Sexual safety motivation and HIV risk among substance-using men who have sex with men (MSM)

BACKGROUND: To examine in detail the role of substance use and high risk sexual behavior among men who have sex with men (MSM), we used qualitative methodology to describe how ethnically diverse substance-using MSM conceptualize their own HIV-related sexual risk.

METHODS: We examined in vivo transcripts from group-based, behavioral intervention sessions of a randomized clinical trial aimed at reducing sexual risk among both HIV-infected and non-infected substance-using MSM (N=26). Themes were identified by applying inductive, iterative coding techniques.

RESULTS: Descriptions of sexual risk split into three thematic categories. “Non-Negotiators” described unmovable boundaries around “safe” versus “unsafe” sexual activities. For “Risk-Negotiators,” sexual acts oscillated between “acceptable” or “unacceptable” risks based on situation-specific needs. “Active Risk-Seekers” actively sought both sex and drugs/alcohol use despite risk. Both Non-negotiators and Risk-Negotiators discussed unsafe sex as a byproduct of excessive substance use, while Active Risk-Seekers strategically used substances to facilitate risky sex. Additionally, Non-negotiators and Risk-Negotiators frequently reported instances when their global approaches to sexual safety were undermined by negative affect and consequent substance use for immediate pleasure.

CONCLUSIONS: Substance-using MSM describe different motivations for sexual risk and safety, which themselves underlie varying patterns of sexual risk and substance use. These findings indicate the need to broaden approaches to HIV-prevention given potentially divergent approaches to sexual safety. More research is needed to determine if these resulting themes can be replicated, and if so, their predictive implications on sexual health outcomes.