Gay men's estimates of the likelihood of HIV transmission in sexual behaviours

Abstract

In 3 studies we recorded gay men's estimates of the likelihood that HIV would be transmitted in various sexual behaviours. In Study 1 (data collected 1993, n=92), the men were found to believe that transmissibility is very much greater than it actually is; that insertive unprotected anal intercourse (UAI) by an HIV-infected partner is made safer by withdrawal before ejaculation, and very much safer by withdrawal before either ejaculation or pre-ejaculation; that UAI is very much safer when an infected partner is receptive rather than insertive; that insertive oral sex by an infected partner is much less risky than even the safest variant of UAI; that HIV is less transmissible very early after infection than later on; and that risk accumulates over repeated acts of UAI less than it actually does. In Study 2 (data collected 1997/8, n=200), it was found that younger and older uninfected men generally gave similar estimates of transmissibility, but that infected men gave somewhat lower estimates than uninfected men; and that estimates were unaffected by asking the men to imagine that they themselves, rather than a hypothetical other gay man, were engaging in the behaviours. Comparison of the 1993 and 1997/8 results suggested that there had been some effect of an educational campaign warning of the dangers of withdrawal; however, there had been no effect either of a campaign warning of the dangers of receptive UAI by an infected partner, or of publicity given to the greater transmissibility of HIV shortly after infection. In Study 3 (data collected 1999, n=59), men induced into a positive mood were found to give lower estimates of transmissibility than either men induced into a neutral mood or men induced into a negative mood. It is argued that the results reveal the important contribution made to gay men's transmissibility estimates by cognitive strategies (such as the 'availability heuristic' and 'anchoring and adjustment') known to be general characteristics of human information-processing. Implications of the findings for AIDS education are discussed.

Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation

“…positioning was less clear; although men reported more receptive anal and oral sex to ejaculation compared with insertive sex, there was no difference in general rates of anal and oral sex in terms of taking a receptive versus an insertive role with HIV-negative casual partners. The data from SUMIT corroborate work [21,32,37] show that HIV-positive men perceive a reduced risk from taking the receptive role during sexual risk behaviors. In both cities, there was no clear evidence of strategic positioning with HIV-positive casual partners, suggesting that men have fewer concerns about re-infection with a different strain of HIV than they do concerns about transmitting HIV to a casual partner.…”

“…For example, despite the significant controversy and debate regarding the level of risk associated with oral sex resulting from conflicting empirical reports [33,34], gay and bisexual men understand the elevated risk of anal sex relative to oral sex [22,30,35,36]. Furthermore, these men tend to have a conceptualization of the relative risks of unprotected insertive versus receptive anal sex, in that they understand that HIV transmission and infection is more likely to occur if an HIV-positive man is the insertive partner and an HIV-negative man is the receptive partner during anal intercourse [22,37]. Such notions of strategic positioning to reduce the risk of HIV infection are supported by some epidemiological evidence [20,21,33,34].…”

“…Withdrawal may serve as a compromise between using condoms or not having anal sex, and the practice is commonly cited as a justification for having engaged in unprotected anal sex [37]. Van de Ven et al [30] found that 46% of the HIV-positive gay men reporting unprotected anal sex in a serodiscordant relationship engaged in consistent withdrawal.…”

“…Although any unprotected anal sex, even that which includes withdrawal before ejaculation, represents a risk because of the presence of HIV in pre-ejaculatory fluid and the possibility that the insertive partner may not reliably withdraw [38,39], there is limited evidence from a study of heterosexual HIV transmission that such withdrawal does reduce the likelihood of HIV infection [40]. There is substantial evidence, however, that gay and bisexual men perceive withdrawal to be a safer option than ejaculation [37,41,42], and that such men are engaged in the use of withdrawal as a harm reduction strategy for HIV prevention [21,[42][43][44]. Some men, however, appear to use a resolve to withdraw as a justification for unprotected anal sex [45], and belief in the safety of withdrawal before ejaculation has been shown to predict HIV seroconversion [44].…”

Präventionsstrategien zur Eindämmung der HIV-Epidemie

“…die Einschätzung des Infektionsrisikos für einen Partner mit unbekanntem oder negativem HIV-Serostatus, der insertiven Analverkehr mit einem HIV-positiven rezeptiven Partner ausübt. Ergebnisse verschiedener Studien und Untersuchungen legen nahe, dass sowohl homosexuelle als auch heterosexuelle Männer das HIV-Infektionsrisiko bei insertivem Analverkehr als niedrig, jedenfalls niedriger als beim rezeptiven Analverkehr einschätzen [28][29][30].…”