AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #287 - Settings, sexual practices and HIV-protection strategies: Circumstances of HIV-infections today.
Authors: Presenting Author: Prof. Dr. Sibylle Nideroest - University of Applied Sciences Northwestern Switzerland
Additional Authors: Mr. Christoph Imhof, Prof. Daniel Gredig,
Aim: About 39% of the 2'019 HIV-infections diagnosed in Switzerland from 2008 till 2010 were classified recent. On behalf of the Federal Office of Public Health, a nationwide qualitative study investigated the circumstances of these recent HIV infections. Its objective was to identify the interplay of the HIV-protection strategy adopted, actual risk behaviour and situational factors that led to the given HIV-infection.
Method / Issue: From April 2008 till January 2011, verbal data were generated in semi-structured qualitative interviews with 31 persons with recent infection between the ages 21 and 64 (24 MSM, 2 heterosexual men, 5 women). The data were analysed along the principles of grounded theory.
Results / Comments: Among the 31 respondents, 25 were able to identify the situation of HIV-infection. Four contracted the virus through sexual encounters with their HIV-positive steady partners, 21 through sexual encounters with casual partners. We determined six ways of getting into relevant risk situations and led to infection: 1) People had adopted a "safer-sex" strategy and failed to implement it for various reasons such as condom failure, alcohol use, etc; 2) People had adopted a protection strategy inappropriate to exclude risk as, for example, asking casual partners about his/her HIV-serostatus; 3) People had adopted a risk-reduction strategy only, like "dipping"; 4) People had adopted a special type of a sero-sorting strategy, as they want to practise unprotected sex only with HIV-positive partners being under HAART, but failed due to relation dynamics. At least, they had unprotected sex with HIV-positive partners who were not under therapy. 5) People oscillated between the use of safer sex, inappropriate and risk-reduction strategies depending on partner-related aspects or sexual arousal; 6) People had adopted no HIV-protection strategy; they didn’t see themselves at risk or were willing to run the risk of HIV-infection.
Discussion: Cases reported in 3, 4, and 5 have evidence of an influence of prevailing discourses on risk- reduction strategies, infectiousness under ART and biomedical prevention on the HIV-protection strategies people adopted. Although there is no direct link between the Swiss-statement about non-infectiousness under ART and behaviour, the results show the growing tensions between the promotion of treatment as prevention and the behavioural messages for prevention like condom use. Against this background, current prevention interventions should include information about HIV-transmission risks inherent to infectiousness under ART, inappropriate and risk-reduction strategies ("dipping", "sero-sorting", "strategic positioning") and continue to encourage condom use.
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