Conflicting images of HIV and AIDS foster sexual risk behavior among MSM in Germany
Background: In the context of significantly rising HIV diagnosis in Germany the present study was implemented to identify psychosocial factors of HIV risk behavior among MSM as the epidemiologically most affected group. Specific regard was paid to existing images of HIV and AIDS, because the perception of the disease was considered to have major influence on sexual behavior. In prevention discourse the vast disappearance of AIDS in public in the HAART era is seen as a promoting factor for therapy optimism and sexual carelessness.
Methods: In co-operation with the Federal Agency For Health Education and the medical Competence Network HIV/AIDS a qualitative interview study was designed. 58 semi-structured interviews with recently HIV-positive diagnosed MSM that were recruited by community magazines and internet forums were carried out between January and June 2007. The research process was escorted by a scientific board and psychologically supervised. Following computer-based categorical analyses, psychoanalytic concepts were applied to the data, and the results were contextualized within social psychological theories.
Results: The analysis showed the simultaneous, often pre-conscious existence of conflicting images of the disease in the perception of a significant part of the interviewees. Alongside “new” images of an uncomplicated life with the infection, fearless and better sexuality and a “positive community”, “old” pre-HAART images of suffering, isolation, and death were detected. In order to maintain a sense of coherence, the cognitive dissonance was covered by diffuse therapy optimism and associated with repression of fearful images. This dynamic exacerbated a rational handling of HIV-specific information before the infection and inhibited an adequate reaction to the HIV risk exposure.
Conclusions: The present study proved the influence of conflicting images of HIV and AIDS on current sexual risk behavior among MSM in Germany. Accordingly, effective prevention strategies have to aim at reducing cognitive dissonances by promoting consistent credible images of the disease.
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