“Knowing Your Status and Knowing Your Partner’s Status Is Really Where It Starts”: A Qualitative Exploration of the Process by Which a Sexual Partner’s HIV Status Can Influence Sexual Decision Making (original) (raw)
Related papers
American journal of men's health, 2018
Men who have sex with men (MSM) may prioritize interpersonal and structural factors, such as LGBTQ-related inequalities, housing instability, financial insecurity, and relationship seeking, over HIV prevention. The aim of this study was to assess how MSM prioritize HIV relative to other factors and the association between HIV prioritization, HIV testing and sexual risk behavior, and perceived risk. Data were collected from a national online survey of MSM in the United States assessing HIV knowledge and prioritization. Participants ranked HIV prevention relative to LGBTQ-related concerns and life issues (e.g., housing, job, relationship). Adjusted regression models were conducted to assess the association of HIV prioritization with HIV testing and condomless anal sex (CAS) and to evaluate associations between perceived risk and HIV risk behavior. Among 516 participants, HIV prevention was ranked significantly higher among MSM reporting recent CAS ( p = .04) and HIV testing within the...
HIV-negative gay men’s accounts of using context-dependent seroadaptive strategies
2014
We enrolled 166 gay and bisexual men who tested HIV-negative at a community sexual health clinic in Vancouver, British Columbia, into a year-long mixed-methods study. A subsample of participants who reported recent condomless anal sex (n 1⁄4 33) were purposively recruited into an embedded qualitative study and completed two in-depth qualitative interviews. Analysis of baseline interviews elicited three narratives relevant to men’s use of context- or relationally-dependent HIV-risk management strategies: (1) seroadaptive behaviours such as partner testing and negotiated safety agreements used with primary sexual partners, (2) serosorting and seroguessing when having sex with new partners and first-time hookups and (3) seroadaptive behaviours, including one or more of seropositioning/strategic positioning, condom serosorting and viral load sorting, used by participants who knowingly had sex with a serodiscordant partner. Within men’s talk about sex, we found complex and frequently biomedically-informed rationale for seroadaptation in men’s decisions to have what they understood to be various forms of safe or protected condomless anal sex. Our findings support the need for gay men’s research and health promotion to meaningfully account for the multiple rationalities and seroadaptive strategies used for having condomless sex in order to be relevant to gay men’s everyday sexual decision-making.
Journal of Applied Social Psychology, 2000
This longitudinal study of gay men examined safer sex within steady relationships and assessed whether relationship quality influenced safer sex with casual partners. The theoretical frameworks of Rusbult's (1980) investment model of romantic relationships and of Ajzen's (1988, 1991) model of planned behavior were used. Unprotected intercourse with a steady partner was practiced significantly more often when both partners in a steady relationship were seronegative and had an explicit agreement to keep it safe with casual partners. However, there was no indication that explicit agreements reduced the occurrence of unsafe extrarelational sex. Both the investment model of romantic relationships and the model of planned behavior were successful in accounting for sexual risk behavior outside the relationship.
