REALITIES, RELATIONSHIP AND SEXUAL RISK AMONG YOUNG GAY MEN (YGM) IN THE CONTEXT OF RISING HIV INFECTIONS IN VANCOUVER

ML Miller¹, AJ Schilder¹, CS Buchner^1,2,4, T Lampinen¹, KJP Craib^1,2, MT Schecter^1,2, MV O'Shaughnessy¹, RS Hogg^1,2, PM Spittal^1,2
1British Columbia Centre for Excellence in HIV/AIDS; ²Dept. of Health Care and Epidemiology, University of British Columbia; ³British Columbia Centre for Disease Control; ⁴Vancouver Coastal Health Authority, Vancouver, British Columbia

Background: Few studies address the intimate lives of young gay men at risk for HIV infections. Sexual risk for YGM is often understood to take place in the context of anonymous sex. Very little is understood about the power dynamics in young gay men's intimate sexual lives that contribute to HIV infection. Recent incidence data indicate that regular partnerships are significant predictors of the likelihood of HIV infection. The objective of this qualitative study was to examine how the dynamics of men's intimate sexual lives and relationships contribute to HIV vulnerability.
Methods: Participants were recruited from the Vanguard Project, and the data were collected through 96 in-depth interviews with 12 HIV-positive participants matched on the basis of age to 12 HIV-negative participants. Ethnographic data were managed through NU*DIST software supporting our analysis. Themes investigated include early life experiences, violence, sexual careers, intention and self-efficacy regarding condomless sex, substance use, kinds of relationships and types of sexual partners.
Results: YGM are influenced by societal norms which emphasize the importance of monogamy. Men in this study related that finding "Mr. Right" was considered one way to assuage the pain and isolation of growing up gay. The lack of social and cultural support and power imbalances between men further exacerbated risk especially in the presence of histories of sexual and physical violence. Relationship breakups profoundly affect sexual vulnerability. In this study many men reported the risks associated with monogamous relationships. Half the seroconverters reported that their seroconversion was due to relationship risks.
Conclusions: YGM's sexual risks are landscaped by relationship dynamics for which they are poorly prepared. HIV interventions that target YGM should address explicitly reduction of relationship-related risks.

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