It's not just condoms: Social contexts of unsafe sex in gay men's narratives of post-exposure prophylaxis for HIV

Abstract

This paper draws on findings from an ongoing prospective cohort study with a quantitative and a qualitative arm to monitor the implementation of guidelines for non-occupational post-exposure prophylaxis in Australia. The aim of the qualitative arm was to explore in-depth details of exposures and participants' understanding of ‘risk’. This paper documents the physical, social and emotional contexts in which unsafe sex leading to post-exposure prophylaxis occurred. It will be argued that unsafe sex happened in spite of participants' knowledge about safe sex and as a consequence of a temporary absence of control. Five themes characterising the social contexts of unsafe sex can be identified in the narratives: issues relating to past, current and potential future relationships, drugs and alcohol, public and private social spaces, stress, and adventure. These contextual categories are not always neatly separated but interact with each other in various ways. Findings suggest that disseminating knowledge of safe sex practices based on condom use alone is not enough. Safe sex messages need to be contextualised to make links between sexual practices and the everyday experiences of those for whom they are intended.