Abstract #118  -  The safety of negotiated safety
Authors:   Presenting Author:   Dr. Iryna Zablotska - University of New South Wales
Additional Authors:
Aim: In the early years of the HIV epidemic, the strategy “condoms every time” resulted in increasing rates of consistent condom use among men who have sex with men (MSM). However, since the HIV testing became available, the HIV risk minimisation strategies (particularly serosorting) have been increasingly used by MSM in the context of unprotected anal intercourse (UAI).
Method / Issue: We reviewed one such serosorting strategy.
Results / Comments: “Negotiated safety” is used by sexual partners in an HIV-negative concordant regular relationship where men agree to have UAI, while negotiating an agreement about sex outside the regular relationship. This practice was first documented in New South Wales, Australia. The local AIDS Council campaign “TalkTestTestTrust” has been developed and running since 1998 to improve the safe application of this strategy. In the cohort of HIV-negative men in Sydney, the application of this strategy reduced the risk of HIV infection significantly (HR=2.16; 95% CI:1.08-4.34) compared to men who did not apply any risk reduction. There have been recent concerns that similar practice may be applied by some HIV-negative men in their casual sexual encounters. We argue that two necessary conditions for the effectiveness of this practice, namely (1) HIV-negative seroconcordance within a relationship and (2) no HIV transmission from the outside, cannot be sustained in the context of casual sex. There is general lack of confidence in the perceived HIV-negative seroconcordance of casual partners and in feasibility of eliminating HIV infection in the context of UAI with multiple casual partners.
Discussion: In conclusion, HIV-negative serosorting is not a reliable strategy of risk minimisation in the context of casual sexual encounters. Evidence-based health-promotion can enhance the safety of negotiated safety by educating men in regular relationships to adhere to this strategy if they use it. Men who engage in casual sex should be encouraged to use condoms in all encounters.
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