Some people choose their sex partners based on HIV status. This is called “sero-sorting.”

HIV status can be a factor in whether someone uses other strategies like condoms, PrEP, or undetectable HIV viral load. Sero-sorting as a method of HIV-prevention may seem simple in concept, but in reality it’s not so clear cut.

For HIV Negative People

Someone who’s HIV-negative might choose to have sex with someone else who is HIV-negative so they can have sex without protection (condoms, dental dams, PrEP etc). Or perhaps when someone says they’re HIV-negative, that acts as a green light to not use barrier protection. When it comes to reducing HIV, choosing to only have sex with other HIV-negative people does not work very well in practice.

Here’s what we know about when HIV-negative people try to sero-sort:

When it comes to reducing your chances of getting HIV, choosing to only have sex with other HIV-negative people does not work very well. This is because approximately 10% of people who have HIV have not been diagnosed with HIV. They may think they are negative, but sometime after their last test they acquired it (or they tested too soon in the HIV testing window period for the test to detect it).

Additionally, if a person’s HIV is untreated, their viral load – the amount of HIV in their body – is likely really high, and high viral load makes the transmission of HIV much more likely. For these reasons, two people who think they are HIV-negative may have a very high likelihood of transmitting HIV if they choose to have penetrative sex without condoms or without using another strategy such as PrEP.

The evidence is showing that many new HIV infections are happening when someone has HIV but has not yet tested positive for HIV. If you have condomless sex, how certain are you of your HIV status? It’s better for your health and for the health of your sexual partner(s) that you know your status as best you can.

Why might someone not know that they have HIV? There are lots of possible reasons.

• They may assume they do not have HIV, because their most recent test came up negative, click here to learn more about testing windows.
• People who have recently acquired HIV may experience no symptoms, or may not recognize the symptoms they experience as HIV infection.
• It is common for folks, especially those in at-risk populations, to underestimate the likelihood of HIV infection.
• It may be because they haven’t tested since they got HIV, but have had riskier sex. They may be so afraid of the stigma they might face if they test positive for HIV that they just don’t get tested. We all have a role to play in fighting stigma, so we can all stay healthier.

So some folks don’t know they’re HIV-positive, and if you are regularly sexually active, it is difficult to be certain of an HIV-negative status. Because of this, the practice of, as someone who is HIV-negative, choosing only to have sex with other people who think they are negative without using barrier protection or PrEP has not been a reliable way to prevent HIV transmission. Research has shown that this kind of sero-sorting is less effective than when folks combine other strategies.

This kind of sero-sorting also plays a role in creating stigma against guys who know they are HIV-positive. In Nova Scotia, 93% of HIV positive folks on treatment have undetectable viral load, and of those, most would know where their viral load is at (4). When you compare this to the 10% of people who have HIV and don’t know, it is clear that you are less likely to contract HIV from sex with someone on HIV treatment than an HIV negative person. People who have an undetectable viral load can’t transmit HIV through sex, but people who haven’t been diagnosed, and therefore think they are HIV-negative, can.

Folks who are sero-sorting and not using barrier protection are also more likely to be exposing themselves to other sexually transmitted infections. Some STIs can be hard to manage, especially if they are untreated, and some (like certain forms of HPV) can progress into serious conditions like cancer. HIV transmission can also be more likely if a sexual partner or you have an STI, and isn’t undetectable or on PrEP.

If you are HIV-negative and you only have sex with other people who believe that they are HIV-negative, there are a few things you might want to think about:

Our customizable testing tool can help you figure out how often it is recommended for you to be getting tested. Testing helps to reduce rates of HIV and other STIs in the community. We know today that the best thing you can do for your health if you do have HIV is to diagnose it as early as possible, so you can get connected to care fast and make decisions about treatment.

Talk about HIV status, sexual health, and strategies with your sex partners. HIV status can change. Talking about your status is better than guessing or making assumptions. Still, remember that a lot of folks may believe they are HIV-negative because they haven’t been diagnosed with HIV. If you and your partner are sero-sorting based on being HIV-negative, you might still want to talk about how often you each are testing and whether either of you have had condomless sex since their last test. You might choose to also use condoms, or decide whether to top or bottom, as ways of lowering the chances of HIV. Some folks entering a relationship(s) will go get tested together before making a decision about condoms or making a relationship agreement.

Even if you’ve hooked up with someone without using condoms before, you may feel differently this time. You can let your partner(s) know that you’d be more into it using a condom, topping rather than bottoming, or changing something else about the sex you’re having this time.

Intimacy can impact our decisions. It’s very possible for HIV transmission to occur when two (or more!) people are falling in love, getting close, or experiencing really intense intimacy. These feelings may, for example, lead somebody to stop using condoms before being certain of HIV status. If you choose not to use condoms or PrEP, but one of you has undiagnosed HIV, the chance of HIV transmission is high. However, some couples or sex partners may choose to go get tested together to be sure that they are HIV-negative before choosing not to use condoms with each other. It’s a good idea to talk to your doctor about the “window period” where testing might not yet detect HIV. Check out our section on testing to learn more about this.

There are times when you can be more certain of your HIV-negative status. If you always use condoms, you don’t have anal sex, or you and your partner have been tested and share an honest, monogamous or negotiated relationship, you may be more sure about your HIV-negative status.

This section was adapted, with permission, from The Sex You Want Website.

Learn more about where we got this information from at: CDC
*disclaimer: we do not necessarily endorse all of the information, content, or language used in these references

For HIV Positive

Some HIV-positive folks may decide to only have sex with other people who know they are HIV-positive. There are a few things to keep in mind about sero-sorting for positive folks.

If you are HIV positive, only sleeping with other positive people can be a relief, since it’s less likely you’ll have to deal with with dating profiles, misunderstanding, and stigma, or in some cases the worry about the transmission of HIV

Two people who know they have HIV choosing to have sex with each other is a reliable form of “sero-sorting” because HIV status is known to be the same.

Still, there are a few things to keep in mind if you’re an HIV-positive person who is sero-sorting:

Getting tested and treated for STIs regularly can help to reduce rates of STIs in sexual networks. The rates of STIs, especially syphilis are a big problem right now for folks who identify as gay men. Some STIs’ including Syphilis can be more dangerous for HIV positive people, especially if left untreated. If you are choosing to sero-sort and have sex without barrier protection, it is important to consider thinking about what you can do to keep you and your partner(s) safe from STIs. It is recommended to look into vaccines, testing for STIs, monitoring symptoms, and reconsider using barrier protection if the number of partners you have increases, or if you know the person/people you are having sex with have increased their number of sexual partners. See sections on other STIs to learn more about risks associated with them and methods of staying safe.

Talk to your partners — it’s possible that one of you is getting treated for an STI or that something about their approach to sexual health has changed. Even if you’ve had sex with someone without using barrier protection before, you may feel differently later on. You can let them know that you’d be more into it using barrier protection this time.

This section was adapted, with permission, from The Sex You Want Website.
*disclaimer: we do not necessarily endorse all of the information, content, or language used in these references.