Docstoc

SNAP

Document Sample
SNAP Powered By Docstoc
					In Their Own Words: Recent
  Seroconversions Among
     Gay/Bisexual Men

  Nicholas Alvarado, Jason Euren,
 Olga Grinstead, Ellen Goldstein and
         William J. Woods
               CAPS
          Acknowledgments
• We would like to acknowledge and thank
  our study participants for sharing their
  stories with us
• This study was funded by the
  Universitywide AIDS Research Program
  (UARP), University of California, Office of
  the President
          Workshop Schedule
•   Study Overview
•   Seroconversion Narratives and Quotes
•   Large Group Discussion
•   Small Group Discussion
•   Report Back and Closure
   Background and Significance
• Innovative approaches are needed to
  address continued new HIV infections
  among gay and bisexual men
• Narrative therapy: exploration and
  modification of people’s stories can help
  them change their behavior
• What actually happened is less important
  than the story each individual chooses to tell
  and how he tells his story
         Research Questions

• What are the common/recurrent themes in
  narratives of recently seroconverted men?

• Is there a relationship between men’s
  understanding of how they became HIV+
  and their current prevention practices?

• How can these findings be used to improve
  the effectiveness of counseling and other
  interventions?
     SNAP: Seroconversion
 Narratives for AIDS Prevention
• Qualitative interview study of 28 recently
  seroconverted gay/bisexual men

• Pilot and Feasibility Study

• Eligibility Criteria
   – Over 18 years of age
   – Able to communicate in English
   – Became infected with HIV in the past 2 years
        Recruitment Methods
• There were three sources of participants:
  – Flyers in AIDS Service Organizations (ASOs)
  – Referrals from ASO clinicians and staff
  – Word of mouth from other participants
• Recruitment was directed to increase the
  diversity of the sample
• All potential participants had telephone
  screening prior to scheduling appointment
            Interview Guide
• Seroconversion Narrative
  – Tell me the story about how it happened that
    you were infected with HIV
  – Probes regarding life circumstances at that time


• Testing Narrative
  – When did you first test positive for HIV?
           Interview Guide
• What does you life look like now since
  you became infected with HIV?

• Current Prevention Ideas/Practices
  – How do you express yourself sexually now?
  – Have you changed the ways you use drugs or
    alcohol?
  – Prevention messages to HIV- and HIV+ men
              Study Sample
• 87 men were screened for the study
  – 72 were recruited from ASOs and 15 by word
    of mouth
• 29 out of 87 men were eligible for the study
• 28 out of 29 eligible men participated in the
  study
               Study Sample
• Average age was 34 years, Range 19-44
• Ethnicity
  –   11 (39%) Caucasian
  –   10 (36%) African American
  –   4 (14%) Latino
  –   2 (7%) Native American
  –   1 (4%) Asian/PI
             Study Sample
• Time since seroconversion averaged 2 years
  Range 7 months - 6 years

• 60% had been infected less than 2 years,

• 82% had been infected less than 3 years
           Study Limitations
• Pilot and Feasibility Study
• Recruitment was from ASOs - men already
  in touch with services
• Recruitment from San Francisco agencies
          Data Analysis Plan
• Themes
• Seroconversion Narrative Types
• Prevention Strategies as HIV+ man
• Relationship between Narrative Type and
  Prevention Strategies as HIV+ man
• Implications for interventions and research
     Qualitative Data Analysis
• Interviews were taped and transcribed
• Investigators read all of the interviews,
  discussed each interview and noted
  themes
• Interviewers independently rated
  themes to select most prevalent
             Overall Themes
• Abuse/Sexual        • Partner Choice
  Violence
                      • Prevention Strategies
• Assumptions           (HIV+ and HIV-)
• Disclosure/Sexual   • Resilience/Coping
  Communication       • Responsibility
• Drug/Alcohol Use    • Travel/Displacement
• Internet            • Trust
• Loss
    In Their Own Words: Themes
•   Drug and Alcohol Use
•   Loss
•   Disclosure and Sexual Communication
•   Assumptions
•   Prevention and Responsibility
•   Resilience/Coping
          NARRATIVE


  “Then he wanted to do it without a
 condom…and he said he would give
me fifty dollars more” (35 year old African
              American man)
        NARRATIVE

 “I was, I think, 16 at the time so I
kind of like went along with him or
something I was like whatever” (19
     year old African American man)
         NARRATIVE

   “That was actually the day that I
  became positive, and then come to
 find out he‟s messing with this other
guy, and you know the chain started”
     (33 year old African American man)
DRUG and ALCOHOL USE

