Table of Contents
Journal of Sexually Transmitted Diseases
Volume 2013, Article ID 583627, 8 pages
Review Article

Serosorting and HIV/STI Infection among HIV-Negative MSM and Transgender People: A Systematic Review and Meta-Analysis to Inform WHO Guidelines

1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
2Social and Behavioral Interventions Program, Department of International Health, Room E5033, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
3Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
4Instituto de Estudios en Salud, Sexualidad y Desarrollo Humano, Universidad Peruana Cayetano Heredia, Lima, Peru
5Department of Medicine, State University of New York at Buffalo, Buffalo, NY 14214, USA
6Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON L8S 4L8, Canada
7Department of HIV/AIDS, World Health Organization, 1211 Geneva, Switzerland

Received 10 January 2013; Revised 21 March 2013; Accepted 26 March 2013

Academic Editor: Benoît Masse

Copyright © 2013 Caitlin E. Kennedy et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We conducted a systematic review and meta-analysis to assess the association between serosorting and HIV infection, sexually transmitted infections (STIs), and quality of life among men who have sex with men (MSM) and transgender people. Two reviewers independently screened abstracts and abstracted data. Meta-analyses were conducted using random effects models. Of 310 citations reviewed, 4 observational studies, all with MSM, met inclusion criteria. Compared to consistent condom use, serosorting was associated with increased risk of HIV (3 studies, odds ratio (OR): 1.80, 95% confidence interval (CI):1.21–2.70) and bacterial STIs (1 study, OR: 1.62, 95% CI: 1.44–1.83). Compared to no condom use, serosorting was associated with reduced risk of HIV (3 studies, OR: 0.46, 95% CI: 0.25–0.83) and bacterial STIs (1 study, OR: 0.81, 95% CI: 0.73–0.91). Among HIV-negative MSM, condom use appears to be more protective against HIV and STIs than serosorting and should be encouraged. However, serosorting may be better than no condom use as a harm reduction strategy.