PLOS global public health, 2022
Background Men who have sex with men (MSM) are at the epicenter of the HIV epidemic. Efforts to prevent sexually transmitted infections (STIs) and HIV transmission have traditionally focused on condoms and abstinence from high risk sexual practices. Recently, additional methods such as pre-exposure prophylaxis (PrEP) and viral load sorting have been introduced. The aim of this study was to gain understanding about risk management and risk perception strategies for HIV among highly sexually active Swedish MSM with men in Berlin. Methods Eighteen sexually active Swedish MSM who travelled to or lived in Berlin were recruited and interviewed in this study. The data were analyzed using content analysis. Results and discussion These men represent a group of knowledgeable MSM in terms of HIV. They acknowledged that having sex with men in Berlin was linked to high sexual risk taking due to the higher prevalence of HIV/STIs than in Sweden, but reported that they nevertheless did not alter their risk management strategies. The analysis resulted in a conceptual model of risk assessment that allows for a deeper understanding of the complexity of the risk reduction decision-making process. Three ontological perceptions of risk were identified: accepting, minimizing and rejecting risk. Seven practiced risk reduction methods were described. Some informants applied their preferred method or set of methods to all settings and partners, while others faced complex decision-making processes. Conclusion HIV is integrated into the core of MSM's sexuality, independently of how they ontologically related to the idea of risk. A constant navigation between pleasure, risk and safety,
Sacramento State University , 2017
This research investigated Risky Sexual Behaviors (RSB) among men with same sex partners, in reference to the increased number of new HIV infections within that population. Men who have Sex with Men (MSM) continue to suffer disproportionately high HIV infection rates, with this population accounting for the majority of new HIV infections, while making up only an estimated 2 percent of the population. Prominent themes were identified and described using a phenomenological perspective to contextualize the experiences of members of the study sample, as gathered from online self-reports and blogs to conduct qualitative research and using Grounded Theory processes to outline interrelated emergent components that form enmeshed schemas. Illicit drug use by MSM was situated within a cyclical relationship with risky sexual practices that facilitate HIV transmission. The study findings indicate that one inadequately recognized driver of RSB could involve the compelling primacy of seminal transaction within male same-sex sexuality. Behavioral, cognitive, and emotional patterns associated with Risky Sexual Behaviors emerged as transferable to other public health issues involving at-risk populations, such as chemical dependency, unhealthy lifestyle patterns as well as general sexual risk-taking. Sexual identity, body image, and social/subcultural constructions of masculinity emerged as primary themes within the study’s findings. A complex combination of factors contributes to RSB among men who have sex with men, including perceived sexual needs, pernicious effects of stigma, issues relating to cultural identity, fatalism, complacency, and use of substances as associated with sexual risk-taking. Recommendations include increased promotion of Pre-Exposure Prophylaxis, increased acknowledgement of ambivalence surrounding HIV prevention among MSM, and targeted educational approaches to minimize the conceptions associated with Risky Sexual Behaviors among males with same sex partners, with the collaborative efforts of governmental and non-governmental organizations.
Archives of Sexual Behavior, 2013
Among gay and bisexual men, primary partners are a leading source of HIV infection. Trust, intimacy, and advancements in HIV treatment may impact same-sex male couples' decisions to engage in unprotected anal intercourse (UAI). This qualitative study explored how Black, White and interracial couples discussed, and made decisions regarding condoms. Qualitative interviews were conducted with 48 same-sex male couples in the New York and San Francisco metropolitan areas. Stratified purposive sampling was used to include Black (n = 16), White (n = 17), and interracial (Black-White) (n = 15) couples. Twenty-six couples were concordant HIV-negative and 22 were HIV-discordant. Interviews were recorded, transcribed, coded, and analyzed using a grounded theory approach. Some couples described explicit processes, which involved active discussion, while others described implicit processes, where condom-use decisions occurred without any explicit discussion. These processes also differed by race and HIV status. Black couples tended to report condom-use as "just understood." White, HIV-discordant couples decided not to use condoms, with some identifying the HIV-positive partner's suppressed viral load and high CD4 count as deciding factors. After an unplanned episode of UAI, White, HIVnegative couples tended to discontinue condom use while Black HIV-negative couples decided to revert to using condoms. HIV prevention efforts focused on same-sex, male couples must consider the explicit/implicit nature of condom decision-making processes. Understanding differences in these processes and considering relationship dynamics, across race and HIV status, can promote the development of innovative couple-level, HIV prevention interventions.
