HIV Risks Reduction Strategies among Gay and Bisexual Men and the Production of Risks in Prevention Discourse
Langer, Phil C.
Psychology Ludwig-Maximilians-University Munich Munich, Germany
Sociology Goethe-University Frankfurt Frankfurt/Main, Germany
Psychology Free University Berlin Berlin, Germany
Background: The number of HIV diagnoses has been rising significantly in most European countries since 2000/01. Men who have sex with men (MSM) are exceptionally affected by this development. As a main factor for new HIV infections risk reduction strategies (RRS) apart from condom use are discussed. Referring to a recent qualitative study on sexual risk behaviour of MSM in Germany we aim at analyzing current risk strategies of gay and bisexual men and evaluating their epidemiological impact in the context of a further production of risks due to a biomedicalization of prevention.
Methods: Based on Grounded Theory 58 semi-structured interviews with recently HIV-diagnosed MSM and untested MSM reporting sexual risk behaviour were carried out in 2006/07. Following computer-based categorical content and discourse analyses, the RRS-related results were contextualized within the concept of an "entrepreneurial self" (Bröckling).
Results: We found considerable evidence of the use of multiple RRS among MSM in our study. They especially encompass serosorting, i.e. the self-restriction to unprotected sexual intercourse to men who are believed to have the same HIV serostatus, strategic positioning, i.e. the taking of an insertive position by the HIV-negative partner, and therapy sorting, i.e. the inclusion of HIV treatment status as criterion for sexual decisions. The reported HIV infection could be linked to "failing" RRS due to inaccurate evaluation of transmission risks in many cases. The decision for unprotected sexual intercourse was based on in-group community knowledge about biomedical virus transmission probabilities. The intentional use of RRS can be interpreted as coping strategy for dealing with the uncertainty of an infection in the context of new treatment options.
Discussion: The omnipresence of RRS we found in the study points towards a change of attitude towards the disease: It signifies a normalization of HIV within the gay community and indicates that sexuality may increasingly be perceived as a normal behavioural system of society. The ongoing biomedicalization of the Aids dispositive, that promotes antiretroviral drugs as biomedical prevention tools, produces new uncertainties that result in a multiplication of sexual risk situations. Paradoxically present prevention discourse is therefore likely to fuel the HIV epidemic.