Through the Rabbit Hole: Considering the Situational Experience of Risk among Men Who Have Sex with Men in the Context of HIV Prevention

Background: After 3 decades of research and programming for MSM, in 2014, HIV remains a major public health challenge in this population. Even in countries where MSM have access to HIV services, civil liberties and community structures, prevalence rates are consistently high. This warrants development and scale up of bespoke, innovative and meaningful HIV combination prevention programmes that better respond to the diverse social and health needs of MSM. A better insight into the experiences of risk and the impact on sexual practices among MSM is required to inform such approaches.

This paper provides a metasynthesis of the linkages between the situational experience of risk for MSM and unprotected sexual intercourse and explores the implications for HIV prevention.

Methods: A systematic search of nine electronic databases was conducted and complemented by a free text search on Google scholar on the name and publications of key authors and an inspection of the references of identified articles. Six qualitative studies that investigated the situational experience of risk among MSM were identified. A metaethnographic synthesis was undertaken to describe, analyse and interpret the studies.

Results: The synthesis resulted in the identification of 6 themes: losing control; relationship building; fatalism, homophobia and stigma of HIV; prevention literacy and confusion; risk management strategies and the biography of individuals.

Conclusions: MSM are well aware of the risks of contracting HIV through unprotected anal intercourse and deploy prevention strategies to stay safe and healthy, but what they conceive as safe and risk is different from that of medical professionals. Frequently MSM are ambiguous about risk and this is reflected in their sexual practices. Those working in HIV prevention must be aware of the lay risk management strategies deployed by MSM and engage with them.