Assumptions about partner serostatus among HIV-positive methamphetamine-using men who have sex with men (MSM)

Background: The use of crystal methamphetamine has been found to be highly associated with sexual risk taking among MSM. Sexual behavior while under the influence may be more likely to take place in contexts that do not facilitate HIV serostatus disclosure, therefore, understanding the assumptions that men make about the serostatus of their partners and how these assumptions guide sexual decision making are critical to developing effective HIV prevention messages. Methods: This qualitative study used thematic analysis to examine the transcripts of 20 semi-structured interviews with HIV-positive methamphetamine-using MSM. Transcripts were coded and analyzed using QSR NUD*IST qualitative analysis software using the most recent sexual encounter under the influence of methamphetamine as a critical incident measure. Results: Of the 20 men included in this analysis, 9 reported making assumptions about the serostatus of their sexual partner(s). These assumptions can be grouped thematically into three categories: behavioral characteristics, such as willingness to engage in high risk behavior and substance use, location or contextual characteristics, and health characteristics. Conclusions: Most HIV-positive methamphetamine-using MSM who reported making assumptions based these assumptions on behavioral characteristics. However, assumptions about seropositivity do not necessarily lead to safer sex behaviors and frequently are the basis for discarding with condom use, which may leave men vulnerable to HIV transmission, STIs, and HIV re-infection. Knowledge of assumption making and its impact on sexual behavior is critical in order to design effective intervention programs that give MSM the skills to engage in sexual communication and safer sex negotiation.