Abstract
ABSTRACTThe study reported here sought to understand the rationales of safer sex practices adopted by newly diagnosed HIV-positive men who have sex with men (MSM). Guided by a socio-ecological framework, an ethnography was conducted among newly diagnosed HIV-positive MSM. In-depth interviews and participant observation were employed to produce an account of the social and cultural settings that was faithful to the perspectives of participants. A total of 31 participants with diverse backgrounds were recruited in a southern city of China. Participant observation was conducted in local healthcare settings, MSM venues, and NGO offices. Most participants (24/31) reported stopping unprotected anal intercourse (UAI) immediately after being diagnosed as HIV-positive. Factors associated with safer sex practices were identified at both individual and environmental levels, including self-protection, establishment of self-esteem, dignity, altruism and reciprocity, disease experience as a source of personal growth, and organizational culture and values. Newly diagnosed HIV-positive MSM navigate their sexual practices within the context of multiple competing factors. Implications for sustained behaviour change enabling safer sex practices include stimulating survival instinct, facilitating safer sex decision making, motivating and facilitating personal growth, and encouraging volunteerism to promote intentional activities for safer sex practices.
Highlights
To date, significant progress has been achieved in identifying the psychological correlations associated with safer sex practices
Researchers found that group level safer sex interventions that have successfully targeted self-efficacy and motivation have improved PLWH’s safer sex practices (Kalichman et al, 2001; Wingood et al, 2004)
Multiple factors associated with safer sex practices among these participants were identified, emphasizing self-protection, establishment of selfesteem, dignity, altruism and reciprocity, disease experience as a source of personal growth, and organizational culture and values
Summary
Significant progress has been achieved in identifying the psychological correlations associated with safer sex practices Some studies identify such characteristics as cognition, intention, emotion, attitude, skills, coping, self-efficacy and motivation associated with safer sex practices of people living with HIV (PWLH) (Inoue et al, 2006; Kalichman, Williams, Cherry, Belcher, & Nachimson, 1998; Rotheram-Borus, Reid, Rosario, & Kasen, 1995; Schutz et al, 2011). A second area of progress has been in the domain of identifying characteristics of sexual encounters associated with safer sex practices Factors such as the number of sex partners, concurrency, duration, partner type, and serostatus concordance are associated with the practice of safer sex (Robinson, Bockting, Rosser, Miner, & Coleman, 2002). Women with high levels of relationship power (i.e., relationship control and decision making dominance) were five times more likely to use condoms, compared to women with low levels of relationship power (Pulerwitz, Amaro, De Jong, Gortmarker, & Rudd, 2002)
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