The willingness of PHAs living in high-income settings to negotiate condom use and use condoms during sex

Key take-home messages

• There is a controversial belief held by PHAs about the efficacy of HAART to reduce or prevent HIV transmission and/or an understanding of having an undetectable viral load. These beliefs have been found to be associated with condom use (i.e. believing an undetectable viral load means HIV transmission is not possible, which translates into believing that condoms are not required).
• Lack of adherence to HAART was found to be associated with increased instances of unprotected anal intercourse as well as more sexual partners as compared PHAs who adhered to their HAART regime.
• Social and mental health factors such as HIV-related stigma, depression, negative beliefs about one’s self and low social support have been found to reduce a PHA’s ability or willingness to use condoms.
• Some MSM-PHAs engage in intentional unprotected anal intercourse (i.e. ‘barebacking’) as a response to social stressors such as low social support and also face discrimination from both the mainstream and LGBT communities, which may make it harder for them to discuss risk reduction strategies.
• Drug and alcohol has been found to be associated with lower motivation to use condoms and, as a result, increased incidence of unprotected sexual intercourse amongst PHAs with both sero-concordant and discordant sexual partners.
• Condom and HIV ‘fatigue’ is a challenge for long-term PHAs regarding consistent condom use (i.e. tired of being responsible for having to monitor sexual behavior).
• Condom use amongst HIV-positive MSM is related to regular condom use being a subjective norm for themselves and their peers.

• Determinants of Health
  • Social support
  • Stigma/discrimination
• Population(s)
  • Men who have sex with men
  • General HIV+ population
• Engagement and Care Cascade
  • Treatment
• Prevention
  • Sexual risk behaviour
• Substance Use
  • Alcohol
  • Nonmedicinal drugs
• Mental Health
  • Depression