We set out to learn what HIV-negative gay men in Vancouver understood about sexual safety and their experiences of having anal sex without condoms.
Participants were asked to talk about their everyday social and sexual lives, including the kinds of sex they have, their understanding of risk, the different HIV prevention strategies they use, their experiences with HIV testing, and sources of social support.
A sample of 33 men who reported recently having anal sex without condoms took part in two in-depth interviews. All participants had recently received a negative HIV test result. Interview questions were developed through discussions with our community partner, Health Initiative for Men.
This research was carried out as part of a larger program of research with the Canadian Institutes for Health Research (CIHR) team in the Study of Acute HIV Infection in Gay Men.
Summary of Evidence
Men talked about a wide range of situations that influenced the decisions that they made during sex, including:
- How well they knew their sexual partners,
- Their use of substances,
- Their desires for sexual pleasure and intimacy.
Many participants described their recent episodes of anal sex without condoms as “low risk” or “mostly safe” based on their knowledge of a partner’s HIV-negative status.
Some men explained that while using other strategies for HIV prevention (that didn’t involve condoms) may not have reduced “all risks” related to HIV transmission, they did provide varying degrees of safety and allowed for greater sexual intimacy, spontaneity and pleasure.
Influence of relationships
When talking about relationships with their primary partners such as boyfriends, husbands, or regular casual partners, anal sex without condoms was almost always described as “safe”, often happened after talking to their partners about it, and sometimes led to decisions to test for HIV together. Participants discussed establishing “rules” in their relationships to maintain sexual safety.
Men explained that the anal sex without condoms they had in casual relationships or with hookups often happened with little discussion about HIV status. For some men the discussion was avoided altogether and determining the HIV status of a sexual partner was based on assumptions or guesses.
Strategies for reducing risk
Those participants who said that they knowingly had sex with HIV-positive partners talked about using a range of strategies, either alone or in combination, including:
- Taking the insertive position in sex (being the top, which has a lower risk of becoming infected than being the bottom),
- Using condoms,
- Considering the man’s viral load and whether he was on HIV treatment or not (as lower viral load may mean less chance of transmission of the virus).
Several participants also talked about not having very much “solid information” regarding how HIV viral load affects the risk of passing on HIV during sex, and said that current public health information on this topic is not clear.
Implications for practice
We believe this research shows the importance of resources to help support gay men’s sexual decision-making, including providing credible information about the risk of HIV transmission in relation to viral load and different non-condom based prevention practices.
For more information
Daniel Grace, Sarah A. Chown, Jody Jollimore, Robin Parry, Michael Kwag, Malcolm Steinberg, Terry Trussler, Michael Rekart & Mark Gilbert. (2014). HIV-negative gay men’s accounts of using context-dependent seroadaptive strategies. Culture, Health & Sexuality, 16(3): 316–330. doi:10.1080/13691058.2014.883644