In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex

Abstract

The aim of this analysis was to examine gay men's sexual risk practice to determine patterns of risk management. Ten cross-sectional surveys of gay men were conducted six-monthly from February 1996 to August 2000 at Sydney gay community social, sex-on-premises and sexual health sites (average n = 827). Every February during this period, five identical surveys were conducted at the annual Gay and Lesbian Mardi Gras Fair Day (average n = 1178). Among the minority of men who had unprotected anal intercourse which involved ejaculation inside with a serodiscordant regular partner, there was a clear pattern of sexual positioning. Few regular couples were both receptive and insertive. Most HIV-positive men were receptive and most HIV-negative men were insertive. Among the minority of men who had unprotected anal intercourse which involved ejaculation inside with casual partners, there was also a pattern of sexual positioning. Whereas many casual couples were both receptive and insertive (especially those involving HIV-positive respondents), among the remainder HIV-positive men tended to be receptive and HIV-negative men tended to be insertive. These patterns of HIV-positive/receptive and HIV-negative/insertive suggest strategic risk reduction positionings rather than mere sexual preferences among a minority of gay men. If so, they point not to complacency but to an ever more complex domain of HIV prevention.

Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men

“…[3][4][5][6] Some researchers point to these findings as evidence of complex, harm-reduction decision-making informed by scientific evidence about the dynamics of HIV transmission and sexual risk among MSM. [9][10][11] However, focusing on barebacking behavior does not necessarily provide insight into barebacking as an identity. Importantly, from a public health perspective, men who identify as barebackers may represent a different and unique subset of MSM who engage in bareback sex with distinct HIV prevention needs.…”

Non-condom related strategies to reduce the risk of HIV transmission: Perspectives and experiences of gay men with diagnosed HIV

“…'Serosorting' (Suarez et al, 2001) refers to a practice of MSM with diagnosed HIV seeking to have condomless anal intercourse only with men who also have diagnosed HIV. 'Strategic positioning' (Van de Ven et al, 2002) is a term often used by researchers to describe how some men attend to the modality of anal intercourse based on the HIV status of each partner, where the infected partner might assume the receptive role in to reduce the risk of transmission (Attia, Egger, Muller, Zwahlen, & Low, 2009). Finally, a study of factors associated with HIV seroconversion among gay men in England (Macdonald et al, 2008) found that men who engaged in receptive condomless anal intercourse to ejaculation were 2.5 times more likely to acquire HIV than men who did this but not to ejaculation.…”

Serosorting Sexual Partners and Risk for HIV Among Men Who Have Sex with Men

“…Strategic positioning is defined as an individual taking on the role of the insertive partner in an effort to reduce his risk of being infected with HIV. 29,30 For example, in HIV serodiscordant couples the HIV positive partner would be the receptive partner, while the HIV negative partner would be the insertive partner. Our findings suggest there is a relationship between engaging in serosorting, engaging in strategic positioning, and increased number of unprotected sexual partners.…”