Resilience, Syndemic Factors, and Serosorting Behaviors Among HIV Positive and HIV Negative Substance-Using MSM, Steven P. Kurtz, Mance E. Buttram, Hilary L. Surratt, and Ronald D. Stall, AIDS Education and Prevention (2012)

This study examined serosorting behavior of substance-using men who have sex with men (MSM) in southern Florida who reported recent unprotected anal intercourse, and compared the behavior of those living with HIV with those without HIV. The study found that although the HIV negative men perceived serosorting to be effective, high rates of unprotected anal intercourse and partner change in that population rendered serosorting an ineffective risk reduction approach. Participants were limited to substance-using MSM (defined as having engaged in "binge drinking [5 or more drinks] or drug use, excluding marijuana, at least three times, or marijuana use at least 20 days, in the past month") due to the higher rates of substance dependence in this population as well as correlations between drug use and rates of HIV transmission.

The study also examined resilience, defined as "a process of adaptation and readjustment that occurs despite multiple personal and social losses," and syndemic symptoms, including mental distress, substance dependence, cognitive escape, and victimization. The authors found that men with HIV were more likely to report syndemic factors than HIV negative men; HIV negative men scored higher than men with HIV on all measures of resilience; men with high coping self-efficacy scores were more than twice as likely to serosort compared to men with lower self-efficacy; and lower rates of syndemic factors and higher rates of resilience correlated with higher rates of serosorting, as hypothesized.

The authors caution that causality between the syndemic and resilience measures to serosorting behaviors should not be drawn from their findings. Syndemic characteristics are likely more prevalent in the population observed in this study. They also noted that participant self-reporting may have led to underreporting of certain behaviors.