“Condoms are … like public transit. It’s something you want everyone else to take”: Perceptions and use of condoms among HIV negative gay men in Vancouver, Canada in the era of biomedical and seroadaptive prevention

Abstract

BackgroundThe emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men.MethodsWe undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies.ResultsContributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk.ConclusionsThese findings indicate that notions of “safety” and “risk” based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men’s current prevention needs. Interventions should advance gay men’s communication and self-advocacy skills in order to optimize these strategies.Electronic supplementary materialThe online version of this article (10.1186/s12889-019-6452-7) contains supplementary material, which is available to authorized users.

‘… if U equals U what does the second U mean?’: sexual minority men’s accounts of HIV undetectability and untransmittable scepticism

“…the view that younger guys were more accepting of biomedical advancements in HIV prevention) and geography (i.e. the experience that BC men were more knowledgeable or understanding) (Klassen et al 2019).…”

“…Knowledge that antiretroviral medications suppress HIV viral load to undetectable levels, thus preventing transmission of the virus-or treatment as prevention (TasP)-heralds a much-celebrated revolution in biomedical HIV prevention at a population-level. Across serostatus, the concept of HIV undetectability or being 'undetectable' appears to be increasingly used among many gay, bisexual, and other men who have sex with men (Grace et al 2015;Gaspar 2019;Klassen et al 2019). However, as research focused on the HIV treatment care cascade has illuminated, significant challenges remain in supporting all people living with HIV in reaching and maintaining an undetectable HIV status, thwarting both the individual and population-level benefits of this state of viral suppression (Gardner et al 2011).…”

Serodiscordance predictors among couples in the HIV context: implications for health care

“…The benefits of condom use to prevent HIV sexual transmission are well settled in literature [4,5,34]. However, its use is influenced by several factors, like gender relations and, maybe fundamentally, by relations of pleasure, affection, and desire [32,34,35].…”

“…The benefits of condom use to prevent HIV sexual transmission are well settled in literature [4,5,34]. However, its use is influenced by several factors, like gender relations and, maybe fundamentally, by relations of pleasure, affection, and desire [32,34,35]. In addition, the notions of risk and prevention to STI based on condoms are running out as new HIV prevention strategies emerge, being necessary to expand prevention awareness to a combined-strategy perspective beyond the prevalence of condoms [34,35].…”

Leisure Boredom, Timing of Sexual Debut, and Co-Occurring Behaviors among South African Adolescents

“…Framing safe sex as the absence of many risks rather than condom use only suggests that compared to boys, girls in this study have higher odds of having a safe sex profile, despite no gender differences in condom use alone. This framing of safe sex as more than condom use is reflected in other studies suggesting evolving definitions of safe sex to encompass many different behaviors that contribute to safe and healthy sexual experiences (Bourne & Robson, 2009;Harden, 2014;Klassen et al, 2019).…”