Personal and partner responsibility for HIV prevention: Locus of control for HIV-positive men who have sex with men (MSM) with HIV-negative partners who use the Internet to find partners for unprotected sex

BACKGROUND: HIV-positive MSM who bareback are at high risk for transmitting HIV to HIV-negative men. This study examines how HIV-positive MSM using the Internet to find partners for unsafe sex view responsibility for safer sex negotiation with HIV-negative men. METHODS: In 2008 and 2009, 332 American MSM were sampled randomly from 16 websites. All used the Internet to search for unprotected sex partners. Interviews were conducted by telephone and lasted 1-2 hours. RESULTS: The older a man was, the more likely he agreed with the following two statements: 1) "HIV-positive men have a special obligation to have safe sex with men who are negative or do not know their HIV status" (Statement 1), and 2) "It should be the responsibility of someone who is HIV negative to make sure their sex is safe" (Statement 2). HIV-positive MSM who agreed with Statement 1 placed more importance on not infecting their partners, and would disclose their serostatus and use a condom when receiving anal sex from an HIV-negative man. If a man did not agree with Statement 1, he was less likely to use a condom during insertive anal sex with an HIV-negative man and would be more likely to ejaculate into his HIV-negative partner's anus. Additionally, if an HIV-positive man agreed with Statement 2, he was more likely to say he would only disclose his HIV status if asked when either having insertive anal sex with or receiving anal sex from an HIV-negative man. Finally, HIV-positive MSM who did not disagree with Statement 2 were less likely to use a condom for insertive anal sex with an HIV-negative man. CONCLUSIONS: Interventions focused on HIV-positive MSM should focus on raising their belief that they have a special obligation to have safer sex with HIV-negative partners.