Sexual HIV risk among gay,bisexual and queer transgender men: findings from interviews in Vancouver,Canada

Abstract

Gay, bisexual, queer and other men who have sex with men are disproportionately affected by HIV in Canada. While up to 63% of transgender men identify as gay, bisexual or queer and report a variety of HIV sexual risk behaviours, transgender men are often overlooked within epidemiological HIV surveillance and research. While a growing body of research has begun to examine sexual risk for transgender gay, bisexual and queer men, most studies have been conducted in the USA. This study explored sexual HIV risk for this population in the Canadian context, specifically in British Columbia, in an environment of publically funded universal access to healthcare, including HIV testing and treatment. We conducted interviews with 11 gay, bisexual and queer transgender men. Participants’ narratives suggest that HIV risk for these transgender men is shaped by a diversity of sexual behaviours, including inconsistent condom use, seeking partners online for greater safety and accessing HIV/STI testing and other healthcare services despite facing transition-related barriers. Public health prevention and health education must recognise the presence of transgender men and ensure health services and broader population health promotion meet the unique sexual health needs of this sub-population of gay, bisexual and queer men.     

HIV risk and sense of community: French gay male discourses on barebacking

This paper analyses the use of the concept of ‘barebacking’ as a risk category in the discourses of French gay men. It discusses how the rise and spread of the term barebacking contributes to reframing gay men’s personal experiences of HIV prevention and their sense of belonging (or a lack thereof) to a gay community. The study is based on 30 qualitative interviews with French gay men conducted between 2005 and 2008. An import from the USA, the term barebacking emerged publicly in France in the late-1990s and was first used to describe intentionally unprotected sexual practices. Debates surrounding this risk category were marked by violent controversy over its use and its definition among HIV prevention actors. There remains a general lack of consensus on the definition of the term, despite its use by activists, in porn culture and in the daily discourses of gay men. By focusing on the relational roots of risk perception, I consider how uses of the term barebacking invoke a moral framework around risk taking.     

Intensive sex partying amongst gay men in Sydney

Intensive sex partying is a framework developed to analyse specific frequent behaviours amongst a small minority of gay men in Sydney, Australia. The behaviours included a higher frequency of dance party attendance, more frequent sex, more anal sex, multiple sex partners, more unprotected anal intercourse with casual partners and more frequent drug taking. These occur at a contextual intersection between a sub-group of sexually adventurous gay men and ‘party boys’. The men appear to be involved in both high-risk, adventurous sex practices and a specific form of partying distinguishable from dance partying and ‘clubbing’. Sex partying occurs on multiple sites (domestic spaces; within dance parties; sex parties; sex-on-premises venues) and appears to be geared to the maximisation of sexual pleasure. Intensive sex partying describes this coincidence of factors and locates them in relation to the multiple pleasures offered by sex partying. It emphasises the importance of ‘intensity’ in order to understand better the relations between sex, drug use, pleasure, care and risk in some gay men's lives.     

Predictors of HIV risk among men seeking treatment for substance abuse in India

The purpose of this study was to investigate the prevalence and correlates of HIV risk among men receiving treatment for substance abuse in India. Consecutive inpatients from the major substance abuse hospital in southern India were screened using a structured interview and standardized measures to obtain demographic, psychiatric, sexual behavior, and substance use data at the time of admission. Seventy-seven percent of the 352 men who were screened reported that they were sexually active during the past year, and 13% reported that they had engaged in sexual practices associated with greater risk. The most common risk practices in the past year included having multiple sexual partners (7%), paying for sex (5%), and having unprotected anal sex (4%). Engaging in risky sexual practices was associated with the presence of a co-occurring psychiatric disorder and higher scores on a drug abuse screening measure. Assessing HIV risk in substance abuse settings can help to identify patients who may benefit from HIV-risk reduction programs.     

