Culture Change Gay Men, HIV and Risk Reduction

1
Culture Change? Gay Men, HIV and Risk Reduction

• Ross Duffin

2
The Current Moment

• Research identifies risk events to be
  concentrated in particular places, locations and
  contexts involving the co-location of groups of
  more than two, crystal and viagra use, UAIC and
  gay men with HIV
• Within these cultures of sexual risk taking
  there are particular issues relating to
  disclosure and non-disclosure by positive men
  and
• We arent yet responding as effectively as we
  could to these contexts.

3
The Current Moment

• We have moved from treatments optimism to
  treatments reality
• There is a great deal of ambivalence about
  working with cultures of sexual risk taking and
  the meanings and understandings of these cultures
  varies considerably and
• Within Australia Gays relationship with HIV
  may be undergoing another transformational shift.

4
1. Pre-HIV (1970s-early 80s)

• Attitudes to STIs
• Burgeoning sexual cultures
• What Gay was

5
AIDS arrives

• The core?
• AIDS as real and virtual
• Safe sex guidelines science? Culture?
• A collective response
• Reality of the early 1990s
• Two moments

6
Treatments arrive, the core rises

• Normalisation of gay
• Neo-liberalism and individual discourses
• Continually improving treatments
• The return of the core and an open discourse
  about the core
• A new public health and the dominance of medicine

7
The challenge

• Over the next period of HIV prevention our
  challenge is to find ways of
• speaking about the meaning of HIV appropriate for
  now and the next ten years without being reliant
  on historical meanings of HIV and
• finding innovative ways of challenging
  inappropriate and reinforcing appropriate sexual
  risk reduction strategies for HIV that
  acknowledge the pleasure / risk balance and the
  desire of many gay men in these sexual cultures
  for safe as possible UAIC.

8
The Current Moment who?

• Sexually adventurous men
• Aspirational /marginal sexually adventurous men
• Sex networks positive / other?
• Organized sex parties / sex party networks
• Intense party and play scenes
• Sex venues
• Spontaneous group scenes sex venue / internet
  facilitated
• Gay men who have lots of 1-1 partners
• Gay men in serodiscordant relationships
• Gay men in open relationships

9
The current moment gaps? Priority groups for
more work?

• Sexually adventurous men
• Party and play scenes
• Positive men / networks
• Common Features
• No perceived need indeed even hostility
• The clash between HIV and anything goes
• Positive men and emotional safety
• Desire for UAIC

10
Priority groups the what

• How to set up and host an event
• How to access chemoprophylaxis
• Facilitating information sharing between
  different groups and networks
• Information packs post-event

11
The Current Moment new Educational Problems

• where things go wrong is unplanned spontaneous
  groups
• Disclosure dependent practices and serosorting
  extension beyond primary relationships into
  casual relationships
• Negative disclosure
• STIs
• Improving risk reduction
• New sexual ethics for gay men

12
Surrounding the core

• Gay men not at risk
• Occasional risk takers
• Regular risk takers that use risk reduction most
  of the time
• UAIC without regard to risk reduction