Negotiated Safety Relationships and Sexual Behavior Among a Diverse Sample of HIV-Negative Men Who Have Sex With Men
February 14, 2005
Some HIV-negative men who have sex with men (MSM) use "negotiated safety" (NS) as an alternative HIV risk-reduction strategy, choosing not to use condoms with their primary sero-concordant partner. Major NS tenets are mutual HIV testing confirmation of a primary partner's negative serostatus and establishment of specific rules or agreements prohibiting unprotected anal (UA) sex outside their relationship. In the current study, researchers examined NS prevalence in a diverse MSM sample -- recruited from San Francisco Bay Area street locations, venues and by referrals -- characteristics of MSM practicing NS, and adherence to NS.Adapted from:
Among 340 HIV-negative men, 265 (78 percent) reported anal intercourse with a male partner in the previous three months, and 143 (42 percent) reported UA. Of the men, 203 (60 percent) were in no primary relationship (NP), 34 (10 percent) were in a relationship with a man of HIV-positive or unknown serostatus, and 103 (30 percent) were in a seroconcordant relationship. Of the 103 men, 76 (22 percent of all seronegative MSM) were in the relationship, exclusively, for at least six months.
Of the 76 men, NS was a more common risk strategy than having no unprotected anal sex with primary partners (NUAP)(38 [50 percent] vs. 30 [39 percent]). Eight men (11 percent) practicing UA with their partner had no rule prohibiting UA sex outside their relationship. Within the NUAP group, 17 (57 percent) practiced 100 percent condom use and 13 (43 percent) reported no recent anal sex. Participants who were younger and had higher incomes were more likely to practice NS than NUAP in multivariate analysis. Choice of NS or NUAP was not associated with race/ethnicity, income, or education. In multivariate analysis, there were no significant sociodemographic differences between NS men and NP men. However, Latino and older men were more likely to report NUAP than whites.
A similar proportion of men practicing NS and NUAP allowed sex with persons outside the relationship (58 percent for NS vs. 57 percent for NUAP). NS men were likelier to have had anal sex with outside partners (47 percent vs. 20 percent). Anal sex with nonprimary partners was highest (70 percent) among NP men. Sample size limited the power to determine differences regarding specific risk behaviors. However, NS men reported higher-risk activities outside their relationship. Of the NS group, 18 percent had one of four STDs (gonorrhea, chlamydia, syphilis or nonspecific urethritis) in the prior year compared to 3 percent of NUAP men and 7 percent of NP men. Of NS men, 18 percent reported UA with casual partners, a rate not significantly different from that for NUAP men (7 percent) and NP men (31 percent).
Of 38 NS men, 19 (50 percent) stated their NS rule was no sex with outside partners, five (26 percent) of whom reported sexual behavior within the previous three months that broke the rule. Sixteen NS men (42 percent) had a rule specifically prohibiting UA with outside partners; five (31 percent) had broken it within the past three months. Of three (8 percent) NS men agreeing to specifically no anal sex outside the relationship, one had broken the rule. Altogether, 29 percent of those in NS relationships reported breaking the NS-specific rules of their partnership, "including 7 who reported UA, which carries the highest risk."
"Although NS was commonly practiced among HIV-negative men in seroconcordant relationships, some men violated NS-defining rules, placing themselves and potentially their primary partners at risk for HIV infection," concluded study authors. "Prevention efforts regarding NS should emphasize the importance of agreement adherence, disclosure of rule breaking, and routine STI testing."
Journal of Acquired Immune Deficiency Syndromes
01.01.05; Robert Guzman, M.P.H.; Grant N. Colfax, M.D.; Sarah Wheeler, M.P.H.; Gordon Mansergh, Ph.D.; Gary Marks, Ph.D.; Melissa Rader, M.P.H.; Susan Buchbinder, M.D.
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.