Unprotected sex among men who have sex with men in Canada: exploring rationales and expanding HIV prevention

Abstract

In Canada, there have been recent increases in HIV infections among men who have sex with men (MSM), making HIV transmission among MSM a continuing public health concern. In this paper, we explore the rationales of MSM for the practice of unprotected sex in casual or anonymous encounters. We found that the men in our sample acknowledged their ‘transgressive’ behaviour, engaged in numerous harm-reduction strategies, and offered varied yet connected rationales for unprotected sex related to pleasure, knowledge, and social and physical locations. Based on these data, we offer a critical perspective on the traditional, psychological approaches to the design of HIV prevention, and contend that HIV prevention needs to become more inclusive and innovative by recognizing, addressing and engaging men's diverse rationales for unprotected sex.

Keywords:

• bareback sex
• harm reduction
• pleasure
• prevention
• public health

Acknowledgements

The authors would like to thank the Canadian Institutes of Health Research (CIHR), the Institute of Gender and Health, and the Institute of Infection and Immunity, for their support.