Negotiating HIV protection in the era of online dating and Pre-Exposure-Prophylaxis (PrEP). Insights into how men having sex with men (MSM) living in Switzerland negotiate their HIV protection with non-steady partners

Abstract

HIV protection depends on the consent and cooperation of sexual partners, which requires negotiation. Early HIV-related research identified condom negotiation strategies. However, strategies used specifically among men having sex with men (MSM) remained underexamined. This project explored how HIV-negative MSM negotiate their protection from HIV when having sex with non-steady partners, considering current risk reduction practices, the availability of several effective biomedical prevention options, the strong presence of STIs and prevailing online dating. We conducted in-person interviews with a maximum variation sample of 29 MSM, aged 21–80, combining narrative interviewing with a virtual-reality serious game and a series of standardized questions. We analyzed the interview data using content analysis, combining deductive and inductive approaches. We identified three categories of negotiation strategies used in chats, during in-person dates or when having sex: (i) subject-centered strategies anchored in the will and determination of MSM; (ii) strategies centered on sexual arousal, asserting MSM’s preferred protection strategy; (iii) strategies centered on risk communication. Further, we identified actions that interrupt negotiations and directly enforce protection or bypass negotiations. Participants combined several strategies during negotiations. The strategies also demonstrated versatility: most were used for various aims and were not systematically related to a specific personal protection strategy. This study posits an elaborate range of HIV-protection negotiation strategies used by MSM, including strategies not previously described. It contributes to a more nuanced understanding of negotiation strategies and encourages prevention professionals to reflect on the attention given to negotiation strategies in prevention offers.