Accounting for unsafe sex: Interviews with men who have sex with men

Adam, Barry D.; Sears, Alan; Schellenberg, E. Glenn

doi:10.1080/00224490009552017

Cited by 63 publications

(38 citation statements)

References 52 publications

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“…The duration of a relationship does not have to be lengthy before condom use decreases, sometimes only a month or less (Fortenberry, Tu, Harezlak, Katz, & Orr, 2002). Attempting to protect oneself from HIV infection during sex between committed partners can be viewed as a sign of mistrust or an accusation of infidelity (Adam, Sears, & Schellenberg, 2000;Afifi, 1999;Buysse & Ickes, 1999;O'Leary, 2000). In general, women tend to perceive a greater sense of closeness within a sexual relationship than men (Carroll, Volk, & Hyde, 1985;Giami & Schiltz, 1996;Hill, 2002;Sprecher, 1989), suggesting potentially less willingness among females to engage in protection practices.…”

Section: Relationship Closenessmentioning

confidence: 95%

The HIV transmission gradient: relationship patterns of protection

et al. 2006

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We describe a gradient of potential HIV transmission from HIV-infected persons to their partners and thence to uninfected populations. The effect of this newly discovered transmission gradient is to limit the spread of HIV. We roughly estimate a 2% long-term transmission probability for sex and 14% for drug injection for two-step transmission. Then we test theories to account for this pattern on a network sample of 267 inner city drug users and nonusers. Although HIV positive persons engaged in a high level of risk with one another, they engaged in less risk with HIV negative partners, and these partners engaged in even lower levels of risk with other HIV negative persons. Analyses suggest that the primary motivation for sexual risk reduction is partner protection, while emotional closeness is the major barrier. Hypotheses accounting for risk in terms of self protection, social norms, gender power, and drug use were weakly supported or unsupported.

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Section: Relationship Closenessmentioning

confidence: 95%

The HIV transmission gradient: relationship patterns of protection

et al. 2006

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“…Others (e.g. Adam et al 2000, Crossley 2004, Kraft et al 2006) use the term when describing, if not defining, such sexual activities. A specific example can be found in Kippax et al (1993) who use the term when describing: Sexual practices, abstracted from the context of their enactment, which are deemed unsafe in terms of transmission of HIV.…”

Section: Introductionmentioning

confidence: 98%

Perceiving risk and (re)constructing safety: The lived experience of having ‘safe’ sex

Bourne

Robson

2009

Health, Risk & Society

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The many and varied sexual health promotion campaigns of recent years have sought to establish safe sex as the main protective mechanism for stemming the spread of sexually transmitted infections. However, the meaning of 'safe' sex remains unclear. Sexual health promotion literature almost entirely constructs safety through a biomedical lens: minimising the risk of bodily fluid exchange and establishing physical barriers between partners. However, this viewpoint may be insufficient when considering the emotionally charged arena of sexual behaviour which is, by its very nature, social. What meaning is ascribed to sexual safety and how is it made sense of or rationalised at the level of the individual? Twenty-two in-depth interviews were carried out with men who have sex with men, men who have sex with women, women who have sex with men, and women who have sex with women aged 18-30. These sought to gain an insight into their understanding of safe sex and their experiences of safe or unsafe sex. Interpretative Phenomenological Analysis was employed to help understand how these individuals made sense of safety. Analysis painted a picture of safe sex that is far more complex than the simple avoidance of infection. The typical biomedical safety rationale was frequently intertwined with lay rationales concerning 'emotional safety' or 'psychological safety'. When establishing a safe sexual relationship it was clearly evident that the risk of contracting a sexually transmitted infection was not always the primary concern and, for many individuals, feeling safe with their partner held far greater importance.

