AEGiS-14IAC: Reflections on the concept of HIV treatment optimism by young gay men (YGM) in the context of rising HIV incidence in Vancouver.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Reflections on the concept of HIV treatment optimism by young gay men (YGM) in the context of rising HIV incidence in Vancouver.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. ThOrD1454)

Miller ML, Schilder AJ, Buchner CS, Martindale SL, Chan K, Craib KJ, O'Shaughnessy MV, Hogg RS, Spittal P
BC Centre for Excellence in HIV/AIDS, Vancouver, Canada

INTRODUCTION: "HAART optimism" or "HIV optimism" is the concern expressed by some health care practitioners that the availability of effective antiretroviral therapy may be linked to a resurgence of risk behaviour. New statistical findings from our cohort, however, indicate that only a minority of gay & bisexual men was optimistic in light of new HIV medications. OBJECTIVES: This study qualitatively explores the social & cultural contexts of high-risk decision-making among both HIV-negative & HIV+ young gay men to ascertain if they believe that new treatments inform risk-taking behaviour.

METHODS: Data were collected through a series of in-depth interviews with 26 participants, 13 of whom had seroconverted since baseline. Key themes and issues were identified & managed through NU*DIST, an ethnographic software system.

RESULTS: Qualitative analysis indicates that as better understandings & experience with drug-related side effects emerge, HAART's cultural function changes. HAART intervention is a healthy choice, but as a concept HIV optimism appears to have little relevance in gay men's sexual risk realities & decision-making. Participants related that more relevant understandings of their sexual vulnerabilities include: childhood trauma - including sexual & physical violence - which serves to propel men into environments of risk, including the survival sex trade; and, later in life, unstable periods of coming out & substance use. Therefore the "optimistic" effects of HAART are attenuated by the daily realities of men living within the epidemic.

CONCLUSIONS: HAART improves the health & well being of HIV+ men; however, we did not find that it affected sexual risk decision-making. Moreover, the omnipresent realities of gay men lives are filled with nested risks associated with issues related to intimacy, stigma, homophobia & substance abuse. To intervene appropriately, health practitioners must accommodate the social & cultural realities of gay men's lives.

Keywords: AEGIS, Homosexuality, Male, Homosexuality, Incidence, Bisexuality, HIV Infections, Risk-Taking, HIV Seropositivity, Antiretroviral Therapy, Highly Active, Attitude, Emotions, Personality, Affect, Coitus, Human, Male, therapy, epidemiology, drug therapy

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ThOrD1454