Abstract #263  -  HIV/aids prevention among French gay men: risk perception and preventive decision with casual partners.
Authors:   Presenting Author:   Mr Gabriel Girard - CERMES EHESS
Additional Authors:
Aim: For the last 15 years, epidemiological surveys have shown significant changes in the prevention behaviors among gay men in Western countries. The emergence of debates about “serosorting” among gay communities, researchers, and aids activists can be related to this evolution. Epidemiological surveys, such as the French one entitled “Enquete Presse Gay” is very informative about the changing trends in preventive behaviours —the use of condoms and any other strategies to reduce risks... This study analyzes unprotected anal intercourse and its relation to the type of partners, and their serological statuses. Unprotected anal intercourse with casual partner of unknown, or different status, remains the main category to assess risks. Yet, few data about the context of prevention behaviors, and its influence on risk perception, are provided by French epidemiological surveys. For example, casual partners are not entirely unidentified. The limit between casual and steady is inappropriate to understand the level of confidence between casual partners and the context within preventive decision is elaborated bay individuals. In this presentation, I’m interested in analyzing how French gay men explain the process of decision-making, whether they choose to have protected or unprotected anal intercourse, the way they perceive their partners and his serologic status.
Method / Issue: This survey is based on 38 semi-directive qualitative interviews with gay men which were conducted in 2007 and 2008. In order to be as inclusive as possible, I chose to give priority to criteria related to diversity, such as age, serologic status and place of residence.
Results / Comments: The analysis of the interviews shows three modes of decision making in context, independently of age, serologic status, place of residence. - A first group of respondents declare a consistent use of condom with any casual partner. They explain it on moral grounds due to their belonging to the gay community which is affected by HIV. - A second group of respondents operate a differentiation between known casual partners (inside a sociability network), and unknown casual partners (anonymous sexual encounters). The use of condoms is linked to the level of confidence they have in their partner and his serostatus and to what the partner said about his serostatus. For HIV positive respondents, a supposedly concordant serostatus is a condition for condomless sex. - A third group of respondents explain that their preventive choices are based on talks they have with their partner about his seorstatus, viral load, and STI. This mode of rationalization of risky behaviors is often associated with a self definition as barebacker. Deciding to have protected, or unprotected, sexual intercourse with casual partners challenges the perception of risk, according to the context. None of the respondents said that they were willing to transmit HIV, or to be infected. However, the modes of rationalization, including open discussion on serologic status, represent a minority of the sample. Most of the time, the serostatus assumption is a criterion of decision which is linked to the context of encounter, and/or to the level of confidence they have in their partner.
Discussion: It is useful to analyse more precisely how risk representations are built in the gay community. Distance or closeness from gay community networks structures different perceptions of danger and responsibility. It seems necessary to enhance the knowledge of the serostatus and the ability to disclose serostatus.
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