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.