Relationship Dynamics and HIV Risk Misperceptions Among MSM
Relationship Dynamics and HIV Risk Misperceptions Among MSM
Our findings indicated that six dynamic components of sexual relationships appear to associate with knowledge of HIV status among male sex workers: intimacy, commitment, socialising, financial, trust and honesty. Among these, greater trust was associated with higher odds of misperceiving a sex partner's HIV status. This result is consistent with previous studies that have found that greater trust in a sexual relationship is related to engaging in risky sexual behaviours. Studies have shown that homeless men have greater feelings of trust in sex partners of short duration than do non-homeless men. More than half the sample in this study were homeless at the time that they were interviewed. This may account for the strong association between greater trust and misperception of a partner's HIV status.
Conversely, the findings showed that stronger feelings of commitment to a sex partner (i.e., respecting what a partner thinks, caring about a partner and willingness to live with a partner) were associated with correctly perceiving a partner's HIV status. This result is consistent with other studies that report that individuals in committed partnerships are more likely to accurately perceive their sex partner's infection status. These findings suggest that stronger relationships are an important component in communications about HIV status in sexual encounters, which can be distinguished from intimacy and honesty. We found that financial and socialising relationships (frequency of contact, hanging out and seeing) were not associated with misperceiving the partner's HIV status. Given that these men also used drugs extensively, it is interesting that drug use was not associated with misperception of HIV status.
Interestingly, male sex workers' perceptions of their sex partners' HIV status were likely to be more accurate than were others in the study. This finding may be because sex workers tend to assume that all sex partners are positive, given the risk environment in which they work. Assuming that all partners are HIV positive may decrease the likelihood of an incorrect assumption about a partners' status. The study also found that HIV-negative individuals and couples in which both partners were gay were more likely to misperceive their partners' status. HIV-negative MSM who engaged in unprotected anal sex with their primary partners tend to assume that the partner was negative. This may be strongly related to feelings of trust in the partner. Conversely, dyads in which both partners were Caucasian or in which one's partner was older, were more likely to have correct knowledge of their partner's status.
Our study has certain limitations. First, the study defined sex partners as 'ever having had sex'. Some forms of sex carry a lesser risk of HIV transmission. Second, the majority of the sample was MSM who had exchanged sex for money, which represents only a part of the risk-potential partnerships of HIV transmission. Therefore, our results are not generalisable to other MSM populations. Future research should test the conclusions against a different dataset to claim any generality for our findings.
Despite these limitations, our study provides a more comprehensive understanding of the relational dynamics that may enhance or curtail HIV risk in sexual relationships. Social networks have substantial effects of HIV risk perceptions among MSM, and the process through which they are formed has been underscored. The study addressed this issue in the context of sexual encounters that involve a sample of most at-risk MSM, i.e., men who use drugs and exchange sex for money. HIV prevention efforts that focus on sexual partnerships, such as couple-based voluntary HIV counselling and testing, could be more effectively delivered with a nuanced consideration of their relational constituents.
Discussion
Our findings indicated that six dynamic components of sexual relationships appear to associate with knowledge of HIV status among male sex workers: intimacy, commitment, socialising, financial, trust and honesty. Among these, greater trust was associated with higher odds of misperceiving a sex partner's HIV status. This result is consistent with previous studies that have found that greater trust in a sexual relationship is related to engaging in risky sexual behaviours. Studies have shown that homeless men have greater feelings of trust in sex partners of short duration than do non-homeless men. More than half the sample in this study were homeless at the time that they were interviewed. This may account for the strong association between greater trust and misperception of a partner's HIV status.
Conversely, the findings showed that stronger feelings of commitment to a sex partner (i.e., respecting what a partner thinks, caring about a partner and willingness to live with a partner) were associated with correctly perceiving a partner's HIV status. This result is consistent with other studies that report that individuals in committed partnerships are more likely to accurately perceive their sex partner's infection status. These findings suggest that stronger relationships are an important component in communications about HIV status in sexual encounters, which can be distinguished from intimacy and honesty. We found that financial and socialising relationships (frequency of contact, hanging out and seeing) were not associated with misperceiving the partner's HIV status. Given that these men also used drugs extensively, it is interesting that drug use was not associated with misperception of HIV status.
Interestingly, male sex workers' perceptions of their sex partners' HIV status were likely to be more accurate than were others in the study. This finding may be because sex workers tend to assume that all sex partners are positive, given the risk environment in which they work. Assuming that all partners are HIV positive may decrease the likelihood of an incorrect assumption about a partners' status. The study also found that HIV-negative individuals and couples in which both partners were gay were more likely to misperceive their partners' status. HIV-negative MSM who engaged in unprotected anal sex with their primary partners tend to assume that the partner was negative. This may be strongly related to feelings of trust in the partner. Conversely, dyads in which both partners were Caucasian or in which one's partner was older, were more likely to have correct knowledge of their partner's status.
Our study has certain limitations. First, the study defined sex partners as 'ever having had sex'. Some forms of sex carry a lesser risk of HIV transmission. Second, the majority of the sample was MSM who had exchanged sex for money, which represents only a part of the risk-potential partnerships of HIV transmission. Therefore, our results are not generalisable to other MSM populations. Future research should test the conclusions against a different dataset to claim any generality for our findings.
Despite these limitations, our study provides a more comprehensive understanding of the relational dynamics that may enhance or curtail HIV risk in sexual relationships. Social networks have substantial effects of HIV risk perceptions among MSM, and the process through which they are formed has been underscored. The study addressed this issue in the context of sexual encounters that involve a sample of most at-risk MSM, i.e., men who use drugs and exchange sex for money. HIV prevention efforts that focus on sexual partnerships, such as couple-based voluntary HIV counselling and testing, could be more effectively delivered with a nuanced consideration of their relational constituents.
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