Gay and Bisexual Men’s Perceptions of HIV Risk in Various Relationships

Abstract

Men who have sex with men (MSM) bear a disproportionate burden of HIV incidence in the United States. Previous study of sexual decision-making and HIV risk among MSM has not accounted for relationship dynamics. Further research must examine this connection between relationship dynamics and sexual decision-making, especially regarding condomless anal intercourse. This study analyzes data gathered from gay and bisexual men regarding their sexual partners and sexual decision-making over a 10-week period through personal relationship diaries (PRDs) and a follow-up in-depth interview (IDI). Through coding and extraction of relationship dynamics, key patterns of participants’ sexual decision-making processes were examined based on relationship type, which was categorized by commitment, formality, and sexual agreement. Participants’ sexual relationships can be divided into five categories: (a) Uncommitted, one time, (b) Uncommitted, ongoing, (c) Transitioning or unknown commitment, (d) Committed, nonmonogamous, and (e) Committed, monogamous. These five categories correspond to patterns in sexual decision making and consequent sexual risk-taking behaviors. Each of these influence HIV risk within male–male sexual encounters in a particular manner, and understanding these is important for appropriately tailored HIV prevention interventions for MSM. Recommendations are included for interventions seeking to address HIV risk across a wide variety of MSM sexual relationships.

Protective Factors That Foster Resilience to HIV/AIDS: Insights and Lived Experiences of Older Gay, Bisexual, and Other Men Who Have Sex with Men

“…In their own unique ways, the remaining four factors that we identified from the analysis of our interview data (i.e., abstinence, trauma from the loss of many lives to HIV/AIDS at the start of the epidemic, "managed" substance use, and meaningful sexual relationships) sparked controversy in the academic literature on HIV/AIDS. In fact, because of their seemingly controversial nature, these factors were discussed extensively in empirical research articles [52][53][54][55][56][57][58][59][60], which could potentially be used as starting points when considering these factors in the development of interventions for addressing HIV/AIDS health disparities that affect older gbMSM. We contend that these factors, despite the controversies they may have inspired in prior scholarly contributions, should be seriously considered, and even valued, in the development of interventions for fostering resilience to HIV/AIDS and addressing health disparities, principally because they were purposefully harnessed from the insights and personal experiences of racially and ethnically diverse, older gbMSM living with HIV/AIDS who have exhibited resilience since their HIV diagnosis.…”

“…Participants revealed that these meaningful relationships have provided them protective effects against the clinical and social impacts of HIV/AIDS, and have been essential to fostering their HIV resilience as they age. Abundant recent research was conducted on the social and intimate contexts of these diverse types of gbMSM sexual relationships, the relationship dynamics immersed in them, and the value of possessing the necessary behavioral and communication skills to negotiate sexual agreements in such sexual relationships [55,57,[77][78][79][80][81]. This recent body of research is of critical importance to informing, influencing, and impacting the HIV care and prevention interventions that ASOs and other community-based agencies are intending to develop to address health disparities that affect gbMSM, particularly those with intersecting, marginalized identities.…”

Awareness, Utilization, and Preferences for Traditional and Contemporary HIV Prevention Strategies Among Facebook and Instagram-Using MSM in the United States

“…These results might reflect varying HIV risk perceptions across different types of relationships. Prior research has found that partnered men in “closed” relationships believe they are at low risk for acquiring HIV through CAS because they trust their partners do not engage in outside sexual activities, 24 and consequently do not get tested annually as recommended by the CDC. 81 In contrast, partnered men in “open” relationships have been shown to lack confidence in their ability to remain HIV-negative, 82 and believe that taking PrEP helps reduce their sexual anxiety.…”

“…Non-responders were more likely to be partnered men in a “closed” relationship, which might reflect their lack of interest in HIV-related issues compared to men who are single or in an “open” relationship. 24 …”

“…For instance, partnered MSM have been documented to test less frequently for HIV and other STIs compared to those who are single, 23 as they tend to believe they are at lower risk. 24 A recent systematic review on relationship-based predictors of sexual risk for HIV among male couples has also reported that positive relationship dynamics such as greater levels of commitment, attachment, emotional intimacy, satisfaction, social support, equality, constructive communication and trust promote condomless anal sex (CAS) with primary partners, but protect against CAS with outside partners. 25 Data from the CDC’s 2017 National HIV Behavioral Surveillance (NHBS) show that Non-Hispanic black and Hispanic MSM are less likely to discuss PrEP with a healthcare provider or to use PrEP compared to non-Hispanic white MSM.…”