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Laying It Bare: Gay Men and Unprotected Sex in the Age of HIV/AIDS

June 23, 2010

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Interventions: What Kinds of Support Do Gay Men Need to Make Sex Safer?

fogcityjohn: Well, that is a good segue into the next segment I hope we can talk about for a bit. And that is sort of interventions or solutions. And what I wanted to ask all of you is: Are there ways in which either you as psychologists, public health officials, HIV educators, you know, can intervene with men who have sex with men, and support them in adhering to safer sex practices?

You know, earlier, Walt Odets, you talked about kind of teaching men how to talk about this issue. And I'd just like for each of you to address, sort of, you know: What can we do? What have you seen that has worked? And Walt, maybe we could start with you.


Walt Odets: Yeah. I think we have to look just for a moment at the history of prevention. It initially was informational, and then it shifted to an instructive approach. And the instructive approach was essentially a condom every time, for everything -- all kinds of sex, not just anal sex. And the informational thing is necessary. The prescriptive thing, I think, is wrong. It gives men impossible instructions, and it doesn't help men to think about things.

GMHC [Gay Men's Health Crisis], when Richard Elovich was there many years ago, did a campaign where they would show different kinds of scenarios. And they'd show two guys sitting on the edge of the bed, talking. And one would be saying to the other, "You know, we've been having unprotected sex and we've never even talked about it." And then the tag line on the entire series of the campaign was, "Think about it. Talk about it."

So this is a way to use a cliché in empowering people to actually come up with their own approaches to prevention, rather than expecting them to be compliant with simple instructions.

The other thing -- and I'm going back to what Rashad brought up earlier -- is that the self-esteem of the community and the general mental health of the community is critical to prevention. Without that, it can't be done. People who are not happy kill themselves sometimes. And we've certainly seen that among gay men.

So there have been programs: Gay City, in Seattle, was a program which was about the general welfare in a community. This is something that is much better understood in the other English-speaking countries I'm familiar with, in England, and Australia, and Canada.

But we haven't done that in this country. By and large, the federal government hasn't been willing to pay to help gay men feel good about themselves. If we look at some of the British prevention, it's extraordinary in its perception of that issue. So that has to be the foundation. The "think about it, talk about" it part then fits on top of that, in a way that I think is much better as instructive work.

fogcityjohn: Rashad Burgess, I wanted to ask you: You were quoted in the January 2002 issue of POZ magazine as saying, quote: We have to think nontraditional beyond handing people a condom. And I'd like you to elaborate on that. I know that was eight years ago.

Rashad Burgess: Yeah, that was eight years ago.

fogcityjohn: But what are your thoughts today? What's nontraditional? Obviously, you seem to be saying just handing people a condom and telling them to use it is not enough. What should we do?

"We have to make sure that the communities of gay men feel good about themselves, and believe that their lives are worth saving."
-- Rashad Burgess

Rashad Burgess: Well, I mean, I think a couple of things. I think we really have to look at HIV prevention in a very holistic, comprehensive way. And I would actually very much start with where Walt is at. We have to make sure that the communities of gay men feel good about themselves, and believe that their lives are worth saving.

We also have to recognize the fact that, in many areas of gay men, nearly half the population is already HIV positive. And so we have to be willing to look at, you know, how treatment, and the benefits of treatment, can actually play a role in HIV prevention. And so there are discussions going on now around community viral load, and actually what would it mean to actually really ensure that entire communities are maximizing the benefits of treatment, so that the overall viral load is reduced, if not undetectable?

But I do think we're also going to have those individuals; we have to have programs that are for those individuals who are HIV negative, but are your risk takers. And I think it was Jeff that spoke earlier about the fact that there are some people who are just risk takers. And it's not because something bad happened to them; it's just that that's their makeup.

And you know, we have behavioral interventions. And we diffuse effective behavioral interventions -- they're known as our DEBIs -- to help do some of that work, more intensive work that has been proven on behavioral science -- using behavioral science theories -- that really help move people to a place of utilizing condoms more, getting tested for HIV with greater frequency.

As well as ... The last thing that I would say is just general awareness. We know that you can exist in an entire gay environment, and never hear about HIV, or never see a condom, or see any sort of discussion. People are going to think it's not as much of a problem as it was before. And so it is still about also raising of awareness. And those of us who have been in the field a long time sometimes make incorrect assumptions that people are completely informed and aware. And what we have to remember is, we have completely new generations of gay men that live in our communities that we have to engage and reengage in HIV prevention and in HIV prevention messages.

fogcityjohn: Jeff Parsons?

"There's not as much funding available for programs that are designed to deal with some of the underlying issues like depression and loneliness."
-- Jeffrey Parsons, Ph.D.

Jeffrey Parsons: Yeah. I think part of that sort of need to think outside the box, and goes directly to what Walt said -- that the majority of our prevention programs are either outdated, or so exclusively focused on condoms that it misses the broader needs of gay men in today's society. And it's frustrating that the funding that's available for prevention programs is really always sort of looking at, you know, what can you do specifically about the safer sex? And there's not as much funding available for programs that are designed to deal with some of the underlying issues like depression, loneliness, those kinds of things.

And so I think that if we were able to package HIV education and risk reduction in the broader context of dealing with things that gay men actually care about and are interested in, that it could go a lot farther in having some positive effects.

The other thing I'd like to add is that we do sometimes forget about the group of gay men who are out there -- and it's a large group -- who are very happy, very satisfied. They're not depressed. They're not lonely. They're not engaged in risk behaviors. They're not seroconverting. They're actually doing very well. And I think -- and I can certainly say this as a researcher -- that too often we don't get to focus on that group. We don't get to actually talk to them and research them and find out: What are they doing to stay safe, and to stay healthy, and to stay well adjusted?

We tend to have all of our sort of emphasis and focus on those who are not doing so well. And so I think we miss a really big opportunity to find out what are the factors that are helping this large group of gay men stay perfectly safe throughout their lifespan.

fogcityjohn: Interesting. So we could actually learn from the gay men who are succeeding, as opposed to sort of focusing all our attention on those who are having trouble adhering to sort of protected sex.

Jeffrey Parsons: They are obviously doing something right. And empirically, we don't know what it is, because we've not really done the research to find out effectively sort of what are they doing, and what are the facilitators to them being able to stay safe.

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