Understandings of risk among HIV seroconverters in Sydney

Abstract

This paper examines the risk discourses of Sydney gay men who had recently become HIV positive. 92 in depth interviews were conducted eliciting narratives about the incident in which they believed they became infected. The veracity of this narrative was negotiated between the interviewer and participant. Qualitative analysis was performed in order to distinguish different styles of thinking and acting in relation to risk. Two overarching discourses were distinguished that broadly related to the fields of public health, HIV prevention education, social theory and health policy. These we characterise as ‘quantifiable/objectivist’ and ‘social/subjectivist’. The first approach sees risk as objectively knowable through the application of scientific method or reasoned thinking. The second regards actors as culturally embedded in relation to risk, itself a cultural category. The fact that all men in this study became infected demonstrates the potential fallibility of both approaches. HIV prevention strategies need to take account of both the cultural aspects of risk, understanding the embedded quality of everyday cultural practices such as hygiene, and understand these assumptions are often inadequate for preventing HIV infection. Objectivist approaches also entail problems as many men using them felt HIV infection to be inevitable or unavoidable in some circumstances.

Keywords:

• risk
• HIV
• gay men
• seroconversion

Acknowledgments

Thanks to Jeanne Ellard and Marian Pitts for their comments, and Andrew Grulich and Anne Kavanagh for help in understanding HIV epidemiology.

This paper is based on data from the Seroconversion Study, a joint project of the National Centre in HIV Social Research and the National Centre in HIV Epidemiology and Clinical Research, University of NSW, Australia. Researchers on this study were Andrew Grulich, Olympia Hendry, John Kaldor, Susan Kippax and Garrett Prestage.

Funding for the Seroconversion Study was provided by the Commonwealth Department of Health and Aged Care.

Notes

HIV seroconversion is distinct from HIV infection. The latter occurs at the moment of exposure when virus enters the body of the previously uninfected person for the first time. Seroconversion typically occurs about two weeks later when the immune system of the new host responds to the virus by developing antibodies. Seroconversion is often but not always associated with a flu-like illness. The HIV antibody assay tests the body's immune response and not the virus itself. Thus seroconversion is the moment at which people become HIV positive.