REFLECTIONS ON THE CONCEPT OF HIV TREATMENT OPTIMISM BY YOUNG GAY MEN (YGM) IN THE CONTEXT OF RISING HIV INCIDENCE IN VANCOUVER

Mary Lou Miller, Arn Schilder, Chris Buchner, Steve Martindale, Keith Chan, Kevin JP Craib, Michael V O’Shaughnessy, Robert S Hogg, Patricia Spittal
The Vanguard Project, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia

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 HIV risk behaviour. New statistical findings from the Vanguard cohort, however, indicate that only a minority of gay and bisexual men was optimistic in light of new HIV medications.
Objectives: This study qualitatively explores the social and cultural contexts of high-risk decision-making among both HIV-negative and HIV-positive young gay men to ascertain if they believe that new treatments inform risk-taking behaviour. Method: Data for this study 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 and managed through NU*DIST, an ethnographic software system.
Results: Qualitative analysis indicates that as better understandings and 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 and decision-making. Participants related that more relevant understandings of their sexual vulnerabilities include: childhood trauma – including sexual and 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 and 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 and well being of HIV-positive 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, and substance abuse. To intervene appropriately, health practitioners must accommodate the social and cultural realities of gay men’s lives.