Gay men with diagnosed HIV can adopt a number of strategies to reduce the risk of transmitting HIV to others, although research has typically focussed on condom use. Interviews with 42 HIV-positive gay men who reported recent engagement in anal intercourse without condoms explored their awareness of sexual risk and their perceptions of non-condom-related strategies to reduce it. In articulating men’s ambivalence for strategies that can only reduce the risk of transmission, rather than eliminating, the findings have implications for the consideration and integration of new biomedical interventions to reduce the likelihood of HIV transmission.
AghaizuABrownAENardoneA. (2013) HIV in the United Kingdom 2013 Report: Data to End 2012. London: Public Health England.
2.
AttiaSEggerMMullerM. (2009) Sexual transmission of HIV according to viral load and antiretroviral therapy: Systematic review and meta-analysis. AIDS23: 1397–1404.
3.
BourneADoddsCKeoghP. (2009) Relative Safety II: Risk and Unprotected Anal Intercourse among Gay Men with Diagnosed HIV. London: Sigma Research.
4.
BourneAHicksonFKeoghP. (2012) Problems with sex among gay and bisexual men with diagnosed HIV in the United Kingdom. BMC Public Health12: 916.
5.
BraunVClarkeV (2006) Using thematic analysis in psychology. Qualitative Research in Psychology3: 77–101.
6.
BrennanDJWellesSLMinerMH. (2010) HIV treatment optimism and unsafe anal intercourse among HIV-positive men who have sex with men: Findings from the positive connections study. AIDS Education and Prevention22: 126–137.
7.
CohenMChenYMcCauleyM. (2011) Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine365: 493–505.
8.
CrepazNMarksG (2003) Serostatus disclosure, sexual communication and safer sex in HIV-positive men. AIDS Care15: 379–387.
9.
DavisMDMHartGImrieJ. (2002) ‘HIV is HIV to me’: The meanings of treatment, viral load and reinfection for gay men living with HIV. Health, Risk & Society4: 31–43.
10.
DouganSElfordJRiceB. (2005) Epidemiology of HIV among black and minority ethnic men who have sex with men in England and Wales. Sexually Transmitted Infections81(4): 345–350.
11.
FlowersPDavisDM (2013) Understanding the biopsychosocial aspects of HIV disclosure among HIV-positive gay men in Scotland. Journal of Health Psychology18: 711–724.
12.
FlowersPSmithJASheeranP. (1997) Health and romance: Understanding unprotected sex in relationships between gay men. British Journal of Health Psychology2: 73–86.
13.
GrantRMLamaJRAndersonPL. (2010) Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine363(27): 2587–2599.
14.
HicksonFBonellCHargreavesJ. (2013) Sexual risk behaviour among men who have sex with men living in England and recruited through the internet in 2001 and 2008. Sexuality Research & Social Policy10: 15–23.
15.
HicksonFWeatherburnPReidD. (2003) Out and about: Findings from the United Kingdom Gay Men’s Sex Survey 2002. London: Sigma Research.
16.
KalichmanSCCherryCAmaralCM. (2010) Adherence to antiretroviral therapy and HIV transmission risks: Implications for test-and-treat approaches to HIV prevention. AIDS Patient Care STDS24: 271–277.
17.
KhosropourCMDombrowskiJCHughesJP, et al. (2014) Measuring purposefully adopted seroadaptive behaviors vs reported sexual behaviors among MSM. In: 21st conference on retroviruses and opportunistic infections (CROI), Boston, MA, 3–6 March.
18.
MacdonaldNElamGHicksonF. (2008) Factors associated with HIV seroconversion in gay men in England at the start of the 21st century. Sexually Transmitted Infections84: 8–13.
19.
McFarlandWChenYHNguyenB. (2012) Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use. AIDS and Behavior16: 121–131.
20.
ParsonsJTSchrimshawEWWolitskiRJ. (2005) Sexual harm reduction practices of HIV-seropositive gay and bisexual men: Serosorting, strategic positioning, and withdrawal before ejaculation. AIDS19(Suppl. 1): S13–S25.
21.
PhillipsANCambianoVNakagawaF. (2013) Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic. PLOS One. DOI: 10.1371/journal.pone.0055312.
22.
RawstornePFogartyACrawfordJ. (2007) Differences between HIV-positive gay men who ‘frequently’, ‘sometimes’ or ‘never’ engage in unprotected anal intercourse with serononconcordant casual partners: Positive Health cohort, Australia. AIDS Care19: 514–522.
23.
RodgerABruunTCambianoV. (2014) HIV transmission risk through condomless sex if HIV+ partner on suppressive ART: Partner study. In: Conference on retroviruses and opportunistic infections (CROI 2014), Boston, MA, 3–6 March.
24.
SchilderAOrchardTBuchnerC. (2008) ‘It’s like the treasure’: Beliefs associated with semen among young HIV-positive and HIV-negative gay men. Culture, Health & Sexuality10: 667–679.
25.
StarksTJPaytonGGolubSA. (2014) Contextualizing condom use: Intimacy interference, stigma, and unprotected sex. Journal of Health Psychology19(6): 711–720.
26.
StephensonJMImrieJDavisMM. (2003) Is use of antiretroviral therapy among homosexual men associated with increased risk of transmission of HIV infection?Sexually Transmitted Infections79: 7–10.
27.
SuarezTPKellyJAPinkertonSD. (2001) Influence of partners’ HIV serostatus, use of highly active antiretroviral therapy, and viral load on perceptions of sexual risk behavior in a community sample of men who have sex with men. Journal of Acquired Immune Deficiency Syndrome28: 471–477.
28.
VandeVenPKippaxSCrawfordJ. (2002) In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care14: 471–480.
29.
VernazzaPHirschelBBernasconiE. (2008) Les personnes seropositives ne souffrant d’aucune autre MST et suivant un traitment antiretroviral efficie ne transmettent pas le VIH par voie sexuelle. Bulletin des Médecins Suisses89: 165–169.
30.
World Health Organization (2012) Antiretroviral Treatment as Prevention (TASP) of HIV and TB: Programmatic Update. Geneva: World Health Organization.
