title: Negotiated safety - components, context and use: an integrative literature review.
abstract: OBJECTIVE
  The aim of this study was to examine the components and use of negotiated safety in the context of HIV prevention and to identify reported factors associated with the concept.
  
  
  BACKGROUND
  There is an emerging interest in dyadic approaches to address HIV transmission. Although there are theoretical foundations for how interpersonal relationships influence individual behaviour, how these dyadic processes influence on health is still not wholly understood.
  
  
  METHODS
  Integrative review of empirical and theoretical literature.
  
  
  METHODS
  The Cumulative Index for Nursing and Allied Health Literature (CINAHL) MEDLINE and PsychINFO electronic databases were accessed.
  
  
  METHODS
  Articles were read to gain a historical context of the term and identify varying interpretations of the concept. Factors warranting consideration in association with NS were identified and clinical and public health implications were noted.
  
  
  RESULTS
  Forty-eight studies were reviewed. Negotiated safety included the following components: (i) HIV sero-negative concordant men within a primary relationship; (ii) joint HIV screening and mutual disclosure of their HIV status; (iii) explicit relationship boundaries which establish either nonexclusively that allows for the dispensing of condoms within the primary relationship and consistent condom use for extra-dyadic sex; or dispensing of condoms within a primary partnership and exclusivity; and (iv) a breach clause that allows communication to re-establish the agreement if needed.
  
  
  CONCLUSIONS
  Negotiated safety is a prescriptive approach to HIV risk reduction among couples. Researchers and practitioners could benefit from promoting this approach to HIV prevention.
authors.affiliation: School of Nursing and Health Sciences, University of Miami, Florida, USA.
authors.forename: Natalie M
authors.identifier: http://orcid.org/0000-0002-8661-1085
authors.initials: NM
authors.lastname: Leblanc
authors.affiliation: Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Mitchell
authors.affiliation: Graduate Programs, School of Nursing and Health Sciences, University of Miami, Florida, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: De Santis
mesh_terms: D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008297:Male; D017008:Negotiating; D012449:Safety
keywords: HIV prevention; couples; gay men; healthcare providers; integrative literature review; negotiated safety; nursing; relationships; safe sex; sexual agreements