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Among MSM, STI have increased over the past decade. Although fully effective protection is not available for sexually active people, MSM pay attention to STI risk reduction. In contrast to HIV protection behavior, measures taken by MSM to prevent other STI have attracted little scholarly attention. While concepts such as condom negotiation for HIV prevention have been investigated since the early days of the HIV pandemic, strategies MSM use to protect themselves from other STI have remained scarcely elaborated. Since risk assessment and the implementation of risk reducing measures such as condom use require the cooperation of the sexual partner, this project aimed to establish how MSM assess their STI risk and negotiate strategies for STI risk reduction when having sex with non-steady partners.
Methods
We conducted in-person interviews with 26 MSM, combining three interview approaches: a) narrative and episodic interviewing to explore participants experiences; b) a virtual-reality serious game (VR-SG) developed in this project to immerse participants in situations similar to those they might have encountered in real life in order to stimulate further narratives; c) another narrative sequence reflecting the VR-SG and a short, structured survey. We analyzed the interview data using open coding.
Findings
When using internet platforms for dating, the MSM in our sample started by evaluating of their STI risk while chatting with a potential sex partner. In certain settings, e.g., gay saunas, silence is the implicit norm and verbal strategies to assess risk and negotiate protection with a non-steady partner cannot be employed before becoming involved. MSM then weighed their risk and decided whether to engage in sexual intercourse or not. The latter could imply leaving the place.
We identified three main categories of strategies used to assess and negotiate STI risk reduction in chats, during in-person dates or when having sex: i) strategies centered on risk communication, such as information seeking (e.g. regarding the frequency and recency of tests), reminding the partner of STI risks or deception regarding their own protection (e.g. by not disclosing that they were taking PrEP); ii) subject centered strategies expressing MSM’s preferences and will, such as a direct request (for condom use), direct question (as to whether condoms were necessary) or autocratic statements (enforcing condom use); iii) strategies centered on sexual arousal supporting the enforcement of MSM’s will and preferences, such as requesting condom use and promising enhanced sexual pleasure in condomless sex at a future date, or threatening to withhold sex.
Conclusions
In the era of digital dating, the three categories of strategies to evaluate STI risk and negotiate risk reduction are starting to be employed in chats. MSM aim to obtain the information needed to decide whether to meet a potential partner for sex. In the case of sex on the premises, MSM take the fundamental decision to stay and run a risk or to leave. MSM who rely on condom use implement negotiation strategies similar to those identified to enforce condom use to prevent an infection with HIV.