Kirby Institute, University of New South Wales, Corner West and Boundary Streets, Darlinghurst, Sydney, NSW 2010, Australia.
AIDS Behav. 2013 May;17(4):1352-61. doi: 10.1007/s10461-012-0180-7.
Gay men increasingly use non condom-based risk reduction strategies to reduce the possibility of HIV transmission. Such strategies rely on men's knowledge and communication with each other, but how they employ these strategies may depend as much on their attitudes toward risk and pleasure. We explored current beliefs about safe sex, sexual desire and risk behavior in an online survey of 2306 Australian gay men. The survey included free text components to explore men's beliefs about risk and pleasure. We conducted a principal components factor analysis on the safe sex belief items in the survey, and thematic analysis of the qualitative material was used to interrogate the concepts underpinning these beliefs. We identified two measures of safe sex beliefs: risk reduction optimism (HRRO; α = 0.703); and viral load optimism (α = 0.674). In multivariate analysis, unprotected anal intercourse with casual partners (UAIC) was associated with HRRO among non HIV-positive men only (p < 0.001), but, regardless of HIV serostatus, UAIC was associated with a belief that serosorting could be an effective risk reduction strategy and with being more sexually adventurous in general. Using the qualitative data we identified four themes in how men think about HIV: 'seeking certainty', 'regretful actions', 'nothing is safe', and 'acting on beliefs'. Each theme interacted with the safe sex beliefs measures to provide a highly contextualised understanding of men's beliefs about safe in specific circumstances. Gay men think about the risk of HIV transmission in qualitatively different ways depending on specific circumstances. While measures of belief about relative risk of HIV transmission are useful indicators of men's propensity to take risk, they oversimplify men's thinking about risk, and fail to account for the role of desire, both in influencing men's thinking about risk, and in how they balance their perception of relative risk against the pursuit of pleasure.
男同性恋者越来越多地使用非避孕套为基础的降低风险策略来降低 HIV 传播的可能性。这些策略依赖于男性之间的知识和沟通，但他们如何运用这些策略可能在很大程度上取决于他们对风险和快乐的态度。我们通过对 2306 名澳大利亚男同性恋者进行在线调查，探索了他们对安全性行为、性欲望和风险行为的当前信念。该调查包括自由文本部分，以探索男性对风险和快乐的信念。我们对调查中的安全性行为信念项目进行了主成分因素分析，并对定性材料进行了主题分析，以探究这些信念的基础概念。我们确定了两种安全性行为信念的衡量标准：风险降低乐观主义（HRRO；α=0.703）；和病毒载量乐观主义（α=0.674）。在多变量分析中，与 HIV 阴性男性相比，与偶然伴侣进行无保护肛交（UAIC）仅与 HRRO 相关（p < 0.001），但无论 HIV 血清状态如何，UAIC 与认为血清分类可以是一种有效的降低风险策略的信念以及更普遍地更具性冒险精神相关。使用定性数据，我们确定了男性思考 HIV 的四种主题：“寻求确定性”、“后悔的行为”、“没有什么是安全的”和“根据信仰行事”。每个主题都与安全性行为信念的衡量标准相互作用，为男性在特定情况下对安全性的信念提供了高度具体的理解。男同性恋者根据具体情况以不同的方式思考 HIV 传播的风险。虽然衡量对 HIV 传播相对风险的信念的措施是衡量男性承担风险倾向的有用指标，但它们过于简化了男性对风险的思考，并且没有考虑到欲望的作用，无论是在影响男性对风险的思考方面，还是在他们如何平衡对相对风险的感知与追求快乐方面。
