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This post was published on 05/04/10 in Men, women and others, Science.

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  1. Comment by Jim Pickett, 05/04/10, 06:58:

    None of this analysis takes into account the large amount of infections that:

    A. happen during acute infection (when people don’t know their status) and

    B. that 68% of new infections (see Patrick Sullivan’s paper from late 2009) happen in the context of RELATIONSHIPS, and not on binging and screwing around.

    Sure, those relationships are defined in all kinds of ways – but they are considered relationships by the men – and that is what matters.

    Where are the prevention campaigns that take relationships into account? We spend TONS of time talking about all these “naughty” boys doing “naughty” things – and completely ignore the context in which most infections occur.

    It’s a very sad state of affairs. And speaks volumes about the ways in which our homophobic society continues to pathologize and disrespect gay men’s lives.

    Sure this is anecdotal – but MANY of the gay men who are POZ seroconverted in relationships – and I am one of them.

    Until we address these realities, and help gay men take better care of themselves in all kinds of relationships – from dates, fuck buddies and friends with benefits to open and monogamous relationships.

    We have known for eons that the number one risk factor for women’s acquisition of HIV is marriage. Somehow no one ever thought something similar could be going on among gay men…

    Why is that?

  2. Comment by Jim Pickett, 05/04/10, 07:00:

    One thing I missed above:

    Sure this is anecdotal – but MANY of the gay men I KNOW who are POZ seroconverted in relationships – and I am one of them.

  3. Comment by olen, 05/04/10, 07:59:

    I am so happy to see that someone in public health/epidemiology actually getting it. Your exploration of rationality cutting clear through the bog of epidemiological statistics, or rather, effectively complementing it. The horrible data and nasty statistics are not the reality lived by developed-world MSM, to whom HIV APPEARS no longer a threat. Continual traumatization from fear-based public health propaganda hastens the subconscious dismissal of statistical fact in favor of the lived experience, while at the same time fueling self-destructive drives towards intentional seroconversion. I am personally working to challenge HIV stigma, as it’s a HUGE problem, and will continue this discussion in an email! 🙂

  4. Comment by Paddy, 06/04/10, 09:59:

    @ Jim Pickett,

    I read your post with interest. How would you recommend that campaigns could better prevent transmission in the context of male-male fuck buddies, fwb, etc?

  5. Comment by Gus Cairns, 09/04/10, 08:27:

    Hi Elizabeth,

    First, thanks for quoting me and calling me sensible (my bf and family would probably not agree).

    I’d like to add in the other two possible reasons I’d suggested for the study’s findings. NB having talked to Ken Mayer, it’s clear now that age and time since diagnosis are so closely correlated in this study it’s impossible to say if what we’re seeing is a “foolish youth” explanation or a “post-diagnosis shock” one.

    For what it’s worth, I favour explanation 2.

    1. The sociopsychological explanation: HIV diagnosis in heterosexuals is marked by shock, shame, withdrawal and social isolation, so they tend to reduce the amount of sex they have. Gay men’s reaction to diagnosis may be very different, if only because they have the opportunity to be different: they may still be shocked but react to it by throwing caution to the winds or drugging and boozing, or they may rationalise diagnosis as relief that they ‘don’t have to worry’ any more. Good qualitative research might unpack some of this.

    The solution would involve really good post-diagnosis education and sociopsychological support.

    2. The biographical explanation: What we’re actually seeing is HIV infection as a passive marker of a period of high risk sex and drug use that a lot of gay men go through once or several times in life, maybe associated with coming out or relationship breakup. Eventually for one reason or another they sober up or get steady relationships or something – a sort of behavioural regression to the mean. Meanwhile some have inevitably caught HIV. We could find this out with a longitudinal cohort study of initially HIV-negative men.

    In this case the solution would be nothing to do with HIV and everything to do with reducing social isolation, stigma and self-stigma in gay men.

  6. Comment by Drew, 15/04/10, 06:22:

    I expect this line of reasoning will be passed-over as a revenant of Freudian thinking; but as a Behaviour Analyst I see some cogency to it:
    MSM recently diagnosed may have a period of compulsive sex due to the “sex proves you are alive”-effect. It may not be any of these elegant suppositions but rather that old & robust: ” Dead people don’t have sex ” concept. Yes, this implies sticky bits like the unconcious mind hypothesis- but is there not a pro intuitive edge to it? A (virally induced) mid-life crisis where the sex act so central to the debate/research is merely a facet of a larger process of wrestling with mortality?

  7. Comment by Yani, 16/04/10, 06:28:

    I think there is some scope here for looking at concepts of Swarm Intelligence (SI). When messages aren’t working then either they aren’t being repeated enough or they have been made too soft to ‘spare people’s feelings’. AA don’t spare people’s feelings, quite the opposite. “Look at what you have done to the people you love!” Certainly here in Australia we need campaigns that really upset people with deliberate intent to reactivate SI. They need to cycle between disturbing and compassion most likely following the seasons. I say that as a negative person with many positive friends and way too many dead friends. HIV and suicide being the biggest killers. Hard messages but in the context that it is life that is to be encouraged.

  8. Comment by Tony, 29/04/10, 04:45:

    The number of times I have slipped up since becoming poz is very small. The reason it’s happened is that I’m human. I try and analyze the factors that came into play (was I drunk, where was I (venue, time of day/night, psychological headspace), was it someone I know well or not, did we talk much or not and about what) and do everything I can to prevent a recurrence.

    I know I’m just as fallible as anyone else, but call it stigma or whatever but the 60 seconds where I get carried away and BB someone before snapping out of it and putting on a rubber or switching to a different activity sure make me feel like I’m a horrible human being. Which feels like a barrier to me doing better in the future, but it doesn’t stop me from trying.

    And the name and email I posted above are a lie, because even though I have an undetectable VL and almost always consistently play very safe, those few short instances of making a mistake could put me in jail for a longtime and/or change my life irrevocably.

    Honestly, I don’t think any of these ads really make a difference, and I think the “Life with HIV sucks” ones in particular are useless and damaging.

  9. Comment by Haris, 30/05/10, 02:22:

    I just finished watching your TED talk, as well as reading your blog post. I am ecstatic that there is finally a multidimensional dialogue about prevention of HIV. Scare tactics, condom use, HIV testing buses simply do not work.

    Young gay men are already feeling too invincible, and defiant after coming out of closet, and in combination with drugs such as meth, condoms are the farthest thing on their mind.

    We have to design a system, where we can tap into this defiance and invincibility to use it as a prevention method.

    For my undergraduate thesis, i have designed a campaign for “safer sex” encouraging “bottom power” i would love to get any and all feedback on it. http://www.harissilic.com/hiv-prevention/

    Thank you in advance.

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