Friday, 14 January 2005 - 10:00 AM

This presentation is part of: HIV Prevention and Treatment

Sex and Culture: A mixed methods study of HIV and STD transmission among Denver MSM in the third decade of AIDS

Purpose: Following a ten year decline, Colorado Department of Public Health and Environment (CDPHE) reports statewide HIV infections have risen 46% since 1999, among those Men who have sex with Men (MSM) comprise 76% of new cases. In addition, syphilis incidence has increased 1,200% since 2001, contributing to a syphilis epidemic among MSM thereby suggesting MSM are engaging in behaviors that pose a high-risk for transmission of HIV and other STDs (CDPHE, 2003). In recent years, several factors have been identified as contributing to epidemic resurgence of HIV among MSM; effectiveness of HIV medications altering perceptions of HIV disease from fatal to chronic, an epidemic outbreak of methamphetamine use among MSM, a generational cohort effect, and prevention burnout (CDC, 2003). Addressing the resurging AIDS crisis among gay men is consistent with core social work values that emphasize assisting vulnerable populations; therefore this study advances the social work mission. Ethnography is coupled with correlational survey research in an effort to elucidate qualitative understandings of behaviors, beliefs, attitudes, and contexts along with empirical evidence of incidence and prevalence. Study results provide HIV prevention planners with ability to develop targeted and scaleable objectives, goals, and strategies for reducing HIV transmission among MSM.

Methods: A snowball sample is recruited from gay bars and bathhouses. The first method involves individual interviews (n=35). In addition, two focus groups each of eight members (n=64) illuminate the perspectives of young, Black, Latino, and HIV positive MSM. Interviews and focus groups center on five research domains; MSM identity, MSM community concerns, HIV risk, knowledge of community resources, and future HIV prevention. Participant observation (sites= 7) is included to illuminate sexual spaces available for MSM. Finally, a survey (n=99) provides empirical support to the ethnographic data, and is included for possible longitudinal use. Both qualitative (thematic analysis of narrative data and observation sites) and quantitative (descriptive and correlations) data analyses were conducted.

Results: The study suggests substance use is frequently associated with unsafe contexts. In addition, participants acknowledged that despite accurate condom knowledge, several factors served as barriers to condom use, including sexual addiction and compulsion, affective states, and desire to please their sexual partner. Disclosure or discussion of individual serostatus appears as another barrier to HIV risk reduction. More specifically, the participants endorsed a wide spectrum of beliefs and practices regarding serostatus discussions ranging from those who always told their partners, to those who did so seldom. Participant observation analyses suggest sexual spaces designed for MSM discourage discussions of serostatus and risk, while perpetuating substance use. Finally, the survey generated several correlations among the variables, most notably for ethnicity, age and HIV serostatus. In addition, correlations were found for substance use and HIV serostatus.

Implications: Implications for micro-level social work include need for culturally appropriate HIV harm reduction strategies for MSM. Macro-level implications included need for development of internal capacity of the MSM community to internally address HIV/AIDS. Finally, policy implications are discussed as they relate to federal policy barriers for HIV prevention planning specific to MSM.

See more of HIV Prevention and Treatment
See more of Oral and Poster

See more of Celebrating a Decade of SSWR (January 13 - 16, 2005)