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“It’s Hard to Know What is a Risky or not a Risky Decision”: Gay Men’s Beliefs About Risk During Sex

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Abstract

Gay men increasingly use non condom-based risk reduction strategies to reduce the possibility of HIV transmission. Such strategies rely on men’s knowledge and communication with each other, but how they employ these strategies may depend as much on their attitudes toward risk and pleasure. We explored current beliefs about safe sex, sexual desire and risk behavior in an online survey of 2306 Australian gay men. The survey included free text components to explore men’s beliefs about risk and pleasure. We conducted a principal components factor analysis on the safe sex belief items in the survey, and thematic analysis of the qualitative material was used to interrogate the concepts underpinning these beliefs. We identified two measures of safe sex beliefs: risk reduction optimism (HRRO; α = 0.703); and viral load optimism (α = 0.674). In multivariate analysis, unprotected anal intercourse with casual partners (UAIC) was associated with HRRO among non HIV-positive men only (p < 0.001), but, regardless of HIV serostatus, UAIC was associated with a belief that serosorting could be an effective risk reduction strategy and with being more sexually adventurous in general. Using the qualitative data we identified four themes in how men think about HIV: ‘seeking certainty’, ‘regretful actions’, ‘nothing is safe’, and ‘acting on beliefs’. Each theme interacted with the safe sex beliefs measures to provide a highly contextualised understanding of men’s beliefs about safe in specific circumstances. Gay men think about the risk of HIV transmission in qualitatively different ways depending on specific circumstances. While measures of belief about relative risk of HIV transmission are useful indicators of men’s propensity to take risk, they oversimplify men’s thinking about risk, and fail to account for the role of desire, both in influencing men’s thinking about risk, and in how they balance their perception of relative risk against the pursuit of pleasure.

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References

  1. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587–99.

    Article  PubMed  CAS  Google Scholar 

  2. Editorial. HIV treatment as prevention: it works. Lancet. 2011;377:1719.

  3. Jin F, Crawford J, Prestage GP, et al. Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS. 2009;23:243–52.

    Article  PubMed  Google Scholar 

  4. Prestage G, Down IA, Bradley J, McCann PD, Brown G, Jin F, Hurley M. Is optimism enough? Gay men’s beliefs about HIV and their perspectives on risk and pleasure. Sex Transm Dis. 2012;39(3):167–72.

    Google Scholar 

  5. Sullivan PS, Drake AJ, Sanchez TH. Prevalence of treatment optimism-related risk behavior and associated factors among men who have sex with men in 11 states, 2000–2001. AIDS Behav. 2007;11:123–9.

    Article  PubMed  Google Scholar 

  6. Brennan DJ, Welles SL, Miner MH, Ross MW, Rosser BRS, and The Positive Connections Team. HIV treatment optimism and unsafe anal intercourse among hiv-positive men who have sex with men: findings from the positive connections study. AIDS Educ Prev. 2010;22(2):126–137.

    Google Scholar 

  7. Van de Ven PG, Bartholow B, Rawstorne P, Crawford JM, Kippax SC, Grulich AE, Prestage GP, Woodhouse M, Murphy D. Scaling HIV vaccine attitudes among gay men in Sydney. AIDS Res Hum Retroviruses. 2002;18(18):1333–7.

    Article  Google Scholar 

  8. Ostrow DE, Fox KJ, Chmiel JS, Silvestre A, Visscher BR, Vanable PA, Jacobson LP, Strathdee SA. Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men. AIDS. 2002;16:775–80.

    Article  PubMed  Google Scholar 

  9. Schwarcz S, Scheer S, McFarland W, Katz M, Valleroy L, Chen S, et al. Prevalence of HIV infection and predictors of high-transmission sexual risk behaviors among men who have sex with men. Am J Public Health. 2007;97:1067–75.

    Article  PubMed  Google Scholar 

  10. Crepaz N, Hart T, Marks G. Highly active antiretroviral therapy and sexual risk behavior. JAMA. 2004;292(2):224–36.

    Article  PubMed  CAS  Google Scholar 

  11. Halkitis PN, Zade DD, Shrem M, Marmor M. Beliefs about HIV noninfection and risky sexual behavior among MSM. AIDS Educ Prev. 2004;16(5):448–58.

    Article  PubMed  Google Scholar 

  12. Ostrow DG, Silverberg MJ, Cook RL, Chmiel JS, Johnson L, Li X, et al. Prospective study of attitudinal and relationship predictors of sexual risk in the multicenter AIDS cohort study. AIDS Behav. 2008;12:127–38.

    Article  PubMed  Google Scholar 

  13. Mao L, Crawford JM, Hospers HJ, et al. “Serosorting” in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia. AIDS. 2006;20:1204–6.

