This result supports previous Portuguese MSM sexual behavior reports However, trust, as some of our participants agreed, is a rather subjective concept, leaving space for various expectations and behaviors.
Further research has also shown that most HIV infections occur from main sex partners 27 , This suggests that relationship dynamics in relation to HIV risk practices are relevant and should be considered in the context of prevention efforts. Our findings suggest that the concepts of safe sex on our sample are highly contextual and therefore in some ways not dissimilar from those found among Portuguese heterosexuals 10 , 11 , but still maintaining their specificity that deserves further inquiry. The sample used for this study is not representative of Portuguese MSM.
It is possible that men who felt uncomfortable with disclosing unsafe sex refrained from participating. Therefore the results of this study reflect the bias associated with a convenience sample containing highly educated and mostly professional individuals, sensitive to the topic of this study, motivated and willing to disclose private matters to a researcher. All participants had experience of meeting sexual partners online, one of the key areas of focus of our research, and therefore our results may disproportionately reflect those experiences.
Uncontrolled sensitivity to certain topics and unintended bias in the selection of quotes to illustrate the issues being addressed is always a possibility in qualitative analysis. To prevent this, standardized procedures were used as much as possible to provide bias-free results. Despite our modest sample size and the limitations identified, we believe our results can contribute to inform the development of more effective health education policies and strategies aimed at promoting safer sex and risk reduction among MSM living in Portugal. Considering that in general, participants in our study were aware of HIV transmission risks and tended to protect themselves in most sexual practices, prevention efforts should do more than just provide information and focus on communication and negotiation skills both on and offline.
They should also work towards building sustainability of safer practices that will be affected by different life contexts, types of partner and social influences. Changing trends in HIV in Portugal as shown by the infection rates for MSM over the last decade suggest that larger surveys as well as qualitative studies should be conducted to support effective and unbiased national prevention efforts. Lisboa: Imprensa Nacional Casa da Moeda; ILGA Portugal.
European Opinion Research Group. Brussels: European Commission; J Appl Stat ; Diagnosed and undiagnosed HIV-infected populations in Europe. HIV Med ; Sex Transm Dis ; Aboim S. Psicologia ; Sexualidades em Portugal: comportamentos e riscos. AIDS Behav ; PLoS One ; 7. Villaamil F, Jociles M. Risk and community: the impact of HIV among gays in Madrid.
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The case of sex clubs. Sexualities ; International mobility, sexual behaviour and HIV-related characteristics of men who have sex with men residing in Belgium. BMC Public Health ; When do online sexual fantasies become reality? The contribution of erotic chatting via the Internet to sexual risk-taking in gay and other men who have sex with men. Health Educ Res ; AIDS ; Trust and sexual interaction: the significance of the Internet on the sex life and sexual risk behaviors of gay and bisexual men in Spain.
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Cybercartography of popular internet sites used by New York City men who have sex with men interested in bareback sex. Hart GJ, Elford J. Sexual risk behaviour of men who have sex with men: emerging patterns and new challenges. Curr Opin Infect Dis ; Relationship dynamics as predictors of broken agreements about outside sexual partners: implications for HIV prevention among gay couples.
Correspondence : N. Rua Jardim do Tabaco 34, Lisboa , Portugal. Contributors N. Nodin contributed to the conception and design, acquisition of data, analysis and interpretation of data, drafting the article, and final approval of the version to be published. Leal and A. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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