HIV-negative men who have sex with men (MSM) living in Vancouver, Canada are redefining ways to negotiate sexual safety and risk, according to qualitative research recently published by Dr Benjamin Klassen and colleagues in BMC Public Health. Condoms are no longer seen as the only means of preventing HIV infection.
Biomedical prevention strategies – including the use of pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) – emerged as important reasons for inconsistent condom use among HIV-negative men. These men also adopted “seroadaptive” strategies such as selecting partners based on their HIV-negative status) and selecting HIV-positive partners who had an undetectable viral load. Ongoing concern over possible HIV infection and the belief in the high efficacy of condoms were some reasons to continue using them.
Semi-structured interviews were conducted with 19 HIV negative men (aged 22-58, median age 36). Eight men had used post-exposure prophylaxis (PEP), seven had engaged in sorting based on partners’ viral loads and two were on PrEP. Interview questions focused on prevention strategies participants had used, their perceptions of these different strategies and how they rated different strategies in terms of efficacy. Researchers conducted thematic analysis considering factors influencing choice of prevention strategy ranging from individual to policy levels. These themes are expanded upon below:
Individual factors
Participants expressed varied views regarding condoms but there was a widespread rejection of the notion of consistently using condoms for all sexual encounters. For most men, a combination prevention approach was used.