infected with HIV have altered their behaviors to reduce their risk of transmitting the virus. Therefore, increasing the proportion of people who know their HIV serostatus can help decrease HIV transmission.

Serosorting 'A Brand of Safer Sex'

But there are also other reasons why people may choose partners of the same serostatus beyond the risk of HIV transmission.

HIV-positive persons may find more support in a relationship with another HIV-positive person because they share the challenging aspects of living with HIV. What looks like serosorting may simply be the rise of a community-generated HIV prevention strategy that is happening whether we have any control over it or not.

"Whether we support the concept or are against it, serosorting is a brand of safer sex," says Tim Horn of AIDSmeds.com. "Anything that reduces the odds of sexual transmission is safer sex. So to dismiss it out-of-hand strikes me as nonsensical. Let's face the facts--serosorting among those thinking they're HIV-negative is riskier than serosorting among people who know they're positive."

So even if Robert Brandon Sandor's methods are unconventional and his rhetoric off-putting to many, the points he is raising may be worth closer scrutiny. Certainly, with AIDS showing no sign of ending in the gay community, it's time to consider any and all options.

Caught between the moon and New York City which he calls home since 2000, Ambrose Aban wrote for Malaysia, Singapore and Bangkok Tatler, reviewed restaurants and wrote special ad supplement, "Christopher Street", for HX Magazine New York, contributed to leading English dailies in Malaysia, Hong Kong and Singapore. Ambrose loves giving up the secrets of everything from where to find the most delicious Orange Glazed Peking Duck to how to prepare extravagant chic soirees in the city.