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MACROSOCIAL CORRELATES OF UNPROTECTED ANAL INTERCOURSE (UAI) AMONG MEN WHO HAVE SEX WITH MEN (MSM) IN MONTRÉAL
M Blais1, J Otis1, M Alary2, RS Remis3, B Mâsse4, R Lavoie5, R LeClerc5, B Turmel6, J Vincelette7
¹Département de sexologie, Université du Québec à Montréal, Montréal; 2Département de médecine sociale et préventive, Université Laval, Québec, Québec; 3Department of Public Health Sciences, University of Toronto, Toronto, Ontario; Centre hospitalier affilié universitaire de Québec, Québec; 5Coalition des Organismes Communautaires Québécois de lutte contre le sida; 6Institut National de Santé Publique du Québec; 7Department of Microbiology and Infectious Disease, Hôpital Saint-Luc du Centre hospitalier de l'Université de Montréal, Montréal, Québec
Background: Two sociological theories hold opposing conceptions of social vulnerability. The traditional view describes vulnerability as a function individuals' socioeconomic and/or symbolic capital. A contemporary view stresses the individualization of social inequalities. In this model, vulnerability is not an a priori condition, but a result of individualized abilities to manage risky situations.
Objective: To describe the macrosocial correlates of UAI by partner type and serological status among Montreal MSM.
Method: From October 1996 to July 2004, 1890 MSM were recruited by the Omega Cohort Study. Every 6 months, participants were administered detailed questionnaires and tested for HIV. Two way ANOVAs and post-hoc tests were used to test the association of macrosocial factors (ie, educational attainment, employment status, socio-professional categories, income) with UAI by partner type and serological status: regular/unknown status (RegUn), regular/positive (RegHIV+), regular/negative (RegHIV–) and casual/unknown status (CasUn). Interactions between age (<30 yo vs ³30 yo) and the macrosocial factors and between educational attainment and the other factors were tested.
Results: Two way ANOVAs revealed that MSM with lower educational attainment have more UAI with risky partners (RegUn, F=5.67, p<0.001, RegHIV+, F=5.78, p=0.002, CasUn, F=5.68, p<0.001).
Men aged ³30yo without a diploma take more risks (UAI with CasUn). Employment status was associated with UAI only among MSM with lower educational attainment (F=10.29, p=0.001). Socio-professional category and income were not associated with UAI.
Conclusion: Except for educational attainment, macrosocial factors showed little association with UAI. The more risk evaluation is required (with partners of unknown or positive status) and relational challenges are present, the more education is associated with protection and appears useful in risk management. This study proposes that HIV vulnerability cannot be theorized in terms of social stratification or hierarchy. Individualization of inequalities in sexual risk-taking must be explored.