Risk reduction is a terms used to describe HIV prevention strategies for HIV-positive and HIV-negative gay and other men who have sex with men (MSM) who practice unprotected anal intercourse with either casual or regular partners. Risk reduction includes activities such as:

Negotiated safety:  an agreement between HIV-negative men that limits unprotected anal intercourse (UAI) to only between partners within a regular relationship. Any sex with other partners outside the primary relationship must be protected.

Withdrawal:  when the insertive partner in UAI withdraws before ejaculation.

Strategic positioning:  the use of serostatus to determine sexual roles during UAI. The HIV-negative partner takes the insertive position and the HIV-positive partner takes the receptive position.

Serosorting:  the restriction of UAI to only with partners believed to be of the same (concordant) HIV status.

Undetectable viral load:  the use of viral load test results to assess the risk of HIV transmission when non-concordant partners engage in UAI.

While such strategies have been in use by some individuals—either sporadically or continuously—for many years, recent studies have indicated that the incidence of gay men utilising a risk reduction approach to sex has been increasing over time.

As this change in gay men’s understanding of (relative) risk has evolved and changed, HIV health promotion messages need to adapt to the changing circumstances and behaviours by reviewing the evidence and where appropriate, creating health promotion messages and programs that assist gay men in making informed decisions in assessing the risk of HIV infection occurring.

Consequently the AFAO Board, has formed a policy reference group, managed and coordinated by the AFAO-NAPWA Education Team, to investigate the policy and practical implications of the increased use of risk reduction strategies by gay men, and to guide the organisation in developing appropriate policy and health promotion responses.

As a first step in investigating this issue, ANET commissioned a literature review/discussion paper on this issue.  Click here to see a copy of this paper.