HIV Seroconversion Among MSM: When Sexual Pleasure is a Source of Vulnerability.

HIV Seroconversion Among MSM: When Sexual Pleasure is a Source of Vulnerability, Joanne Otis and Marie-Eve Girard, Universite du Quebec a Montreal; Michel Alary, Universite Laval and Institut National de Sante Publique du Quebec; Robert S. Remis, University of Toronto and Direction Generale de la Sante Publique Montreal-Centre; Rene Lavoie and Roger LeClerc, Coalition des Organismes Communautaires Quebecois de Lutte Contre le SIDA; Bruno Turmel, Institut National de Sante Publique du Quebec; Jean Vincelette, Hopital Saint-Luc du CHUM

We studied the importance of sexological factors to our understanding of HIV seroconversion among men who have sex with men (MSM). As a part of a longitudinal study conducted in Montreal from 1996 to 2003, seronegative MSM at baseline (n = 1,890) were tested for HIV and completed a questionnaire every six months. Guided by epidemiological, psychosocial, sexological, and ecological models, this study explored a diversity of factors (individual to macrosocial) potentially associated with risk behavior and seroconversion. In this sample, the incidence of HIV was 0.62 per 100 person-years and remained relatively stable between 1996 and 2003, despite an increase in unprotected anal sex between serodiscordant partners. In addition to the most commonly-identified risk factors (needle sharing and unprotected receptive anal sex), this study's findings highlighted the important role of anal sex and of having a large number of partners in seroconversion. In terms of cognitive factors, only lower perceived control over condom use in the months preceding seroconversion and a greater belief in the possibility that they would one day become infected with HIV were found to characterize men who seroconverted. The other variables significantly associated with seroconversion were generally sexological in nature: being a sexual sensation-seeker; seeing anal sex as the ultimate sexual pleasure and an expression of power; and using a variety of means to heighten sexual pleasure (e.g., voyeurism-exhibitionism, erotic conversations, sex toys, and alcohol or drugs). Seroconversion in the gay community does not seem to be associated with social indicators of vulnerability, but rather, to be complex and intimately-tied personal factors, in which sexual pleasure is the prime source of vulnerability to HIV. The challenge is therefore to integrate both the clinical and educational perspectives of sexology with the current prevention efforts among MSM.