南宁市男男性行为人群HIV感染率及影响因素

目的 了解广西南宁市男男性行为人群(MSM)艾滋病病毒(HIV)、丙肝病毒(HCV)与梅毒(TP)的感染情况,分析该人群感染HIV的主要影响因素。方法 通过同伴驱动抽样方法,以面对面访谈方式调查2 296名MSM的艾滋病知识及性行为特征,并对其进行HIV、HCV、TP的血清学检测,通过单因素及多因素logistic回归模型分析HIV感染的影响因素。结果 研究对象平均年龄为(30.61±7.68)岁,以汉族为主,占65.3%;寻找性伙伴最常用的方式是通过互联网联系,占63.6%;艾滋病知识知晓率为95.4%;最近半年,与同性发生过性行为的占86.3%,最近1次发生肛交时安全套使用比例为75.2%;最近半年,与异性发生过性行为的占13.1%,最近1次与女性发生性关系时安全套使用比例为40.7%;HIV、HCV、TP感染率分别为3.2%、0.3%、10.1%;多因素分析显示,文化程度、第1次性伴的性别、最近半年与男性发生过肛交性行为是HIV感染的影响因素。结论 南宁市MSM人群性行为活跃,存在不安全性行为,HIV、TP感染率较高,应针对主要影响因素进行有效的干预。     

Fatherhood,marriage and HIV risk among young men in rural Uganda

Compared to a large body of work on how gender may affect young women’s vulnerability to HIV, we know little about how masculine ideals and practices relating to marriage and fertility desires shape young men’s HIV risk. Using life-history interview data with 30 HIV-positive and HIV-negative young men aged 15–24 years, this analysis offers an in-depth perspective on young men’s transition through adolescence, the desire for fatherhood and experience of sexual partnerships in rural Uganda. Young men consistently reported the desire for fatherhood as a cornerstone of masculinity and transition to adulthood. Ideally young men wanted children within socially sanctioned unions. Yet, most young men were unable to realise their marital intentions. Gendered expectations to be economic providers combined with structural constraints, such as limited access to educational and income-generating opportunities, led some young men to engage in a variety of HIV-risk behaviours. Multiple partnerships and limited condom use were at times an attempt by some young men to attain some part of their aspirations related to fatherhood and marriage. Our findings suggest that young men possess relationship and parenthood aspirations that – in an environment of economic scarcity – may influence HIV-related risk.     

Self-Disclosure of HIV Status to Sexual Partners: A Qualitative Study of Issues Faced by Gay Men

Objective:This study aimed to explore the range of issues faced by HIV-positive and HIV-negative gay men concerning HIV serostatus self-disclosure to sexual partners. Methods: In-depth semistructured interviews of 1–2 hr each were conducted with 26 HIV-positive and 15 HIV-negative gay men who were recruited from a larger cohort of gay men followed longitudinally for several years at a major medical center. Interviews were audiotaped, transcribed, and content-analyzed by two independent raters. Results: Several themes emerged concerning how disclosure was viewed, who and what was told, why disclosure occurred, and how disclosure decisions related to sexual behavior. Variations occurred in when and why men disclosed, and in the contents and definitions of their disclosures. Men disclosed using codes and indirect hints. Various rationalizations arose for not telling as well. Many men adopted the position that they do not tell, but practice safer sex, yet definitions of safer sex varied such that what some men consider safe, others do not. Conclusion: Recognition thus needs to be increased among clinicians, researchers, patients, and others that definitions of disclosure and of safer sex can vary significantly. The data have critical implications for designing appropriate interventions to limit the further spread of HIV.     

Love and HIV serodiscordance in gay men's accounts of life with their regular partners

This paper examines discourse on serodiscordant relationships in interviews with 16 HIV-positive and 3 HIV-negative gay men living in Scotland. Drawing on critiques concerning love, reason and HIV serostatus normativity, this paper supplies a much-needed insight into how gay men in serodiscordant relationships negotiate HIV prevention. Among other matters, some HIV-negative men were said to knowingly request risky sex with their HIV-positive partners as an expression of love. In some situations, the person without HIV claimed a normative serostatus that implied they could ‘invest’ more in the relationship by offering to have sexual intercourse that may expose them to HIV. Such dynamics expressed devotion on the part of the HIV-negative man, but implied obligation for the HIV-positive man. Based on these and other perspectives we argue for closer attention to gay men's subjectivity in the present circumstances of proliferating biomedical forms of HIV prevention; more thoroughly reflexive public health engagements with gay men's sexual cultures; and a research agenda for gay men that challenges HIV-serostatus normativity.     

Sexual behavior and HIV risk among age-discrepant,same-sex male couples

Research has suggested that men who have sex with men and who have older sexual partners are at increased risk of HIV infection. However, while several studies have explored risk among men in age-discrepant non-primary partnerships, only two have explored age discrepancy and risk in primary same-sex male relationships. We used data from semi-structured in-depth interviews to explore sexual behaviour and HIV risk among 14 Black, white and interracial (Black/white) same-sex male couples with an age difference of 10 or more years. Most couples regularly used condoms, and sexual positioning tended to lead to lower risk for younger partners. Some serodiscordant couples abstained from anal sex, while others used seropositioning to avoid transmission within the relationship. Within some couples, older partners acted as mentors on HIV prevention and broader life lessons. Future studies should further explore the potential risks and benefits of large age differences in same-sex male primary relationships.     

