Monday, September 19, 2011

The Safety Spectrum: Negotiating Strategies and HIV Risk

The vast majority of gay men, HIV-positive and negative, make some effort to moderate their risk of transmitting or acquiring HIV, Dr Limin Mao of the University of New South Wales in Australia told the Tenth AIDS Impact conference.

The results of three annual surveys show that the decisions faced by gay men are much more complex than the decision whether or not to use a condom.

Choices range in terms of the likely degree of protection from HIV they offer: from avoiding sex or anal sex altogether to at least avoiding unprotected anal sex with someone known to have the opposite HIV status.

Using condoms 100% of the time for anal sex is still the most popular single strategy, the study found, but only a third of HIV-negative men and a quarter of HIV-positive men now do this.

Taken as a whole, strategies involving basing whether to have unprotected anal sex on a partner's HIV status (serosorting) are now at least as popular as consistent condom use.

The study found a clear difference between serosorting practices according to participants' HIV status. The second most popular safer-sex strategy for HIV-negative men was to restrict unprotected sex to an HIV-negative regular partner – a strategy that has been called 'negotiated safety'.

HIV-positive men were less likely to restrict unprotected sex solely to their primary partner; instead the most popular strategies were to limit unprotected anal sex, both with regular and casual partners, to other HIV-positive partners – or at least to try and exclude having it with regular and casual partners not known to be HIV positive.

The study involved three successive Gay Community Periodic Surveys which took place in eight metropolitan locations in Australia between 2007 and 2009.  Before now, national and international surveys have asked gay men whether they use condoms and, more recently, about their and their partners' HIV status.

But this survey also asked whether, in the previous six months, the respondents' safer-sex behaviour was different between regular or casual partners; and it divided the HIV-positive men into those with an undetectable and detectable viral load.

One hundred per cent condom use was still the most popular strategy, but a minority one, being practised by 33.8% of the HIV-negative men, 25.5% of HIV-positive men with an undetectable viral load and 22.5% of HIV-positive men with a detectable viral load.

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