Young gay men talk to their friends about sexual health, but they don’t always get the best advice

Young gay men in California frequently discuss sexual risk with their best friends, new research shows. While these conversations have the potential to encourage and influence safer sex behaviour, many of the conversations are based on faulty assumptions, such as that ‘knowing’ your partner well is enough to protect against HIV infection. Moreover, the advice given by female best friends is often different from that offered by gay male best friends.

Reporting their findings in the journal Health Education Research, Matt Mutchler and Bryce McDavitt recommend that HIV prevention interventions should help young people have more constructive conversations with friends about sexual health and sexual risk taking.

The researchers recruited 24 young gay men (aged 18 to 21) in Los Angeles. Those taking part had to have a best friend who they had known for at least a year and who was also willing to be interviewed. Half named a friend who was also a gay man, whereas half identified a heterosexual woman as their best friend.

In-depth paired interviews, lasting approximately two hours, were then conducted with both friends together. The interviews focused on the way the friends talked with each other about dating, relationships, sex, safer sex and condoms.

In almost all friendships, the importance of safer sex was emphasised. Many understood it in terms of ‘self-respect’ (prioritising one’s own health and safety over the wishes of a sexual partner). Many encouraged friends to maintain high standards of sexual safety, and some would ask specifically about whether their friends had used condoms with a particular partner.

However many of the female participants and some of the male participants talked mostly about choosing a sexual partner carefully, and paid little attention to condom use or different sexual activities. For example, they suggested that risk could be eliminated by being in an avowedly monogamous relationship, or by quizzing a potential partner on his sexual history.

Although the female friends often wanted to help their gay male friends ‘settle down’ and find a good partner, they also sometimes encouraged their gay male friends to adopt practices based on trusting their partners without addressing the potential risks that such strategies might entail. For example one female friend said:

“If you really know the person then you don’t really have to worry about [STDs]… Cause if you really know the person, you know that they don’t have anything cause you know them for a long time. Like I told Gary—he used to go find some random persons - you don’t know anything cause you just met that person. So, I mean he has a lot more risks… I still think he needs to learn from my example.”

However a number of the male participants talked about using condoms ‘no matter what’. The phrase conveyed the idea that condoms should be used regardless of the circumstances, the character of the partner, the intimacy of the relationship or the partner’s belief that he is HIV negative. One young man said:

“You never know if they’re cheating on you or not. That’s why I always say use a condom, no matter what”.

The condoms ‘no matter what’ attitude was only expressed by the young gay men and never the women. When men had other gay men as best friends, it was often a shared standard of behaviour that was firmly and repeatedly advocated. When best friends were women, the men sometimes tried to persuade their female friends that they needed to be more realistic and less trusting about their partners.

However a number of the gay men who expressed this attitude did at the same time express seemingly contradictory ideas about the importance of choosing a partner carefully. Furthermore, their actual behaviour was not always as consistent as their advice.

More generally, the researchers found that discussion of condoms and safer sex was usually limited in nuance or detail. Friends might ask if a condom had been used, but if the answer was negative, they would not explore their friend’s motivations or the circumstances of the encounter. Conversations rarely touched on questions of how to advocate for condom use with a reluctant partner, whether to use condoms for oral sex or the steps involved in giving up condoms in a relationship.

The researchers believe that it is through conversations such as these that peer norms about sexual health and sexual behaviour are communicated and re-shaped.

“Since social support in general is linked to overall well-being among sexual-minority youth, building on the good intentions of young gay men’s friends seems to be a promising avenue for increasing health behaviors,” they say. “Interventions can build on peers’ strong desires to help each other, enabling friends to facilitate revised sexual scripts that discourage unsafe sexual encounters and reinforce the values underlying safer sex scripts.”

They suggest that interventions should help friends communicate with each other, challenge problematic assumptions and work with the different values expressed by male and female friends. Interventions should help young people think about risky sexual practices rather than risky partners.