This is an article Larry sent me today, I found it very interesting and wanted to share.HIV-positive gay men who have unprotected anal intercourse think of themselves as being in settings where ‘everybody knows the rules of the game’, but these understandings are not shared by all gay men, report Barry Adam and colleagues in the November 2008 issue of
Culture, Health and Sexuality. Tacit miscommunication, faulty assumptions and differences in decision-making processes are all extremely common, and this raises questions of how to develop HIV prevention messages for specific micro-cultures, they write.
The researchers from the University of Windsor and the AIDS Committee of Toronto conducted in-depth interviews with 34 men who have sex with men. All men reported that their sex was unprotected most or all of the time, although there was one respondent who did maintain consistent condom use, with some difficulty. Ten of the men were HIV-negative, and the rest HIV-positive. The interviews focused on unprotected sex, and examined “the narrative sequences, verbal and nonverbal communication and tacit decision rules” surrounding the practice.
In common with many other studies, the researchers found that many HIV-positive respondents expressed a strong desire to avoid passing on their HIV infection. One respondent said: “I don’t want to put anyone through what I went through when I found out I was positive”.
Whilst the HIV-negative respondents had very little to say about disclosure “as they have the luxury of experiencing it as no problem”, the HIV-positive respondents discussed their dilemmas at length. Direct, explicit discussion ran the risk of hostility or of derailing a potentially pleasurable experience. Instead, the men dropped hints and picked up clues. Whilst these hints might be easy for other HIV-positive men to understand, they might not always be self-evident to men who are less in the know.
Indirect disclosure remained common when cruising online, sometimes thought to be a setting that encourages disclosure of HIV status. Many respondents were reluctant to tick the 'HIV-positive' box on their profile, because it appears on a publicly accessible page.
One HIV-positive respondent took the view that all HIV-negative men would be happy to openly declare their status, which implied for him that anybody whose status was left undeclared would in fact have HIV. He commented: “I’ve always assumed that someone who was negative would see that, like they would kind of figure it out”.
Other respondents thought that ticking 'safe sex only' clearly indicated having HIV, because it suggested that precaution was needed. Furthermore, once a 'safe sex only' man had established that his partner was positive too, unprotected sex could become a possibility.
Given the risks and complexity of disclosure, venues such as saunas and sex-clubs were attractive to men with HIV precisely because disclosure was not perceived to be expected. The same respondent who was quoted above on his desire to avoid transmission also discussed going to a sauna: “Disclosure wasn’t as much an issue because everybody is kind of there having sex and some people disclose and some don’t, but there’s not as much pressure to sort of have to deal with it”.
Moreover the researchers describe 'taken for granted rules of conduct' described by a sub-set of the respondents. For example, discussing saunas, several HIV-positive respondents expressed the view that: “If they start to fuck you [without a condom], you probably figure, well, unless he’s an idiot, he’s probably positive himself.” However none of the HIV-negative interviewees mentioned this presumption.
Moreover, several positive men described non-verbal interactions where a failure to introduce a condom or to halt a penetration is understood as informed consent. One said : “Well you start doing it, if they don’t stop, then you keep going”.
Another described an interaction: “When he pulled like the lube out, he put a couple of condoms on the table. So I was given the choice… However, we never actually discussed condoms and as the sexual encounter progressed, we just kind of took it at the silence of not saying anything about it and that it’d be okay and or it was going to happen”.
These men articulated a worldview in which all present were adults who fully understood the risks they were taking. The researchers write that the men’s rhetoric “draws on a particular mix of individualism, personal responsibility, consenting adults and contractual interaction”. Their ‘rational’ accounts of the reasons why a man may be willing to have unprotected sex with a casual partner do not take into account a host of other potential reasons such as condom and erection difficulties, recreational drug use, momentary lapses, trade offs, personal turmoil and depression.
The researchers stress that the HIV-positive respondents wanted to avoid HIV transmission. However they perceived themselves to be in settings where their prospective sexual partners would have the same assumptions and understandings of what was going on. Different micro-cultures exist within the larger population of men who have sex with men, and Barry Adam writes that “the meeting of men carrying these divergent visions of the sexual game plan can create situations of high risk for HIV transmission”.
