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. Read more via AIDSmap
“Condoms are … like public transit. It’s something you want everyone else to take”: Perceptions and use of condoms among HIV negative gay men in Vancouver, Canada in the era of biomedical and seroadaptive prevention
The emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men.
We undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies.
Contributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk.
These findings indicate that notions of “safety” and “risk” based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men’s current prevention needs. Interventions should advance gay men’s communication and self-advocacy skills in order to optimize these strategies.