 “I would normally use condoms but
when I was high on cocaine or drunk,
     I didn‟t” (34 year old Latino man)
DRUG and ALCOHOL USE

 “In fact I wouldn‟t even shoot up if I
 couldn‟t make it while I was doing it
  and then immediately follow with
   having sex” (31 year Caucasian man)
DRUG and ALCOHOL USE

 “…drugs and sex were my way of
  getting off the streets…of feeling
needed and desired and popular” (31
        year old Caucasian man)
DRUG and ALCOHOL USE

“So I was completely a novice at it…I
  had no idea of the effects except it
 made me feel very sexual” (23 year old
      Native American/Caucasian man)
                LOSS

“Before she passed, I always had it in
   control. But this is like too many
things came at me really at one time”
     (43 year old African American man)
               LOSS

  “…I didn‟t really care what was
happening to me and I just engaged
in risky behavior” (33 year old API man)
             LOSS

“My mom passed…I just started
doing drugs and hanging out and
drinking and not giving a damn”
  (40 year old African American man)
DISCLOSURE AND SEXUAL
   COMMUNICATION
  “I have to say that I never say I am
      positive - never” (34 year old
          Latino/Caucasian man)
DISCLOSURE AND SEXUAL
   COMMUNICATION

  “When people asked me my status I
 would say: the last time I tested I was
   negative” (30 year old Caucasian man)
DISCLOSURE AND SEXUAL
   COMMUNICATION
 “…in the future relationships I have,
  there‟s gonna be some period of
   getting to know that person and
    there‟s gonna be disclosure”
        (25 year old Caucasian man)
DISCLOSURE AND SEXUAL
   COMMUNICATION

  “I can be honest with myself and I
 can know that I was doing the right
 thing by being honest with someone
  else” (19 year old African American man)
DISCLOSURE AND SEXUAL
   COMMUNICATION

   “But I think at least they‟re saying
  „we‟re having unprotected sex‟ in a
 sort of public way” (30 year old Caucasian
                   man)
DISCLOSURE AND SEXUAL
   COMMUNICATION
 “…don‟t really want to tell too many
  people that I‟m positive, therefore I
  don‟t have sex” (31 year old Latino man)
      ASSUMPTIONS

 “…I found out that he thought that if
I was being fucked without a condom,
    then I was probably positive”
       (37 year old Caucasian man)
      ASSUMPTIONS
“…there‟s an assumption that a lot of
 people make when you look at their
  ads on the Internet or you talk to
    them” (37 year old Caucasian man)
  PREVENTION AND
   RESPONSIBILITY
“I don‟t want to date HIV negative
people because I‟m not a condom
  wearer” (37 year old Caucasian man)
   PREVENTION AND
    RESPONSIBILITY
“I practice safer sex because it‟s the
     only way to really go at it”
    (43 year old African American man)
  PREVENTION AND
   RESPONSIBILITY
“… we kind of assumed that he was
  already at risk - at high risk”
   (19 year old African American man)
   PREVENTION AND
    RESPONSIBILITY
“… I also recognize that it takes two
people to not make the decisions that
  we didn‟t make or however that
   works” (25 year old Caucasian man)
   PREVENTION AND
    RESPONSIBILITY
  “I just will not be a person that
spreads this” (44 year old Caucasian man)
RESILIENCE/COPING

“I was telling him what I found out
 and that I was kinda scared and
 worried” (25 year old Caucasian man)
RESILIENCE/COPING
“The infrastructure and everything
 was just gone. And so I am in the
 process of rebuilding” (35 year old
        African American man)
RESILIENCE/COPING

“I ain‟t going to cry no more over
this” (40 year old African American man)
 RESILIENCE/COPING

“Having HIV is just another obstacle
 in life” (40 year old African American man)
RESILIENCE/COPING
 “…It gets better and there are still
good people out here and there are
still services available and you just
gotta keep pluggin‟ away” (36 year old
         African American man)
 RESILIENCE/COPING
 “I know I can‟t save the world, but if
I can help one or two then I think I‟ve
done my job” (33 year old African American
                  man)
RESILIENCE/COPING
“It‟s not just about not contracting
 HIV” (33 year old African American man)
        Discussion Questions
• Are these themes/stories familiar from what
  are you hearing in your programs and
  research?

• What are the implications for prevention,
  intervention and research?
    Contact Information
Olga Grinstead, Ph.D., MPH
UCSF-CAPS
(415) 597-9168
ogrinstead@psg.ucsf.edu

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:4
posted:12/21/2011
language:English
pages:49