Abstract #70  -  Understanding barriers to safe sex of MSM recently diagnosed with HIV
Authors:   Presenting Author:   Mrs. Titia Heijman - Health Service of Amsterdam
Additional Authors:  MSc Freke Zuure, Dr Udi Davidovich,
Aim: Supporting safe sex behaviour of recently HIV diagnosed men who have sex with men (MSM) is essential as these men might be developing new sexual behavioural patterns while coping with and readjusting to their new HIV status. In addition recently diagnosed men could have a higher viral load, either because they are still in the stage of primary infection or not yet under treatment. This study aims to learn about the specific barriers to safe sex which emerge among MSM shortly after being diagnosed with HIV and are typical for this adjustment period.
Method / Issue: From May 2007 till December 2008, 30 HIV-positive MSM participated in semi-structured qualitative interviews about sexual behaviours in the first year after HIV diagnosis. The sample included 15 recently diagnosed HIV-positive MSM (<12 months before the interview) and 15 men who were diagnosed > 12 months ago but after introduction of ART in the Netherlands. The former group could provide present-life experiences, actual thoughts and emotions related to diagnosis whereas the latter group could provide a more retrospective and crystallized account of the period after their HIV diagnosis. We explored thoughts and experiences regarding the first sexual encounters after diagnosis, related safe and unsafe sexual behaviours and their motives. All interviews were recorded, transcripted and analysed using flexible content analyses. We used the Information Motivation, Behavioural skill model (Fisher & Fisher) as the theoretical basis for the interpretation of the interview results.
Results / Comments: We found several barriers for safe sexual behaviour soon after HIV diagnosis. Some men reported a feeling of loss of self esteem after their diagnoses and related anticipated fear of rejection as a sex partner. In order to cope with this loss of self esteem some MSM felt they needed to be valued and accepted sexually. If they perceived that initiating safe sex would hamper their chances of having sex they were less likely to insist on condom use. Insisting on condom use was often perceived as indirect disclosure of HIV status, especially to regular sex partners with whom they previously used to engage in unprotected anal intercourse. Related to this, inexperience with communication about HIV status soon after diagnosis led men to either ascribe responsibility for condom use to the casual sexual partner or assume his concordant HIV+ status based on invalid heuristics. In addition, for most men the most important reason to use condoms was to avoid HIV infection. Some MSM reported that soon after their HIV diagnosis they felt a feeling of freedom as avoiding HIV was no longer an issue, which directly resulted in less condom use.
Discussion: We found several barriers to safe sex that are specific for recently diagnosed MSM. Supportive behavioural interventions addressing these barriers are needed. However the results of the study show the complexity and diversity of the barriers for safe sex among this specific group. Interventions should therefore be tailored in order to effectively meet the needs of MSM recently diagnosed with HIV.
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