Room 524-A | Sexual Orientation Tuesday, July 12, 2005 Time: 2:30 PM-4:30 PM |
HIV seroconversion among men who have sex with men: When sexual pleasure is a source of vulnerability.
Otis, Joanne*,1, Girard, Marie-Eve1, Alary, Michel2, 3, 4, Remis, Robert5, 6, Lavoie, René7, Turmel, Bruno4, Vincelette, Jean8, LeClerc, Roger7, 1 Département de sexologie, Université du Québec à Montréal, Montréal, Québec, Canada2 Département de médecine sociale et préventive, Université Laval, Sainte-Foy, Québec, Canada3 Centre hospitalier affilié universitaire de Québec, Québec, Québec, Canada4 Institut National de Santé Publique du Québec, Montréal, Québec, Canada5 Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada6 Direction générale de la santé publique Montréal-Centre, Montréal, Québec, Canada7 Coalition des Organismes Communautaires Québécois de lutte contre le sida, Montréal, Québec, Canada8 Department of Microbiology and Infectious Disease, Hôpital Saint-Luc du CHUM, Montréal, Québec, Canada
ABSTRACT- In North-American gay communities, despite the implementation of prevention efforts, HIV infection continues to threaten the health of men who have sex with men (MSM). The objective of this presentation is to discuss the importance of sexological factors to our understanding of HIV seroconversion among MSM. As a part of a longitudinal study conducted in Montreal from 1996 to 2003, seronegative MSM at baseline (n:1890) were tested for HIV and completed a questionnaire every six months. Guided by epidemiological, psychosocial, sexological and ecological models, this study explored a diversity of factors (individual to macro–social) potentially associated with risk behaviour and seroconversion. This presentation will report the main findings of the Omega Cohort Study′s final data. In this sample, the incidence of HIV was 0.62 per 100 person–years (95%CI: 0.41–0.84), and remained relatively stable between 1996 and 2003 despite an increase in unprotected anal sex between serodiscordant partners. In addition to the most commonly identified risk factors (needle sharing and unprotected receptive anal sex), this study–s findings highlight the important role of anal sex, in and of itself and of having a large number of partners (>50 partners in the previous 6 months) in seroconversion. In terms of cognitive factors, only lower perceived control over condom use in the months preceding seroconversion and a greater belief in the possibility that they will one day become infected with HIV, were found to characterize men who seroconverted. The other variables significantly associated with seroconversion were generally sexological in nature: being a sexual sensation seeker (factor: adventurism); seeing anal sex as the ultimate sexual pleasure and an expression of power; using a variety of means to heighten sexual pleasure (e.g., voyeurism–exhibitionism, erotic conversations, sex toys and alcohol or drugs). Seroconversion in the gay community does not seem to be associated with social indicators (e.g., poverty, discrimination, low community involvement) of vulnerability but rather to complex and intimately tied personal factors, in which sexual pleasure is the prime source of vulnerability to HIV. The challenge is therefore to integrate both the clinical and educational perspectives of sexology with the current prevention efforts among MSM.
Key words: HIV/AIDS, men who have sex with men, seroconversion, determinant, ecology