HIV testing and ongoing relationships are part of 'safer sex' for young gay men

Many young gay men consider ‘safer sex’ to be about more than condom use, according to a qualitative study conducted in Scotland. Encouragingly, many consider regular HIV testing to be a component of safer sex. More problematically, condomless sex with a regular partner was described as being relatively safe, even when there was little clarity about HIV testing within the relationship.

Nicola Boydell presented the results to GAYCON 2014, the 5th National Conference for Scotland on Gay and Bisexual Men’s Health and Wellbeing. Her research involved in-depth interviews with 30 young gay men, aged 18 to 29.

When asked to outline their understanding of ‘safer sex’, some respondents included HIV testing alongside other practices. For example, a 21 year old said:

Glossary

safer sex

Sex in which the risk of HIV transmission is reduced or is minimal. Describing this as ‘safer’ rather than ‘safe’ sex reflects the fact that some safer sex practices do not completely eliminate transmission risks. In the past, ‘safer sex’ primarily referred to the use of condoms during penetrative sex, as well as being sexual in non-penetrative ways. Modern definitions should also include the use of PrEP and the HIV-positive partner having an undetectable viral load. However, some people do continue to use the term as a synonym for condom use.

condomless

Having sex without condoms, which used to be called ‘unprotected’ or ‘unsafe’ sex. However, it is now recognised that PrEP and U=U are effective HIV prevention tools, without condoms being required. Nonethless, PrEP and U=U do not protect against other STIs. 

disclosure

In HIV, refers to the act of telling another person that you have HIV. Many people find this term stigmatising as it suggests information which is normally kept secret. The terms ‘telling’ or ‘sharing’ are more neutral.

qualitative

Qualitative research is used to explore and understand people’s beliefs, experiences, attitudes or behaviours. It asks questions about how and why. Qualitative research might ask questions about why people find it hard to use HIV prevention methods. It wouldn’t ask how many people use them or collect data in the form of numbers. Qualitative research methods include interviews, focus groups and participant observation.

“Safer sex generally speaking is using condoms and making sure it’s used properly and stuff and getting checked up regularly, very regularly.”

Another man gave a more extensive definition:

Safer sex “is making sure you’ve got condoms, you have them, they’re in date, you have the proper lubrication for it and make sure you have the, all different sizes and non-latex and make sure you get yourself tested and you’ve got the support there to talk to somebody if you feel uncomfortable or have somebody to go with you.”

Sex without a condom was often seen differently, depending on the nature of the relationship.

“Anal sex I know is, with a casual partner I know is the highest risk activity… Anal sex is more risky than any other type of sex, but with a regular partner is less risky than with a casual partner.”

A recurring theme in interviews was the desire to stop using condoms in the context of a committed relationship.

“If it was just like a casual thing, I would always use condoms and then if we’re going out like, at the start for like a couple of months depending on the person, we would use a condom and then after that if like we trusted each other, if I trusted him, we wouldn’t.”

While some men described careful processes of HIV testing and discussing results before giving up condoms, others were vague or relied on a perception of fidelity and trust. Expectations around monogamy or sex with other partners were rarely clearly discussed.

“At the moment we’re monogamous, but at the same time we both appreciate other men, and there have been occasions when we’ve both been together with other guys, but we use protection in that instance… But I, I don’t think we’ve ever sat down and discussed that, but I know that’s… we must have discussed it in bits over time, because I just know that’s, that’s the case.”

A better understanding of how couples communicate around sex and HIV is needed, in order to provide better HIV prevention interventions for young gay men in relationships, the researcher said. This could include interventions for couples, such as couple-based HIV testing, which facilitate disclosure of HIV status and negotiation of safer sex.

References

Boydell N et al. HIV risk management in the context of relationships: An exploratory qualitative study with young gay and bisexual men in Scotland. GAYCON 2014, 5th National Conference for Scotland on Gay and Bisexual Men’s Health and Wellbeing.