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They felt this helped reduce stigma. But both HIV-positive and HIV-negative participants questioned the impact of identifying as undetectable in a context where the concept is not well understood in the community. As a result, some gay men felt that they might as well just wait for the confusion around new biomedical prevention options to pass, and actively avoided any new information related to HIV prevention as they found it unhelpful. In discussion of treatment-based prevention strategies, several gay men across the four focus group types expressed considerable distrust of the pharmaceutical industry and of the biomedical research establishment.
They made reference to conspiracy theories linked to profit motives of the pharmaceutical industry. Despite the skepticism expressed by many gay men, some of them identified trusted sources, which were typically healthcare professionals or people working in the HIV field. They throw their own curve to it. My friends had told me that. But it took a nurse and doctor to tell me that before I actually realized that: Some gay men, especially those connected to the HIV sector and those in serodiscordant relationships, expressed frustration at the lack of evolution in HIV prevention messages, with its persistent emphasis on condom use.
They acknowledged that messages around condom use are simpler, but felt that information about risk-reduction strategies other than condoms was being withheld from them, considered taboo, or forbidden by public health. Is this information boycotted? No one is passing it on. Where is this coming from? Even when facing a vast and complex array of information sources and opinions, many gay men across the four types of focus groups described making their own autonomous decisions after reviewing information that they can understand and that they deem credible.
Some of the HIV-negative high-risk men stated that they refuse to pay attention to new information, relying instead on what they already know. But in the meantime — condoms. I feel like anything I say is uninformed.
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Gay men are sifting through a considerable amount of complex information about HIV prevention. They are devising their own personal strategies for how to integrate the information into their sex lives based on decisions about what information and whom they can trust, and on their own values and experiences with HIV. As noted in our article from the perspective of service providers , community discourse is building around biomedical prevention, sometimes without adequate input or guidance from service providers. These are the very service providers who are most trusted when it comes to HIV prevention information.
An important role for service providers is to communicate in clear, sex-positive and user-friendly ways the key messages of what we now know works for HIV risk reduction. Some gay men are acting as peer educators, albeit sometimes reluctantly. PrEP users and gay men who have an undetectable viral load are often acting as key opinion leaders, shifting the conversation, one hook-up profile or chat conversation at a time.
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As service providers, we can support key opinion leaders and sometimes reluctant peer educators by getting easily accessible information into the very virtual or physical venues in which gay men are meeting and interacting. Too often, prevention approaches such as PrEP and undetectability are framed as biomedical tools without recognizing their broader implications.
Biomedical prevention strategies such as PrEP and undetectable viral load are having some important benefits in terms of reducing HIV-related fear and stigma, breaking down serodivides the divisions between people who are HIV negative and HIV positive , allowing HIV-positive men and serodiscordant couples to have the kind of sex they desire, and generating renewed conversations around HIV prevention in gay communities. San Patten , the Resonance Project Coordinator, is a consultant based in Halifax who specializes in HIV policy, community-based research, facilitation, and program evaluation.
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You told us: HIV stigma still exists
What gay men are saying about biomedical information on HIV prevention. Current Issue Back Issues Subscribe. What is the Resonance Project? We conducted four types of focus groups with gay men in Vancouver, Toronto and Montreal: The data are from a larger study of gay couples aimed at exploring relationship-based predictors of sexual risk behavior. We expect that our findings will highlight the need for focused HIV-testing interventions for gay male couples. We recruited gay male couples from the San Francisco Bay area between June and February using active and passive recruitment strategies at community venues.
To be eligible, both partners had to be at least 18 years old, have been in the relationship for at least 3 months, know their own and their partner's HIV status and be fluent in English. The resulting sample consisted of couples of all three serostatus groups — concordant HIV-negative, serodiscordant and concordant HIV-positive — as well as all agreement types.
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The present findings are from the HIV-negative gay men in the sample belonging to concordant HIV-negative and serodiscordant relationships. Participants also reported about various aspects of their health including sexually transmitted diseases STDs. Participants' responses about the type of their sexual agreement were used to create two couple-level agreement categories: Was determined by self reports of the result of the participants' last HIV test.
