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Gay men are at disproportionate risk for HIV, accounting for 63% of new infections in 2010. While prevention efforts emphasize 100% condom use, we’ve seen increased discourse around the concepts of serosorting and seropositioning (choosing sexual partners and acts based on partner HIV-status) as individuals seek alternative strategies. Therefore, it’s likely that the influence of partner HIV-status on sexual risk is growing and it’s critical that prevention specialists better understand the process by which individuals learn about their partners’ HIV-status and the ways in which this information influences sexual behavior.
Methods:
Qualitative analysis was undertaken with a sample of 193 HIV-negative and HIV-positive participants enrolled in a mixed-methods study of sexual behavior among gay men in San Francisco. Participants’ ages ranged between 19 and 72 years with a mean age of 44 years. 59.1% of the sample was White, 19.7% was African American, and 20.7% reported being Latino or Hispanic. Participants were asked to identify whether the HIV-status of their last sexual partner influenced the “type of sex” in which they engaged. They were then asked to qualitatively describe the nature of the influence (or lack thereof) and how typical this influence was across other sexual partners. A phenomenological framework was used to explore participants’ understanding of and relationship to the concept of influence. The data was first coded broadly to identify the range of influence. These codes were then condensed into discrete thematic content areas. Two independent coders were used during the analysis.
Results:
64.2% of the sample qualitatively reported that a partner’s HIV-status influenced their sexual decisions. The presence of influence was reinforced by the quantitative data, which showed that participants who were aware of their last sexual partners’ HIV status were more likely to be with someone of the same HIV-status. Many participants reported that they would not, or were reluctant to, engage in sexual activity with partners who were serodiscordant. Participants also described having different safer sex guidelines regarding condom use and/or engaging in anal sex for partners who were serodiscordant. Several participants also identified a psychological impact in knowing a partner’s HIV-status, describing increased anxiety and decreased sexual pleasure with serodiscordant partners. 43.5% of the participants who reported influence explicitly discussed what they knew about their last sexual partners’ HIV-status. More than half of these participants reported that they either did not know, were unsure about, or made assumptions about their partner’s HIV-status. Only a third of the participants reported that HIV-status information was verbally disclosed.
Implications:
These findings highlight the importance of HIV-status information in sexual decision making and identify ways that HIV-status information influences risk behavior for gay men. The challenges of relying on potentially inaccurate HIV-status information for making risk decisions are also documented. The findings support the need for social workers to carefully understand the risks and motivations associated with alternative prevention strategies and to develop interventions that provide gay men the information necessary to think critically about and effectively assess and use multiple protective strategies to decrease HIV transmission.