E-dating, identity and HIV prevention: theorising sexualities, risk and network society

This paper addresses how London gay men use the internet to meet sexual partners, or for e-dating. Based on qualitative interviews conducted face-to-face or via the internet, this research develops an account of how information technologies mediate the negotiation of identity and risk in connection with sexual practice. E-dating itself is a bricolage, or heterogeneous DIY practice of internet-based-communication (IBC). A central aspect of IBC is "filtering" in and out prospective e-dates based on the images and texts used to depict sexual identities. Interpretations and depictions of personal HIV risk management approaches in IBC are framed by the meanings of different identities, such as the stigma associated with being HIV positive. This paper argues for a sexualities perspective in a theory of network society. Further, HIV prevention in e-dating can potentially be addressed by considering the interplay of the HIV prevention imperatives associated with different HIV serostatus identities. There is a case for encouraging more explicit IBC about risk in e-dating and incorporating the expertise of e-daters in prevention activity. There is also a need to rethink traditional conceptions of risk management in HIV prevention to make space for the risk management bricolage of network society.     

Unwanted pregnancy and sexually transmitted infection among young women in rural Kenya

Early sexual debut and premarital sex are increasingly common features of female adolescence in Kenya—putting girls at the risk of unwanted pregnancy and infection by sexually transmitted infections and HIV/AIDS. Levels of knowledge concerning the protective value of condoms and other contraceptives are high, but unprotected sex is still common. Against this background, this paper examines the strategies used by young women to deal with these risks. Qualitative data were obtained from eight focus group discussions conducted with school attending girls aged between 15 and 19 years in Makueni District of Eastern Kenya. Findings suggest that, despite knowledge of the protective value of condoms and other contraceptives, the use of these methods by girls is hampered by inability to access them, the fear of the side effects of contraceptives, and the desire by girls to remain faithful to their religious calling. Most girls also resort to the use of traditional methods such whose potency and efficacy is unproven. These findings suggest the need to make condoms more easily accessible to girls in rural areas, and also for education in the proper use of ‘natural’ family planning methods. Young women may also benefit from training in how to be more assertive in sexual negotiations.     

Stigma matters: HIV and HIV risk perception among men who have sex with men in Serbia; a qualitative study

As a social determinant of health, stigma is a major barrier to health care access, illness management and completing the treatment. It is attributed both to HIV as a health condition and to the populations at risk of being infected with it. In Serbia, HIV is associated with men who have sex with men (MSM), with a noticeable stigma towards them. Drawing upon a qualitative cross-sectional study, conducted in three Serbian cities, we explore the MSM’s perception of HIV in the context of that social stigma. Using a respondent-driven sampling approach, 62 targeted MSM respondents participated in focus groups discussions and in-depth interviews. We found that the participants’ understandings of the HIV infection, risks and prevention are shaped by stigma. Those MSM who resisted stigma relativised the HIV risk, associating it with the general population and HIV-positive MSMs, believing that HIV, perceived as a chronical illness, was unjustly related to MSM. As one of the main preventive measures, serosorting was based on alleged HIV-positive statuses of potential sexual partners. HIV-negative participants described perceiving HIV-positive MSM as the ones responsible for spreading the virus, since they were concealing their positive status. As a response to stigma, MSM tended to challenge the HIV discourse, shifting it away from MSM onto the general (male) population and HIV positive MSM. Our analysis suggests that stigma resistance may make MSM more susceptible to taking risks. HIV prevention programmes should take the social context of MSM into account and target MSM-related stigma.     

The 'loss of community' and other problems for sexual citizenship in recent HIV prevention

Increases in reported unsafe sex among gay men have been explained as resistance to HIV prevention, or most recently, with the idea that a hyper-individualization of sexual action contributes to the loss of sexual community. This turning in HIV prevention has come to focus on the sexual action of gay men with HIV through the frames of: sexual transgression, sometimes called 'barebacking'; and altruism. Adopting the perspective of sexual citizenship in connection with qualitative interviews, this paper considers how gay men with HIV account for their sexual practice in light of the dual discourse of transgression/altruism. The paper will argue that gay men with HIV are deeply aware of what transgression/altruism implies for their identities and sexual relations, indicating the continued salience of community for sexual practice. Further, in the circumstances of blaming in relation to the moral labour of safer sex, gay men with HIV are trying to work out a co-operative practice for HIV prevention based on self-care, a moderated altruism and the voluntary action of sexual partners.     

