Exploring challenges to safe sex for men in long-term relationships living in KwaZulu-Natal who have sex with both men and women.

Abstract

Numerous research studies continue to show that HIV/AIDS is still a burden in South Africa. Although in recent years there have been breakthroughs in biomedical research, leading to the development and improvement of HIV treatment, a vaccine and a cure have yet to be found. Research has further suggested that people in long-term relationships are at a heightened risk of HIV infection owing to decreased condom use within these relationships. In addition, the majority of studies that investigated sexual safety in South Africa have focused on heterosexual relationships. This creates a problem, as international literature and some South African-based surveys have suggested that men who have sex with men (MSM) are at an increased risk of HIV infection when compared to men who have sex with women only (MSWO). This means that there is a gap in our current understanding of barriers to safe sex for MSM, particularly within the South African context. This gap is further problematised by the presence of homophobia and the persistent concealment of same-sex sexual activities within the South African context. This study focused on a subset of MSM, called men who have sex with men and women (MSMW), because even though in South Africa the burden of the HIV pandemic is still largely carried by women, there is reason to believe that MSMW could be at an intersection of HIV infection risk, which is yet to be understood fully. This study used a social constructionist approach as a theoretical lens that undergirded the study’s conceptual framework throughout the research process. Qualitative research methodology was selected as the method of inquiry, and 12 African MSMW were sampled for one-on-one interviews and seven MSMW for an online focus group discussion. The sampling of participants was conducted using convenience and non-random purposive sampling techniques, and the data were transcribed verbatim. Data analysis was conducted using a combination of inductive thematic analysis underpinned by social constructionism, and the sex script theory as contemporary analytical tools. The findings of this study showed that long-term romantic relationships were important in the lives of MSMW for varying reasons. The findings further showed that MSMW’s understanding of safe sex was related to condom use. This study adds to the already existing body of research, which highlights that condom use within long-term relationships is problematic. The findings indicated that the construction of these relationships relied heavily on the dynamic concept of trust, and, as such, MSMW within these relationships drew on the trusted partner is a safe partner script, which mediated condom use within the relationships. The main findings in this study suggested that challenges to safe sex for MSMW in long-term relationships are rooted in the nature of how gender norms are socially constructed. The current heteronormative gender norms affected the way the participants understood their same-sex sexualities and how they navigated these within a social context that still bore negative attitudes towards same-sex behaviours. The findings indicated that the participants’ understanding of their gender and sexuality led to the enactment of the desire script, the redefined traditional sex script, and the understanding male partner script. These scripts allowed for sexual agreements to exist between male partners that permitted a form of polyamorous sexual relationships. The risk of HIV infection thus seems to rest on the intersectional enactment of different scripts while the expectation to enact the trusted partner is a safe partner script remains. This trusted partner is a safe partner script was not abandoned even in the presence of HIV infection risk. This study highlighted the need for research to focus on diverse populations such as MSMW in the response to the HIV epidemic. Keywords: Men who have sex with men and women,social constructionism,sex script theory,HIV,sexual agreements.