Casual sex, risk and context HIV risk-reduction strategies among men who have sex with men

The general aim of this thesis is to provide insights into the contextual and cognitive factors that affect sexual-risk behaviors and adopted HIV-prevention strategies among men who have sex with men (MSM) with casual partners using psychosocial and epidemiological data. In the general introduction, we provided a brief historical overview of the HIV epidemic among MSM. In chapter 2.1, we investigated the proportion of HIV-negative MSM who engage in ‘serosorting’, and whether this risk-reduction strategy offers sufficient protection against HIV infection. In chapter 2.2, we examined another prevention strategy, called ‘viral load sorting’ among HIV-positive MSM. Sexual behaviors with different types of casual partners were investigated in chapter 3.1. In chapter 3.2, we investigated the context of group sex, sexual behaviors and STIs. To further increase our understanding of men’s setting-specific sexual behaviors, in chapter 3.3 we examined sexual risk-related perceptions and behaviors in different physical and online settings across the Netherlands. Finally, in chapter 4, we were interested in core individual values that might play a role in shaping sexual risk choices. In the general discussion we concluded that MSM engage in a wide range of protective sexual behaviors according to different settings and types of sex partners and that different external factors and internal motives influence engagement in such behaviors. We call for this knowledge to be used by HIV-prevention professionals to support MSM in their decision to engage in protective behaviors that best suit their desires and needs and to address the consequences of the strategies chosen.