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Curtin University
Collaboration for Evidence, Research and Impact in Public Health

Pleasure and Sexual Health Project (National quantitative and qualitative study of perceptions of sexual health and HIV among gay men) (2009 - 2010)

Investigators:

Chief Investigators

  • Dr Graham Brown (WACHPR, Curtin University)

Collaborating Partners

  • Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University
  • National Centre in HIV Epidemiology and Clinical Research (NCHECR), The University of New South Wales (UNSW)

Project Overview

The PASH Study collected both quantitative and qualitative data from gay and bisexual men to ascertain their understandings of pleasure and how it affects the decisions they make about sex. Men were recruited from a range of sources including gay community events, online social networking websites, and gay dating websites. 2306 men completed the survey and 40 were interviewed in depth. We explored men’s current understandings of the risk of HIV transmission and their feelings about HIV and AIDS. In particular, we asked men about their motivations for their decisions to use or not use condoms on specific occasions.

For full details and final report see:

Summary of Findings

In most respects the men in the study appeared to be very similar demographically and in terms of their social engagement with other gay men to most other samples of Australian gay men. The average age of respondents was 35, and the majority were university-educated, sexually active and HIV-negative.

In general, while we purposefully recruited men from all jurisdictions, there was little difference across the country in terms of the key issues around perceptions of risk and in their behaviour. Men in some of the less populous states, particularly Queensland and Western Australia, had some difficulties with access to supportive, gay-friendly health services and with perceived stigma, but nonetheless, their behaviour and their beliefs about HIV and risk were mostly similar to those found in other states.
Most men in the study had safe sex most of the time and when they did not they often employed a range of strategies to minimise the risk of HIV transmission. These strategies ranged from the fairly sensible, such as HIV-positive men sero-sorting for sex together, to the much less sensible, such as HIV-negative men making assumptions based on how a partner looked. In other cases, though, many men just simply decided to take a risk. Much of the decision-making involved appeared to be rapid, only partially ‘informed’ and often included a momentary break with a general intention to avoid risk. Mostly, though, even in these ‘heat of the moment’ situations, men appeared to make some sort of risk calculation, however poorly framed or rationalised those calculations may have been. Often their decisions about non condom-use were based on an assessment that they could take a risk with this partner, or on this occasion, or under these circumstances. Some of these men seem more likely to speak of ‘hot’, ‘raw’ and ‘taboo’ sex in describing episodes of UAIC, but many were also likely to revert to a sense of moral failure when assessing what they had been doing.

Amongst many of the non HIV-positive men, much of this behaviour occurrs in a general context where diagnoses of AIDS are relatively rare, and there is considerably diminished experiential knowledge of what is involved in living with HIV. Over half knew no one who had died of AIDS, almost a half spent no time with PLHIV and only a small minority knew anyone diagnosed with HIV in the previous year.

Even so, some men told of coming of age in the midst of an epidemic, and others told of their experience of their friends dying. Men who had achieved majority in a pre-AIDS society told of initial fear in an ill-informed and media-infused hysteria in the early days of the epidemic – and how some of those fears dissipated as more was learned about how HIV was treated and treatments advanced. Yet others seemed to have relatively little experience with HIV in their lives and appeared not to be particularly concerned with it. Men’s stories included being traumatised into a fear of sex by the representations of or experience of the lives of those living with HIV and AIDS, as well as stories of blithely incorporating a range of strategies the men considered safe into their sex lives. In practice, at least for these latter men, safe sex has been rewritten to include risk reduction. Some men questioned safe sex messages, and many men made case-by-case choices on what level of risk they were prepared to accept in specific situations, with specific partners.

For many, HIV is no longer the absolute threat it once posed and their attitudes to risk are more relaxed than even they care to admit themselves. We may be seeing a discursive squeeze in safe sex cultures between what is desired and what is needed for infection avoidal that makes it difficult for those who engage in UAIC, especially occasional risk-takers, to face up to what they are doing. These men require information they can trust – factual, non-emotive information about relative risk to allow them to make their own informed decisions – but they also require health promotion that includes community development and engagement strategies supportive of ongoing self-awareness of what they are doing.

Publications

Prestage, G., McCann, P.D., Hurley, M., Bradley, J., Down, I. & Brown, G. (2010) Pleasure and Sexual Health: The PASH Study 2009. Monograph, National Centre In HIV Epidemiology and Clinical Research, Sydney, Australia.