The couple as context: Latino gay male couples and HIV

HIV-prevention efforts with gay men in relationships frequently omit primary partners. When they are considered, examinations of race/ethnicity are often overlooked despite higher infection rates among gay men of colour. Acknowledging both the need to contextualise the behaviours that may affect HIV risk for gay men of colour and the disproportionate impact of HIV on Latino gay men, the present study utilised semi-structured, qualitative interviews to explore relationship dynamics, sexual agreements and behaviours, safer sex choices and HIV risk among nine Latino gay male couples. All participants were HIV-negative and in concordant negative relationships. Additionally, nearly all reported closed agreements. Analysis revealed participants engaging in four behaviours that may actively reduce their HIV risk: approaching sexual agreements from a practical standpoint, maintaining a high literacy around HIV, having exposure to social support groups for Latino gay men and finding support in their relationship with another Latino gay man. Additional issues are raised where long-term HIV prevention is concerned. Intimate relationships are an important context for understanding both HIV risk and prevention among Latino gay men. Likewise, race/ethnicity provides an indispensable perspective on all research with gay couples. Future prevention efforts with gay men must strive to include both.     

Internalised conflicts in the practice of religion among kwandengue living with HIV in Douala,Cameroun

Religion plays an important role in the life of many Africans. Given that most faith-based organisations are vehemently opposed to homosexuality, the question arises as to the extent to which African gay men feel free to express and enjoy their faith while simultaneously acknowledging their sexual orientation. This study explored this question in relation to gay men living with HIV in Douala, Cameroon. For the study, we analysed questionnaires used by a local HIV-support centre to assess the psychosocial life of people living with HIV. Additional follow-up discussions were held with self-help groups and one-to-one conversations were conducted. The majority of the participants practised a religion and felt generally satisfied with their religious life. At the same time, many men said that they were ‘conflicted with’ their faith. They did not always wish to choose between their faith and their sexual orientation, these being two important dimensions of their identity. Religion's attitude towards homosexuality does not seem to make religious life less important for gay men in Africa, but can be a source of stress, which makes their spiritual fulfilment more problematic and deprives them of a coping strategy that may be helpful in adapting to HIV.     

Silence,assent and HIV risk

Based on interviews with 34 men, almost all of whom have unprotected sex with men most or all of the time, this paper documents the interactional process, narrative elements and meaning construction in situations of ‘bareback’ sex. Narratives show the differentiated cultural capital circulating among distinct circuits of gay and bisexual men that define the taken‐for‐granted rules of conduct for sexual interactions and give rise to high‐risk situations. Many of the positive men speak of being part of a social environment where ‘everybody knows’ a set of rules whereby sex without condoms can happen as a default circumstance to be interrupted only when a partner asserts a need to protect himself. The practical reasoning processes and interactional back‐and‐forth in the unfolding of sexual interactions, both on the internet and in person, show the uneven and fallible accomplishment of sero‐sorting and the generation of situations of high HIV risk and vulnerability when men from different micro‐cultures encounter each other.     

Cultural factors in young heterosexual men's perception of HIV risk

This paper analyses why HIV risk perceptions vary in a sample of 19-year-old Glaswegian men. The main approaches to explain risk behaviour can be characterised as: individual cognition theories, cultural theories and phenomenology. To date there have been few empirical applications of cultural theory. This paper explores how far a cultural approach can explain the variability in HIV risk perceptions and behaviour, focusing on two key socio-cultural factors: current occupation and stage in partnership career. The analysis shows that young men's perceptions of HIV risk are shaped in part by the cultural meanings associated with their lifestyles and friendship groups, which largely arise from their occupational paths, and in part by the meanings that come with a particular stage of their partnership career. Recognising the role of cultural factors in lay people's response to a new health threat has broader implications for health promotion.     