    Article  PubMed  Google Scholar 

  14. Hart GJ, Elford J. Sexual risk behaviour of men who have sex with men: emerging patterns and new challenges. Curr Opin Infect Dis. 2010;23:39–44.

    Article  PubMed  Google Scholar 

  15. Mao L, Kippax S, Holt M, Prestage G, Zablotska-Manos I, De Wit J. Rates of condom and non-condom based anal intercourse practices among homosexually active men in Australia: deliberate HIV risk reduction? Sex Transm Infect. 2011;87(6):489–93.

    Article  PubMed  Google Scholar 

  16. Parsons JT, Schrimshaw EW, Wolitski RJ, Halkitis PN, Purcell DW, Hoff CC, et al. Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation. AIDS. 2005;19:S13–25.

    Article  PubMed  Google Scholar 

  17. Prestage GP, Mao L, Kippax S, Jin F, Hurley M, Grulich A, Imrie J, Kaldor J, Zablotska I. Use of viral load to negotiate condom use among gay men in Sydney, Australia. AIDS Behav. 2009;13(4):645–51.

    Article  PubMed  Google Scholar 

  18. Deleuze G. Desire and pleasure. In: Davidson AI, editor. Foucault and his interlocutors. Chicago: University of Chicago Press; 1997.

  19. Race K. Pleasure consuming medicine: the queer politics of drugs. Durham: Duke University Press; 2009.

    Google Scholar 

  20. Halperin DM. What do gay men want? An Essay on sex, risk, and subjectivity, Ann Arbor: University of Michigan Press; 2007.

  21. Race K. Revaluation of risk among gay men. AIDS Educ Prev. 2003;15(4):369–81.

    Article  PubMed  Google Scholar 

  22. Kalichman SC, Johnson JR, Adair V, Rompa D, Multhauf K, Kelly JA. Sexual sensation seeking: scale development and predicting AIDS-risk behavior among homosexually active men. J Pers Assess. 1994;62:385–97.

    Article  PubMed  CAS  Google Scholar 

  23. Mao L, Van de Ven P, Prestage G, Jin F, Grulich A, Crawford J, Kippax S, Murphy D, Allan B. Health. In: Men baseline data. Monograph 6/2002. National Centre in HIV Social Research, Kensington: The University of New South Wales; 2002.

  24. Eaton LA, Kalichman SC, Cherry C. Sexual partner selection and HIV risk reduction among black and white men who have sex with men. Am J Public Health. 2010;100(3):503–9.

    Article  PubMed  Google Scholar 

  25. Strauss AL. Qualitative analysis for social scientists. New York: Cambridge University Press; 1987.

  26. Bourdieu P. Outline of a theory of practice. Cambridge: Cambridge University Press; 1977.

    Book  Google Scholar 

  27. Hurley M, Prestage GP. Intensive sex partying amongst gay men in Sydney. Cult, Health Sex. 2009;3:1.

  28. Race K. Revaluation of risk among gay men. AIDS Educ Prev. 2003;15(4):369–81.

    Article  PubMed  Google Scholar 

  29. Hurley M. When HIV is endemic amongst gay men. In: Smaal Y, Willett G, editors. Out here: gay and lesbian perspectives VI. Melbourne: Monash University Publishing; 2011. pp 120–134.

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Acknowledgments

This study was commissioned by and funded by the Departments of Health in the states of NSW, Victoria, South Australia and Western Australia. Indirect support was also provided by the Queensland Health Department. The Kirby Institute is affiliated with the Faculty of Medicine, University of New South Wales. The Australian Research Centre in Sex Health and Society (ARCSHS) is affiliated with the Faculty of Health Sciences, La Trobe University. The Kirby Institute and ARCSHS receive funding from the Commonwealth of Australia Department of Health and Ageing.

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Authors and Affiliations

  1. Kirby Institute, University of New South Wales, Corner West and Boundary Streets, Darlinghurst, Sydney, NSW, 2010, Australia

    Garrett Prestage, Ian Alan Down & Fengyi Jin

  2. Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, Australia

    Garrett Prestage, Graham Brown, Ian Alan Down & Michael Hurley

  3. Western Australian Centre for Health Promotion Research, Curtin Health Innovation Research Institute, Perth, Australia

    Graham Brown

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  1. Garrett Prestage
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  2. Graham Brown
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  3. Ian Alan Down
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  4. Fengyi Jin
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  5. Michael Hurley
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Correspondence to Garrett Prestage.

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Prestage, G., Brown, G., Down, I.A. et al. “It’s Hard to Know What is a Risky or not a Risky Decision”: Gay Men’s Beliefs About Risk During Sex. AIDS Behav 17, 1352–1361 (2013). https://doi.org/10.1007/s10461-012-0180-7

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  • DOI: https://doi.org/10.1007/s10461-012-0180-7

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