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Participants were queried in detail about their sexual behavior in the past three months. The questions asked about the number of episodes of anal sex they had with their primary partner as well as with outside partners of HIV-positive, HIV-negative and unknown serostatus. The questions asked about insertive and receptive anal sex, with and without ejaculation, and with and without condoms.
Using these responses about anal sex as well as the participant's and his primary partner's serostatus reports, we created two separate risk variables: Further, each of these risk variables was dichotomized into zero episodes of UAI and at least one episode of UAI in the past three months.
Descriptive statistics for the sample were first generated. The elapsed time between the men's reported latest HIV test date and the survey date was calculated in months. Frequencies were calculated for the overall sample and for each of the subgroups of men, for the time-since-last-test categories.
All analyses were conducted using S AS V9. The median age was 39 years Range: Among this last group, the time since last test varied widely, for instance, from both partners getting tested in the past three months, to one partner getting tested over three years ago and the other in the past three months, to both partners getting tested over five years ago.
HIV testing is the first step towards early detection and linkage to appropriate care and thereby towards reduction in transmission for those uninfected and a better quality of life for those infected. In contrast, in our present sample of HIV-negative men in committed relationships, only half got tested within the previous 12 months. Even more alarming is the finding that among those who engaged in risky sex in the past three months, small proportions got tested in the same period. For instance, only one third of the men in discordant relationships and only a quarter of the men in concordant negative relationships who had UAI with a discordant or unknown status partner within the 3-month period prior to the survey got tested in that time frame.
It appears from this, that men in serodiscordant relationships are more sensitive to the need for prompt testing in the presence of sexual risk behavior.
While the number of concordant HIV-negative couples where both partners reported sexual risk behavior is too small to draw generalized conclusions, only one couple among them got tested in the period of exposure. It is unclear why so few men got tested after potential exposure to HIV.
HIV-negative men in longer term serodiscordant relationships, may have, over time, adapted a combination of risk reduction strategies such as viral load monitoring of HIV-positive partners, strategic positioning and withdrawal and therefore don't necessarily test after having UAI. Among men in concordant HIV-negative relationships the reasons for inadequate testing are not self-evident. Perhaps they too use risk reduction strategies and thus perceive being less susceptible to HIV.
It is known that, to be able to have UAI with each other, many HIV-negative couples have monogamous agreements or agreements about condom use with outside partners, which may provide a sense of security and diminish the perceived need or urgency to get tested. One of the strengths of these findings is that they come from a sample of gay couples as opposed to single gay men who are the focus of most MSM research.
Further, in contrast to surveillance data, we were able to highlight the testing behavior of men in the presence of one or more episodes of risky UAI in the recent past.
Tempering our findings are limitations that include a non-probability sample that may not be representative of all gay couples, and self-reported data that are subject to recall biases. Additionally, social desirability bias, while reduced by the use of ACASI, could have still lead to underreporting of sexual risk and a more favorable reporting of date of most recent HIV test; however, both of these possibilities would make the findings more conservative.
Since it was not a focus of the parent study, we do not have data on motivations and barriers to testing or the context within which gay men in relationships decide for or against testing. Finally, it is possible that with a median relationship length of four years, our sample is more representative of gay couples in longer-term relationships and as such the present results may or may not directly apply to younger individual gay men who are more often the subjects of periodic surveillance.
Similar investigations are needed with other independent samples of gay male couples with shorter and longer relationships in order to draw more generalizable conclusions about the lack of prompt testing in the presence of sexual risk behavior with primary as well as outside partners.
HIV testing and prevention strategies for HIV-negative gay men in committed relationships should be specifically designed to utilize the interplay of the couples' relationship dynamics. Efforts have been made to conduct couples-based counseling and testing for HIV for gay male couples in the US But given the high prevalence of new infections among men who have tested in the past year 8 , the high rate of seroconversions that occur within primary relationships 9 - 11 and clear delays in testing even in the presence of sexual risk behavior, additional research into the testing habits and needs of HIV-negative men in primary relationships should be a priority.
Testing recommendations should put a stronger emphasis on testing more frequently, independent of perceived risk behaviors.