Non-condom use risk-reduction behaviours: can they help to contain the spread of HIV infection among men who have sex with men?

In this issue of the journal, Jin et al. [1] report a detailed analysis of the association between sexual risk-reduction behaviours other than condom use and incident HIV infection in a cohort of HIV-seronegative men who have sex with men (MSM) in Sydney, Australia. Sexual riskreduction behaviours that are studied here include ‘serosorting’, unprotected anal intercourse with HIVseronegative partners only; ‘negotiated safety’, unprotected anal intercourse with HIV-seronegative primary partners only; ‘strategic positioning’, unprotected insertive anal intercourse and ‘withdrawal’, unprotected receptive anal intercourse without ejaculation. In a world where condom use during anal intercourse has been the cornerstone of HIV prevention among MSM, it is remarkable that all these risk-reduction behaviours include anal intercourse without condom use. This inevitably raises the question why the sexual behaviour identified as the primary driver of the HIV epidemic in MSM has become the central component of HIV riskreduction behaviours employed by MSM.