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“…Research with general population samples suggests that involvement in a steady, affectionate relationship is a strong predictor of HIV risk behavior among both MSM (Adams, Sears, & Schellenberg, 2000;Koblin, Chesney, Husnik, Bozeman, Celum, Buchbinder et al, 2003) and heterosexual men (Laumann, Gagnon, Michael, Michaels, 1994;Misovich, Fisher, & Fisher, 1997;Seal & Ehrhardt, 2004). The association between involvement in an affectionate relationship and increased sexual risk also has been documented among HIV-positive MSM (Semple, Patterson, & Grant, 2000;Wegner, Remien, & Carballo-Dieguez, 1998;Weinhardt, Kelly, Brondino, Rotheram-Borus, Kirshenbaum, Chesney et al, 2004).…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Sexual Behavior, Mental Health, Substance Use, and HIV Risk Among Agency-Based Male Escorts in a Small U.S. City

Smith

Seal

2008

International Journal of Sexual Health

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Relatively little research has examined the personal sex lives of indoor male sex workers (MSWs) or possible connections in this group between sexual behavior and factors related to HIV risk. As part of a larger project, this study collected data from 30 agency-based indoor MSWs (mean = 22.4 years) about their sexual behavior, mental health, and substance use. Few HIV risk behaviors with clients occurred. Drug use and mental health problems were relatively frequent, but not related to increased risk behavior. Instead, MSWs appeared to employ rational decision-making and harmreduction strategies. Conceptualization of MSW sexual behavior may be required where HIV risk is not attributed to sex work per se, but to other influences such as economic and relational factors. KeywordsSex work; prostitution; male sex worker; HIV risk behavior; HIV; mental health; substance use; sexual behavior During the past 20 years, much of the literature on the sexual behavior of male sex workers (MSWs) has focused on HIV risk behavior with clients. This line of study likely grew from concerns that MSWs may have been introducing HIV into the sexual networks of people who hired them (Bimbi, 2007). Thus, some researchers postulated that MSWs could be a transmission vector into less vulnerable populations (Morse, Simon, Osofsky, Balson, & Gaumer, 1991). Most of this initial research examined men working in a single type of venue, the street (Vanwesenbeeck, 2001). Street-based MSWs (i.e., hustlers) were found to exhibit relatively frequent sexual risk behaviors (Simon, Morse, Osofsky, & Balson, 1994), especially when they engaged in sex work to obtain basic needs or when they were using injection drugs (Estep, Waldorf, & Marotta, 1992). High rates of HIV risk also were found with non-clients due to unprotected sex and injection drugs (Rietmeijer, Wolitski, Fishbein, Corby, & Cohn, 1998). One study of street-based MSWs in Manhattan found that men reported the least sexual risk with paid clients, greater risk with male partners for pleasure, and the most risk with female partners for pleasure (Pleak & Meyer-Bahlburg, 1990). However, this study did not explore contextual factors accounting for the observed differences in sexual risk among these three types of partners.Address correspondence to: Michael Smith, PsyD, Psychology Department, Susquehanna University, Selinsgrove, PA 17870 (smithmichaeld@susqu.edu). NIH Public Access Author ManuscriptInt J Sex Health. Author manuscript; available in PMC 2009 September 23. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptSubsequent examination of MSWs who work in other settings has presented a more complex view. Independent and agency-based MSWs (i.e., escorts) exhibit fewer HIV risk behaviors with clients than men working on the street (Minichiello, Marino, Browne, Jamieson, Reuter, & Robinson, 2000;Simon, Morse, Osofsky, Balson, & Gaumer, 1992). Further, a growing body of research has suggested that indoor MSWs engage in less HIV risk behavior with clients than the...

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Accounting for unsafe sex: Interviews with men who have sex with men

Cited by 63 publications

References 52 publications

The HIV transmission gradient: relationship patterns of protection

The HIV transmission gradient: relationship patterns of protection

Perceiving risk and (re)constructing safety: The lived experience of having ‘safe’ sex

Sexual Behavior, Mental Health, Substance Use, and HIV Risk Among Agency-Based Male Escorts in a Small U.S. City

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