213P
Protective Factors Facilitating Consistent “Safer Sex” Practice over Decades in Men Having Sex with Men in Switzerland Confirm the Importance of Structural Prevention Approaches
In Switzerland, studies suggest that some 20% of MSM do not use condoms consistently when having sex with casual partners. In prevention discourses, these MSM receive most attention: studies concentrate on the identification of factors hindering condom use and interventions subsequently address the identified barriers.
However, the same studies evidence that a vast majority of MSM use condoms consistently. So in order to develop affirmative prevention interventions supporting and stabilizing the adherence to “safer sex,” it would be productive to learn more about protective factors enabling and facilitating MSM to maintain condom use practice over long periods. A qualitative study provided first insights into protective factors.
The study aimed
a) to determine the personal HIV protection strategies adopted by MSM aged 30-44, and
b) to identify rationalities and meanings behind the corresponding strategies and behaviors.
Methods
We conducted semi-structured, qualitative interviews with MSM aged 31 to 45 living in Switzerland. We chose the 26 participants iteratively by theoretical sampling and analysed the interview data along the principles of theoretical coding.
Results
HIV-negative participants reported a broad array of protective and risky behaviors, ranging from complying with safer sex guidelines to dispensing with protection altogether.
Some participants have been adhering to safer sex guidelines during their entire sexual biography.
Analysis suggests the existence of protective factors supporting MSM in the long-term maintenance of safer sex. They
- could come out in a gay-affirmative social environment (family, school, peers) and experience neutral or positive responses,
- perceived HIV infection as severe and burdensome, despite the achievement of antiretroviral treatment, and
- had their first sexual intercourse with another man not before adolescence.
Conclusion and Implications
Analysis showed the existence of protective factors. Future prevention interventions could aim to strengthen these factors in order to support MSM in maintaining safer sex practice: it is important—on a structural level—to support the development of a gay-affirmative social environment. Prevention should provide MSM with balanced and adequate information about the consequences of HIV infection and broach the issue of sexuality (including same-sex sexuality) at a young age.