HIV Risk Management in the Context of Relationships: An Exploratory Qualitative Study With Young Gay and Bisexual Men in Scotland

Background: Recent US research has highlighted the role of primary sexual partners in the transmission of HIV among young men who have sex with men (MSM), estimating that up to 84% of new transmissions were from men’s main partner. This suggests that work with couples could contribute to prevention efforts. Methods: We conducted qualitative interviews with 30 MSM (aged 18-29) in Scotland. Thematic data analysis focused on identifying how men understand ‘safer sex’ and HIV risk management in the context of relationships. Findings: Men discussed their aspirations for sex in relationships, and although all discussed the use of condoms as part of ‘safer sex’, a recurring theme was the desire to discontinue condom use in the context of a ‘committed’ relationship. Of the nine participants in relationships at the time of interview, six had stopped using condoms, but not all tested for HIV prior to discontinuing, nor discussed expectations for monogamy/sexual exclusivity with their partners. Communication around testing and condom use was complicated by issues of trust and intimacy. Conclusions: How young MSM understand and manage HIV risk in the context of relationships has implications for HIV prevention. Knowledge of their own (and partner’s) HIV status - particularly where serodiscordant relationships are identified - could enable men’s decision-making around prevention. Our research suggests young MSM continue to base safer sex decisions on perceptions of trust and fidelity in their partners. We explore potential for interventions targeting young MSM accessing testing in different settings, to encourage HIV status disclosure and informed safer sex negotiation