Using a "Positive Deviance" Framework to Discover Adaptive Risk Reduction Behaviors Among High-Risk HIV Negative Black Men Who Have Sex with Men

Published in: AIDS and Behavior, [Epub May 2017]. doi: 10.1007/s10461-017-1790-x

Posted on RAND.org on June 06, 2017

by Allison J. Ober, Derek Dangerfield, Steven Shoptaw, Gery W. Ryan, Brian D. Stucky

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Research Question

  1. Do black men who have sex with men (MSM) who stay HIV-negative despite high-risk substance use engage in intentional or unintentional HIV risk reduction behaviors?

Despite the high incidence of HIV among young Black MSM in the United States and engagement in high risk behaviors, many men in this group avoid infection. This suggests that some men may engage in systematic risk reduction behaviors when not always using condoms or abstaining from substances. Using a "positive deviance" framework, we conducted qualitative interviews with HIV-negative, Black MSM between 25 and 35 who reported unprotected anal sex and drug use in the past six months or current heavy drinking (N = 29) to discover behaviors that could facilitate remaining HIV-uninfected. Findings showed that MSM who remain HIV negative despite continuing to engage in high-risk behaviors may be engaging in adaptive risk reduction behaviors that, through successive decisions and advance planning along the timeline to a sexual event, could lead to increased condom use, avoidance or delay of a risky sexual event, or reduction of HIV positive partners.

Key Findings

  • Interviews with black MSM between 25 and 35 yielded a continuum of deliberate and unintentional behaviors that could lower risk for HIV, including behaviors while looking for a sexual partner, selecting a partner, preparing for a sexual encounter, and immediately before and after a sexual encounter.
  • Over 40 percent of participants said they avoid bathhouses, despite having friends who frequent them and knowing that condoms and lubricant are likely to be offered.
  • Participants reported behaviors to screen potential partners, based on personal preference (or stigma) or apps that allow sorting by HIV status.
  • Advance planning of sexual encounters, or only engaging in heavy drinking or drug use with trusted people, may help avoid situations that could interfere with condom use.
  • Further study is needed to determine the relationship between these potential risk reduction behaviors and remaining HIV negative.

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