Abstract: HIV Protection Behavior in the 2020s: How Men Who Have Sex with Men Negotiate Their Protection from HIV (Society for Social Work and Research 28th Annual Conference - Recentering & Democratizing Knowledge: The Next 30 Years of Social Work Science)

Schedule:

Thursday, January 11, 2024

Monument, ML 4 (Marriott Marquis Washington DC)

* noted as presenting author

Daniel Gredig, PhD, Professor, Head of study programs, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland

Patrick Weber, PhD, Research Associate, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland

Jasmina Bogdanovic, MA, Research fellow, University of Applied Sciences and Arts Northwestern Switzerland, 4600 Olten, Switzerland

Daniele Bigoni, MA, Research fellow and doctoral student, University of Applied Sciences and Arts Northwestern Switzerland, 4600 Olten, Switzerland

Background and objective

HIV protection depends on the consent and cooperation of sexual partners and must be negotiated. Acknowledging this, early HIV-related research has identified negotiation strategies for HIV protection, such as condom negotiation strategies. However, negotiation strategies used specifically among men who have sex with men (MSM) remained underexamined. Moreover, potential changes in negotiation strategies in the context of Pre-Exposure Prophylaxis (PrEP) and online dating are still unknown. Given this research gap, this project aimed to establish negotiation strategies for HIV protection among MSM before and during sex with non-steady partners.

Methods

We conducted in-person interviews with 29 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

In our sample, MSM who used dating applications initiated negotiation about HIV protection in their chats. They tried to agree to HIV protection before arranging a date. For some, explicit agreement on HIV protection was a condition for a date. In gay saunas where silence is the implicit norm and negotiation cannot take place beforehand, e.g., with a non-steady partner, negotiation occurred on site, shortly before or during sex.

We identified seventeen negotiation strategies used by MSM in chats, during in-person dates or when having sex to motivate their non-steady partners to pursue their HIV protection strategy. These strategies can be grouped into three categories: subject-centered strategies (such as asking explicit questions, being authoritative, using visual cues to demonstrate their intention, presenting arguments, tacit agreement with their partner’s action); strategies leveraging sexual arousal (such as seduction); and strategies centered on risk communication (such as providing risk information, information seeking, calming the partner, dramatizing life-threatening consequences of a HIV infection). Further, we identified actions taken by MSM to end negotiations which did not align with their aims and to break off interactions (such as pushing the partner away, changing over to practices perceived as lower risk, breaking off sex).

Conclusions

HIV protection negotiation strategies take different forms and – given the option of PrEP – go beyond those identified regarding condom use early in the HIV pandemic. They may be directed to condom use or condomless sex, depending on the individual protection strategy adopted by MSM. They span from explicit autocratic enforcement of their own preferred strategy to silent agreement with an action taken by the partner during sex or the defensive rejection of it. In contrast to previous findings, in the era of digital dating, condom negotiations do not only take place before or during having sex. Rather, they should be considered as a potentially multi-tiered process, starting on the dating platform and, in some constellations, continuing or re-opening during the in-person date or sexual intercourse.