Barcelona 2013
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| Abstract #346 - E-Posters English | ||||
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Session: 50.46: E-Posters English (Poster) on Sunday in Chaired by Authors: Presenting Author: Mr Christoph Imhof - University of Applied Sciences and Arts, Switzerland |
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| Additional Authors: Dr. Jordi Casabona, Sra Cristina Sanclemente, Dra. Anna Esteve, Dra. Victoria Gonzalez, Grupo HIVITS TS, | ||||
| Aim: In the last decade, an increasing number of HIV diagnosis among men who have sex with men (MSM) has been registered in Switzerland (after a period of declining HIV rates). Surveys related this increasing HIV rate to an increase in unprotected sex among MSM. However, adequate empirical data was missing to explain these changes. Therefore, the aim of this study was to provide insight into the actual personal HIV-protective strategies and the HIV-protective and -risk behaviour among MSM and to reconstruct the rationalities and meanings behind the corresponding personal strategies and behaviours. | ||||
| Method / Issue: From August 2009 until November 2011 we conducted semi-structured, qualitative interviews with 26 MSM living in Switzerland (16 were HIV negative, 9 HIV positive, 1 of unknown HIV status). We analysed the data using Theoretical Coding. | ||||
| Results / Comments: Both HIV-negative and HIV-positive participants reported a broad array of protective and risky behaviours as the following: a) complying with Safer Sex guidelines; b) exceeding Safer Sex compliance: condom use also during oral sex (HIV negative men), protected anal sex plus avoiding sex with HIV-positive men (HIV negative men), avoiding semen on skin on sex partner (HIV positive men), practicing anal intercourse only after disclosure or exclusively with other PLWH (HIV positive men); c) modifying or relaxing Safer Sex guidelines: occasional unprotected sex when "in love" (HIV negative men), unprotected sex with known and trusted partners, unprotected sex with steady partners (HIV negative men after HIV-test) and Safer Sex with casual partners; d) experiencing occasional, unspecified slip-ups; e) dispensing with Safer Sex altogether; f) alternating, depending on: partner serostatus, partner type, setting, partner attributes. Among HIV-negative MSM, the analysis evidenced protective factors supporting long term maintenance of safer sex. These are: a) a gay affirmative social environment (family, school, peers), b) the perception of an HIV infection as − albeit the achievement of antiretroviral medication − still severe and burdensome, and c) starting sexual contacts not before adolescence. Unprotected sex among these men was related with aspects like a) love and trust, b) sexual preferences (like getting semen in the mouth), and c) gauging based on partner's sexual history. In HIV-positive MSM, personal strategies and behaviour depend on a) considerations of infectiousness under ART, b) thoughts about responsibility, c) sexual preferences, d) preventing another STI, e) questions around disclosure (fear of rejection and stigmatization). | ||||
| Discussion: A wide variety of strategies and behaviours that MSM consider (partially) protective exist on a continuum ranging from "Safer Sex" to conscious risk taking. This variety marks the challenge to be met by either "positive prevention" and primary prevention. Our analysis showed further, that − on a structural level − supporting a gay affirmative social environment acts as a protective factor in maintaining an appropriate protection behaviour. On a personal level, prevention interventions should consider more strictly that people adopt diverse personal protection strategies. As HIV positive MSM are confronted with substantially different challenges in (sexual) life, they should be offered a special platform supporting them in their identity finding as an HIV-positive person after diagnosis. | ||||
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