Relative safety: risk and unprotected anal intercourse among gay men diagnosed with HIV

Duration: January 1998 - January 1999

This study investigated the experiences of gay men with diagnosed HIV in order to better understand the range of social, psychological and cultural meanings attached to HIV risk. We examined how men engaged in unprotected anal intercourse (UAI) and how they felt about it. We looked at the meanings they attached to UAI, the risks (if any) they perceived, and how engaging in UAI affected their lives.

The study generated data from two sources. First, information on sexual risk behaviour was provided by the second annual Gay Men's Sex Survey in 1998. We compared the demographics and sexual behaviour of men diagnosed with HIV, those who had never tested and those who had tested negative in order to gain a comparative picture of sexual risk behaviour. This data demonstrated that, on a population level, substantial differences in sexual behaviour occurred between men who had never tested for HIV and those that had. Men who had never tested were substantially less likely to engage in sexual activities implicated in HIV exposure (UAI and sero-discordant UAI) compared to those who had tested. Among those who had tested, men with diagnosed HIV were no more likely to engage in UAI than those tested negative. However, among men that engaged in UAI, men who had tested positive did so substantially more often.

The study also included 64 in-depth, semi-structured interviews with gay men who had diagnosed HIV. All had engaged in UAI in the previous year: some with partners who they knew were also HIV infected; others with partners whom they knew to be uninfected; and some with partners whose HIV status they did not know. Most interviewees had done UAI with a range of partners from all three categories.

We found that UAI was an act that resists easy classification, imbued with multiple meanings, it's perceived safety and desirability dependent upon the circumstances in which it occurs and the partners involved. Moreover, the concepts of safety and risk that health promoters employ in relation to UAI were not necessarily shared by the positive men we interviewed. Important for our purposes was that gay men with diagnosed HIV engaging in UAI, felt they were risking something entirely different to their uninfected partners. For them, risk was experienced in a mediated and diffuse manner on three levels: risks to personal health, risks to psychological well-being and risks to social standing.

The final report was called Relative safety: risk and unprotected anal intercourse among gay men diagnosed with HIV.