A relational and dynamic perspective when designing prevention messages for gay self-identified men in a biomedicalised HIV context
Issues: The availability of HIV antiretroviral drugs for treating existing infections and possibly for preventing new infections in the form of pre or post exposure prophylaxis presents a challenge to existing prevention approaches. Alterations in HIV risk—epidemiologically and medically demonstrated—have led some gay men to devise new modes of risk minimisation. This minimising may for take the form of ‘serosorting’ (selection of sexual partner for serostatus) and/or ‘strategic positioning’ (selection of insertive or receptive positioning with a partner of unknown or opposite serostatus). For those of HIV positive status, such strategies may be likely to incorporate knowledge of an ‘undetectable’ viral load. However, these innovations do not simply mean condoms are not present. They have affected the meaning of condoms whereby the absence of a condom may mean differently to partner’s of different serostatus. When this leads to unexpected and unrecognised seroconversion from HIV negative to positive, the continued practice of the same strategy of minimising risk to self may, in turn, become risk to others.
Description: A literature review of analyses of risk minimisation strategies was undertaken in association with a review of 55 in-depth interviews with self identified gay HIV positive and known or assumed HIV negative status.
Lessons learned: The meaning and material effects of HIV continue to alter through the work of diagnostic and pharmaceutical interventions. In this context individuals engaged in negotiating risk are also altered, sometimes in ways which, in turn, affect the transmission and treatment of HIV. These relational dynamics offer new possibilities for designing prevention messages.
Next steps: Utilising the relational and dynamic nature of treatment and prevention in the mode of social marketing, potentially toxic forms of chemo-prophylaxis could be exploited to give new and more fashionable meaning to condoms.
-Abstract available at link below-