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Pre-Expose Prophylaxis and Non-Monogamous, HIV Negative Gay Men in Serodiscordant Relationships Robert Dale Gallagher Walden University

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Pre-Expose Prophylaxis and Non-Monogamous, HIV Negative Gay Men in Serodiscordant Relationships Robert Dale Gallagher Walden University Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2018 Pre-Expose Prophylaxis and Non-Monogamous, HIV Negative Gay Men in Serodiscordant Relationships Robert Dale Gallagher Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Sociology Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Social and Behavioral Sciences This is to certify that the doctoral dissertation by Robert Gallagher has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Andrew Garland-Forshee, Committee Chairperson, Social Work Faculty Dr. Tracey Phillips, Committee Member, Social Work Faculty Dr. Eric Youn, University Reviewer, Social Work Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2018 Abstract Pre-Expose Prophylaxis and Non-Monogamous, HIV Negative Gay Men in Serodiscordant Relationships by Robert Gallagher MA, Cleveland State University, 1998 BA, Cleveland State University, 1997 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Human Services Walden University October 2018 Abstract HIV transmission continues to increase for Gay men, especially for those Gay men in nonmonogamous serodiscordant relationships. As the use of PreExposure Prophylaxis (PrEP) increases, much less is known about how PrEP is creating social meaning and transforming the sexual behaviors of HIV negative, non-monogamous Gay men. Accordingly, the purpose of this study was to investigate the meaning making experiences of Gay men in nonmonogamous serodiscordant relationships. Using the Minority Stress Model, Resiliency Theory, and Queer Theory as theoretical frameworks, the research question for the study focused on how HIV negative Gay men who are on PrEP and involved in nonmonogamous serodiscordant relationships navigate their sexual lives. Interpretative Phenomenological Analysis was employed within a purposeful sample of 13 Gay men. The two themes of resiliency and reframing emerged from the descriptive coding, member checking, and triangulation of the data. Of the two themes identified, participants noted pre-PrEP resiliency strategies including looks and trust, while current PrEP strategies included strategic positioning, getting educated about HIV and PrEP, and dating undetectable men. Reframing experiences included marketability, greater feeling of sexual freedom and responsibility, new rules around nonmonogamy, increased sexual confidence, and new masculine terms for condomless anal sex. Findings and recommendations from the study may advance positive social change when researchers and practitioners combat stigma, understand perceived lower risk of HIV transmission through new resiliency techniques, and facilitate the reframing of sex within an individual, relational, and Gay cultural context. Pre-Expose Prophylaxis and Non-Monogamous, HIV Negative Gay Men in Serodiscordant Relationships by Robert Gallagher MA, Cleveland State University, 1998 BA, Cleveland State University, 1997 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Human Services Walden University October 2018 Dedication I dedicate this work to my family, friends, and colleagues. To my grandparents, who are deceased, you provided the inspiration for me to be the first person in our extended family to go to college. Your hard work as a homemaker and a coal miner taught me the value of working hard for your passion and never giving up on your dream. You also always protected me and provided for me in times of need. I truly believe this dissertation would not have been possible without the both of you in my life. I would also like to dedicate this dissertation to my mother. Thank you for pushing me to continue my education. Many times, you struggled to ensure that I would not have to struggle as much as you did. Your ability to always lift yourself up and out of a negative situation and believe that there is a better future, was a major driving force in me pursuing my dream of an education. I also want to dedicate this dissertation to my spouse. Your continued support of me throughout this dissertation, and in life overall, is the reason I married you. You were always the person I could talk to when I was struggling with the research, or anything in life. The advice and support you gave me will never be forgotten. Finally, I want to dedicate this dissertation to all my other family, friends, and work colleagues who supported me. My family and friends would always tell me how proud they were of me. This gave me the motivation to continue. Thank you to my work colleagues, my boss, and administration at my work for not only providing the financial means to earn this doctoral degree, but also the encouragement and support needed to complete this dissertation. Acknowledgments Thank you to my committee, Dr. Andrew-Garland-Forshee and Dr. Tracey Phillips for your support and assistance during the dissertation process. Dr. Garland- Forshee, it was an honor meeting you in person in 2017. You would always call, email, or text me when I felt frustrated with the process of completing this dissertation. Your mentoring and leadership style was beyond excellent. I could not have picked a better dissertation chair. I will always remember you for mentoring me through this process and hope to be as good of a mentor to my students that you were to me. I would also like to thank Dr. Phillips. The first time you spoke at one of the residencies I attended, and then when I spoke to you in person, I knew I wanted you to be on my committee. I loved that you are an attention to detail person, which is one of my faults, and you quickly picked up on APA issues or methodological that I may have missed. You, also, are a great mentor to students who seek a dissertation from Walden University. Table of Contents List of Tables ..................................................................................................................... vi List of Figures ................................................................................................................... vii Chapter 1: Introduction to the Study ....................................................................................1 Background of the Study ...............................................................................................3 Problem Statement .........................................................................................................6 Purpose of the Study ......................................................................................................7 Research Questions ........................................................................................................8 Theoretical Foundation ..................................................................................................8 Nature of the Study ......................................................................................................10 Definition of Terms......................................................................................................12 Assumptions .................................................................................................................15 Scope and Delimitations ..............................................................................................15 Limitations ...................................................................................................................16 Significance of the Study .............................................................................................17 Summary ......................................................................................................................18 Chapter 2: Literature Review .............................................................................................20 Introduction ..................................................................................................................20 Literature Search Strategy............................................................................................23 Theoretical Foundations...............................................................................................25 Minority Stress Model .......................................................................................... 26 Resiliency Theory ................................................................................................. 28 i Queer Theory ........................................................................................................ 30 The Social Construction of Sex by Gay Men ..............................................................34 Condomless Sex and Gay Men ............................................................................. 34 The Role of Masculinity in Condomless Sex ....................................................... 36 Condomless Sex and Gay Serodiscordant Couples .............................................. 39 Gay Men and Open Sexual Relationships ...................................................................40
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