Sex and the Internet: Gay men,risk reduction and serostatus

Access to the Internet has increased dramatically over the past decade as has its use for meeting sexual partners (e‐dating), particularly among gay men. Between June 2002 and January 2004, 128 gay/bisexual men living in London were interviewed one‐to‐one about their experience of e‐dating, sexual risk and HIV prevention. The men were recruited both online (through the Internet) and offline (in clinics and the community); 32 men were HIV‐positive, 59 HIV‐negative, while 13 had never had an HIV test. A key finding was that both identity as well as anonymity are vital to e‐dating. Through a process of online filtering and sero‐sorting, HIV‐positive men are able to meet other positive men for anal sex without condoms. While this does not present a risk of HIV transmission to an uninfected person it does have implications for the potential transmission of other STIs such as syphilis and LGV. Through e‐dating, HIV‐positive gay men can also avoid abuse, discrimination and sexual rejection. Our findings do not support the suggestion that the attraction of e‐dating is that it affords absolute anonymity. We found that the gradual expression of identity is vital for e‐dating among gay men. Internet‐based HIV prevention campaigns need to take account of the different ways in which gay reflexively manage aspects of their identity online

Résumé

Dans cet article, l'auteur explore le contexte dans lequel la femme risque d'attraper le virus du Sida dans la ville de Chiang Mai en Thaïlande. Il examine le comportement sexuel des hommes et des femmes, leur attitude vis‐à‐vis des métiers du sexe et la perception du risque d'attraper le VIH. Ses conclusions sont tirées des données recueillies au milieu des années 90, au plus fort de l'épidémie. Les hommes et les femmes qui participèrent à cette recherche soulignèrent un certain nombre de thèmes importants. Tout d'abord, certains hommes continuaient à avoir des rapports sexuels non protégés avec des professionnelles du sexe. Deuxièmement, au lieu d'avoir recours aux professionnelles du sexe, les hommes, étant donné leur crainte du Sida, étaient conduits à chercher des partenaires sexuels parmi leurs amies et connaissances car ces personnes étaient censées ne présenter aucun danger par rapport à l'éventuelle transmission du virus. Troisièmement, les femmes qui participèrent à cette recherche ignoraient en grande partie cette extension du réseau sexuel au delà du milieu professionnel du sexe proprement dit. Enfin, la sexualité des femmes était en grande partie méconnue de ceux chargés de promouvoir la politique de santé publique; les participants hommes et femmes n'en tenaient pas compte non plus, ce qui mettait les femmes en danger d'attraper le VIH.

Resumen

En este artículo examino en qué contexto las mujeres corren el riesgo de contraer VIH valorando la conducta sexual de hombres y mujeres, las actitudes hacia el trabajo sexual y la percepción de riesgo de HIV en la ciudad tailandesa de Chiang Mai. Los resultados se basan en datos recopilados durante mediados de los noventa cuando la epidemia estaba en su punto más álgido. Los hombres y mujeres que participaron en este estudio destacaron una serie de cuestiones importantes. En primer lugar, algunos hombres seguían teniendo sexo arriesgado con las trabajadoras sexuales. En segundo lugar, el miedo a contraer VIH motivaba a los hombres a buscar amigas y conocidas en lugar de trabajadoras sexuales para sus encuentros amorosos porque pensaban que así estaban seguros de no infectarse. En tercer lugar, las mujeres de este estudio desconocían en gran medida la expansión de la red sexual más allá del trabajo sexual. Por último, la sexualidad de las mujeres en general no era reconocida en las respuestas de salud pública o por los participantes masculinos y femeninos, con lo que corrían el riesgo de contraer VIH.     

Assessing the effectiveness of HIV prevention peer education workshops for gay men in community settings

Objective : To use existing evaluation data of community‐based HIV prevention peer education workshops (PEWs) for gay men to explore the challenges in evaluating such programs in community settings. Methods : Data came from 33 PEWs conducted with gay and bisexual men. A basic pre/post‐test design was used to measure sexual health capacity. The Sexual Health Capacity Scale (SHCS) was anonymously completed before participation and twice afterward, with the men measuring perceptions of themselves before participation and perceptions of themselves after participation. The anonymous nature of the SHCS created problems for matching data so, for the most part, independent samples tests were used for analysis. Results : Overall, 399 gay and bisexual men participated in PEWs. Participants perceived themselves as having more sexual health capacity after participation than before (p<0.001). Those who had previously been HIV tested before the PEW had higher perceived capacity (p<0.001). Conclusions and Implications : Participation in the PEWs appeared to increase the perceived sexual health capacity of gay and bisexual male participants. Several limitations in the data arose from issues in the original data collection. A mixture of anonymous and identifiable data‐sources meant that data could not always be matched to individuals. Stronger partnerships between HIV researchers and professionals within community organisations could significantly improve evaluation of the effectiveness of HIV peer education.