HIV risk management in the context of relationships: an exploratory qualitative study with young gay and bisexual men in Scotland

Boydell, N. , Buston, K. and McDaid, L. (2014) HIV risk management in the context of relationships: an exploratory qualitative study with young gay and bisexual men in Scotland. HIV Medicine, 15, p. 52. (doi:10.1111/hiv.12147)

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Abstract

Background: HIV prevention for men who have sex with men (MSM) hastypically focused on behaviour change at the individual-level, rather than aspart of a couple. However, recent research has highlighted the role of primarysexual partners in the transmission of HIV among young MSM in the US,estimating that as many as 84% of new transmissions were from men’s mainpartner. This suggests that work with couples could contribute to preventionefforts.Methods: We conducted qualitative in-depth interviews with 30 young MSM(aged 18-29) in Scotland, recruited via a number of strategies; onlineadvertisements, through voluntary sector organisations working with MSM,and snowballing. Thematic data analysis focused on identifying how menunderstand HIV risk management strategies in the context of relationships,specifically the role of ‘safer sex’ practices, HIV testing, and expectationsaround monogamy and/or sexual exclusivity.Results: At the time of interview, nine men reported being in a relationship,and the majority (n=28) discussed their aspirations for sex in long-termrelationships. Participants’ demonstrated varying levels of HIV literacy (i.e.HIV-related knowledge and an individual’s capacity to apply this), andalthough all discussed condom use as part of ‘safer sex’ and their individualmanagement of HIV risk, a recurring theme was desire to discontinue condomuse in the context of a committed relationship. Over a third of the men (n=22)discussed discontinuing condom use in this context. Of those in relationships,six had discontinued condom use, but not all tested for HIV prior to this, norexplicitly discussed expectations for monogamy and/or sexual exclusivity withtheir partners. Agreeing to testing and discussing expectations of fidelity werecomplicated by issues of trust and intimacy.Conclusion: How MSM understand and manage HIV risk in relationships hasimplications for future HIV prevention. Knowledge of their own (and partner’s)HIV status - particularly where serodiscordant relationships are identified -could enable men to make decisions around prevention, and whereappropriate, open up the possibility of accessing biomedical prevention. Ourresearch suggests young MSM in relationships continue to base safer sexdecisions on perceptions of fidelity and trust in their partners. Young MSMaccessing testing in clinical settings could be targeted for interventions toencourage HIV status disclosure and informed safer sex negotiation.

Item Type:Articles
Additional Information:MRC 978281. Gay Community Norms and Sexual Health (Personal Communities' and safer sex: A qualitative study of young gay and bisexual men in Scotland).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Boydell, Dr Nicola and McDaid, Professor Lisa and Buston, Dr Katie
Authors: Boydell, N., Buston, K., and McDaid, L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO Unit
Journal Name:HIV Medicine
Publisher:John Wiley & Sons Ltd.
ISSN:1464-2662
ISSN (Online):1468-1293

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
656571Sexual Health and Families ProgrammeLisa McDaidMedical Research Council (MRC)MC_UU_12017/2IHW - MRC/CSO SPHU
727631SPHSU Core Renewal: Relationships & Health Improvement Research ProgrammeLisa McDaidMedical Research Council (MRC)MC_UU_12017/11IHW - MRC/CSO SPHU
727631SPHSU Core Renewal: Relationships & Health Improvement Research ProgrammeLisa McDaidMedical Research Council (MRC)MC_UU_12017/11IHW - MRC/CSO SPHU