SEX, INTIMACY AND POWER: THE LIVED EXPERIENCES OF YOUNG GAY MEN (YGM) IN THE CONTEXT OF RISING HIV INFECTIONS IN VANCOUVER

AJ Schilder¹, C Buchner^1,2, ML Miller¹, S Martindale¹, MT Schechter^1,2, MV O’Shaughnessy^1,3, RS Hogg^1,2, P Spittal^1,2
1British Columbia Centre for Excellence in HIV/AIDS; ²Department of Health Care & Epidemiology, University of British Columbia; ³Department of Laboratory Medicine & Pathology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia

Background: Recent seroconversion data indicate that regular and significant relationships are potent predictors for HIV infection. However, after 15 years of research few studies address the intimate/affective lives of young gay men (YGM). Even less is understood regarding the power dynamics that characterize YGM’s intimate sexual lives. Objectives: To better understand the issue of rising HIV incidence in a prospective study of YGM, it is necessary to understand the dynamics of men’s intimate sexual lives which place them at increased risk for HIV infection.
Method: Participants were recruited from the Vanguard Project, for which these data were collected through 104 in-depth interviews with 26 HIV-positive and HIV-negative YGM. These ethnographic data were managed through NU*DIST software. Themes investigated include family history, experiences with physical and sexual violence, intimate relationships and HIV-related vulnerabilities.
Results: Results indicate that despite early heterosexual conditioning, monogamy is an elusive concept in YGM’s sexual lives. Gay men’s relationships can be characterized by the term serial and non-serial gay polyandry. Regular and sero-discordant coupling occurs within a polyandrous cultural context wherein multiple relationships are influenced by various constructs of power and status. YGM’s beliefs about power are intricately tied to meanings imbued in both penetrative and receptive roles in anal intercourse known as topping and bottoming. Men who socially identify as “bottoms” relearn to use their bodies and minds. To facilitate bottoming, drug use – including nitrite inhalants and alcohol – is a means to disinhibit or disengage; exacerbating further higher risks associated with unprotected receptive anal sex.
Conclusions: YGM’s experiences with risk are landscaped by inequitable power relationships. Cultural identities tied to topping and bottoming are gender and power constructs that must be better understood by HIV interventionists.