Frontiers in public health, 2018
The use of HIV serostatus information has played a pivotal role in partner selection norms. A phenomenon known as is the practice of selecting a partner based on a perception that they are of the HIV status in order to avoid transmission from one partner to the other. An understudied aspect of serosorting is that it has a divisive effect-one accepts or rejects a potential partner based on a singular characteristic, the partner's HIV status, and thus excludes all others. This division has been formally referred to as the HIV . In this study, we explored partner selection strategies among a group of HIV-negative, young men who have sex with men ( = 29) enrolled in a PrEP demonstration project in Northern California. We found that trends in serosorting were in fact shifting, and that a new and opposite phenomenon was emerging, something we labeled "seromixing" and that PrEP use played a part in why norms were changing. We present three orientations in this regard: (1) : i...
Sexual Risk Behavior and Risk Reduction Beliefs Among HIV-Positive Young Men Who have Sex with Men
AIDS and Behavior, 2013
With young men who have sex with men (YMSM) continuing to be disproportionately affected by the HIV/AIDS epidemic in the U.S., secondary prevention efforts with this population take on increasing significance. We surveyed 200 HIV-positive YMSM (ages 16-24, 66% Black, 18% Latino, 7% White, 7% Multiracial/Other) recruited from 14 HIV primary care sites to examine associations of unprotected anal intercourse (UAI) and partner HIV status with endorsement of serosorting, sexual positioning, and viral load beliefs. Proportions of participants engaging in UAI one or more times during the past three months were consistent across type of UAI (insertive or receptive) and partner status. Belief that an undetectable viral load reduces infectiousness was significantly associated with insertive UAI (p<.05) and receptive UAI (p<.05) with HIV-negative or unknown-status partners and receptive UAI with HIV-positive partners (p<.01). Endorsement of belief in serosorting was significantly associated with receptive UAI (p<.01) and insertive UAI (p<.05) with HIV-positive male partners. Implications for sexual behavior and risk reduction beliefs in this population are discussed.
AIDS and Behavior, 1999
With the advent of highly effective antiretroviral therapies, the prospects for persons living with HIV infection (HIV+) undoubtedly include many years of continued sexual activity. Reports of unsafe sexual behavior among a subset of HIV+ men has alarmed some prevention researchers and stimulated rethinking of HIV prevention interventions for gay/bisexual men. This paper examines the rates of unsafe sex among HIV+ gay/bisexual men and their correlates, comparing them to HIV-men recruited simultaneously to the Chicago MACS/ C&CS and AIM studies. Aside from initial differences in the rates of unprotected anal sex (UAS) among men prior to learning their HIV serostatus, there were no differences in actual rates of UAS or their correlates in the two samples. Further, the importance of attitudinal measures-i.e., sexual sensation seeking, preference for UAS, and belief in the efficacy of the new therapies-in predicting risky sex among gay/bisexual men regardless of serostatus argues for an emphasis on modifying these attitudes in any HIV prevention interventions for gay and bisexual men and the importance of combining primary and secondary HIV prevention strategies whenever possible.
AIDS and Behavior, 2008
Selecting sex partners of the same HIV status or serosorting is a sexual risk reduction strategy used by many men who have sex with men. However, the effectiveness of serosorting for protection against HIV is potentially limited. We sought to examine how men perceive the protective benefits of factors related to serosorting including beliefs about engaging in serosorting, sexual communication, and perceptions of risk for HIV. Participants were 94 HIV negative seroconcordant (same HIV status) couples, 20 HIV serodiscordant (discrepant HIV status) couples, and 13 HIV positive seroconcordant (same HIV status) couples recruited from a large gay pride festival in the southeastern US. To account for nonindependence found in the couple-level data, we used multilevel modeling which includes dyad in the analysis. Findings demonstrated that participants in seroconcordant relationships were more likely to believe that serosorting reduces concerns for condom use. HIV negative participants in seroconcordant relationships viewed themselves at relatively low risk for HIV transmission even though monogamy within relationships and HIV testing were infrequent. Dyadic analyses demonstrated that partners have a substantial effect on an individual's beliefs and number of unprotected sex partners. We conclude that relationship partners are an important source of influence and, thus, intervening with partners is necessary to reduce HIV transmission risks.