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This poster was presented
to complement the oral presentation
at the AIDS Impact conference in Brighton, England, in July 2001.
"Coming Out" is associated with HIV seroconversions
among young gay men
Arn J. Schilder,
Patricia M. Spittal, Mary Lou Miller, Steve Martindale, Jill Parsons,
Kevin JP Craib, Michael V. O'Shaughnessy, Robert S. Hogg.
BACKGROUND:
This prospective study of over 900 Gay youth mirrors the rising
HIV infections in other cities throughout North America. HIV sero
incidence has increased 7 fold within the Vanguard study over
the last year. The experiences and concerns of HIV positive men
have received scant attention both epidemiological and ethnographic.
We asked these questions:
- Why seroconvert to HIV in these times?
- Is antiretroviral therapy responsible for the slippage?
- Heard more in hallways of public health then on the street.
- Are there new trends in substance uses?
- "You know how big drugs are now-a-days?"
- Are beliefs about intimacy linked barebacking?
- "Fucking is more intimate without condoms. Sex without
condoms is the real thing"
- Are Gay men just tired of being afraid?
- "Before I was just so worried about becoming HIV positive...
And now I am!"
OBJECTIVE:
Our objective is to determine the factors associated with HIV
serconversion among young Gay men in this prospective study sample.
METHODS:
- Case study methodology was used to compare the lived experiences
of 13 Gay participants who seroconverted to HIV during observation
and 13 gay youth who remained HIV-negative matched on the basis
of age.
- All 26 study participants have been recruited
- Participants are interviewed up to 4 times over 10 months
- Textual data are coded, managed and explored using NUDIST
qualitative research software
- We investigate the experiences with abuse, family, community,
substance use, beliefs about of condom use and 'cum', therapeutic
optimism
RESULTS:
SEXUAL VIOLENCE: Non Consensual Sex
"He about seventeen and I was eight years old. I guess
I was just giving off this energy. He started molesting me and
forced me to blow him. That was my introduction to sex and that
went on for years."
STIGMA: A Devalued and Spoiled Social Identity
"I think I was probably going through a really rough
time. I was 'coming out... [and] dealing with being 'Gay' and
finally admitting it to myself? I was not really feeling very
positive about my future. I was wondering are people going to
accept me? Like... Really accept me?"
FAMILIAL DISCORD: Incomplete Interpersonal Skills
"In the past years I have had a lot of time to think
about our family. Since seeing my behaviours and how I react
in situations I get myself into; I am just really starting to
appreciate how dysfunctional my family was."
BEING OUT: Often means inevitable migration
"For me and a lot of people especially if your from a
small town, when you first come out, you are a new face in town.
You are a kid in a candy store because all these men want you."
COMING OUT IN LIMINAL TIME: Starting at Ground Zero
"Adolescents have all this knowledge that they have been
given, but even then emotions can take-over completely. That
is the same thing that is happening to Gay youth. We start from
ground zero as far as dating and emotional involvement. Gay men
just don't have the tools, especially in those first few years
when we first come out. Tools to negotiate safer sex. Intellectually
you know you should be using a condom and thinking: 'this is
insane what I am doing'. But at the same time there is that little
voice saying: 'He won't love me, won't want me, and will walk
out the door. I will lose this partner and intimacy.' "
ISOLATION: Sex and Loneliness
"I was just so lonely coming out. I went out and met
someone. I think that because of loneliness and that need to
connect emotionally, that probably does override a lot of common
sense and teaching."
TIMES OF PARTYING: Party Drugs and Alcohol
"When I came out, I would party for a good year. We would
go out like every weekend. Sometimes I was going out 5 of 7 nights
a week. I was not necessarily doing party drugs every one of
those times."
SUBSTANCE USE: Loneliness and Distress
"I was pretty messed up when I came out in the summer
of 1995. I was going out with this guy and then we broke up.
I started drinking a lot and going to the bathhouse. This one
time, I just slipped up and wasn't careful."
INTIMACY
"Sex with condoms is what you do until you get to the
point where you can have sex without condoms. But you get to
a point where you want that intimacy. Bareback sex is real. I
feel you and you feel me. There is nothing in between us. It
is the ultimate in intimacy."
DISASSOCIATION: Separating Emotions From Sex
"When I'm depressed ... I have incredibly low self-esteem
and feel self-destructive. It is like anyone can do anything
they want to me. And I don't care. It is almost like I'm not
there. And I go for physical intimacy, and separate myself from
emotions. That is my escape."
SUMMARY:
Convergence of Vulnerability and Risk In 'Liminal Time'
Times of "coming out" are "liminal times".
Liminal time is a cross-cultural phenomenon. These are times
of social transition. Transitions are usually marked by 'rites
of passage'.
FACTORS ASSOCIATED WITH "COMING OUT" IN LIMINAL
TIME
- Histories of violence
- Adopting a devalued social identity
- Familial discord led to poor interpersonal skills
- Migration to urban Gay villages
- Transitions were unsupported and unguided
- Loss of identity and social support
- Substance use
- Distress, depression and loneliness
- Need for intimacy
- Disassociation during sex
IMPLICATIONS:
What Can Be Done
Practitioners of health care and prevention and Gay communities
need:
- To be aware of 'liminal' time in the context Gay men.
- To address child abuse and its subsequent disregulatory adult
sequelae and make referrals.
- To help innovate customs and a mentoring process to assist
in the safe passage of youth during the liminal time of coming
out.
- To become aware of the cultural issues of Gay men.
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