HIV-negative gay men's accounts of using context-dependent sero-adaptive strategies

Abstract

We enrolled 166 gay and bisexual men who tested HIV-negative at a community sexual health clinic in Vancouver, British Columbia, into a year-long mixed-methods study. A subsample of participants who reported recent condomless anal sex (n = 33) were purposively recruited into an embedded qualitative study and completed two in-depth qualitative interviews. Analysis of baseline interviews elicited three narratives relevant to men's use of context- or relationally-dependent HIV-risk management strategies: (1) seroadaptive behaviours such as partner testing and negotiated safety agreements used with primary sexual partners, (2) serosorting and seroguessing when having sex with new partners and first-time hookups and (3) seroadaptive behaviours, including one or more of seropositioning/strategic positioning, condom serosorting and viral load sorting, used by participants who knowingly had sex with a serodiscordant partner. Within men's talk about sex, we found complex and frequently biomedically-informed rationale for seroadaptation in men's decisions to have what they understood to be various forms of safe or protected condomless anal sex. Our findings support the need for gay men's research and health promotion to meaningfully account for the multiple rationalities and seroadaptive strategies used for having condomless sex in order to be relevant to gay men's everyday sexual decision-making.

“ … it’s almost therapeutic, right? Because it’s almost like that session that I never had”: gay men’s accounts of being a participant in HIV research

“…Whether participation in national gay men's health surveys such as SexNow (CBRC, 2015) and GCPS (Holt, 2013) or involvement in smaller qualitative or mixed methods studies (Grace et al, 2014(Grace et al, , 2015, advancing research with and for communities of gay men is reliant on their interest in, and commitment to, participation. Through a novel analysis of participant narratives, we have used rich accounts of the self-described, interrelated impacts of study participation to reveal the ways in which the methods of quantitative and qualitative public health data collection may produce unintentional and unexpected effects for participants.…”

“…Participants had to report at least one incident of recent condomless anal sex to be eligible for qualitative interviews (Grace et al, 2014). Upon completion of the study, a final interview was conducted ∼360 days (T2) after enrolment; 29 participants (85%) completed this in-depth second interview.…”

“…Emergent themes were identified and memos were recorded in an iterative coding and analysis process (Creswell, 2003;Mason, 2005). This involved conducting regular analysis meetings in which passages of transcripts were read and interpretations of findings across interviews were discussed and compared (Grace et al, 2014). Participants are identified by pseudonyms and their age at the time of their baseline interview.…”

“…We conducted mixed methods research with a cohort of HIV-negative gay men (Grace et al, 2014) to build upon our research with gay men recently diagnosed with acute or recent HIV infection (Gilbert et al, 2013;Grace et al, 2015). In this paper, we draw upon the rich narrative data of our HIV-negative study participants to elucidate some of the complex emotional and behavioural impacts of mixed methods study participation.…”

“…Participation of this heterogeneous population in research is necessary to renew HIV prevention efforts. This requires a deeper appreciation of the social determinants of "HIV risk", cultural and biomedical shifts that shape sexual interactions and possibilities and a richer understanding of the lived experience of an evolving epidemic (Adam, Husbands, Murray, & Maxwell, 2005;BC Provincial Health Officer, 2014;Dowsett, 2009;Grace et al, 2014;Lewis, 2014).…”