Wrapped or raw: pos-pos sex


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This presentation was given by Kathy Triffit, Positive Life NSW, at the AFAO HIV Educators Conference, May 2010.

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  • Sex and sero sorting multi-media workshop Name one or two things important for good sex? Safe sex- what does it mean for you? What are the benefits and disadvantages of pos-pos sex? Is pos-pos sex a choice or a reaction to stigma (discrimination, sexual rejection)? How do you negotiate pos-pos sex? What about sexual decision making and negotiation (verbal and non-verbal) especially in casual or anonymous settings? Does decision making and negotiation change in different contexts? (different environments/locations –SOPV, away from home, behaviours, viral load, STIs) How do you know someone is positive? (assumptions; familiarity and trust ) Think about the last time you had pos-pos sex, how did you manage disclosure? How did you tell him? When? How did you feel? (fear of rejection; gossip) How did he respond? Was there a time you didn’t tell? Why? (bad vibe, spoil the moment) How do you assess risk? (What is risk for you?) What risks are involved in sex realistically/honestly now? How do you manage risk? (e.g. viral load/ strategic positioning etc) What reasons have influenced your decisions around risk taking? If you had a risk event what did you do? What message do you want neg guys to take away from your video?
  • Topics covered: Syphilis Hep c HIV re-infection Decisions made about ditching condoms and information so guys make more informed decisions Viral load Assumptions around HIV Disclosure and handling no Communication PEp
  • For sexually adventurous men, condom reinforcement messages can be seen as incongruous or contradictory when in the pursuit of pleasure and “sexual freedom”. While some couples in serodiscordant relationships (where one partner is HIV positive and one is HIV negative) are using undetectable viral load without condoms not only to reduce their risk of passing on or getting HIV, but also “for intimacy and connection”.
  • Wrapped or raw: pos-pos sex

    1. 2. <ul><li>Content and context - </li></ul><ul><li>Campaign development is evidence based with research </li></ul><ul><li>data and community consultations providing the background </li></ul><ul><li>to this work. </li></ul><ul><li>‘ WRAPPED OR RAW (POS-POS SEX)’ engages with </li></ul><ul><li>sexually adventurous HIV positive gay men who have </li></ul><ul><li>adopted sero sorting (or are considering sero sorting) to </li></ul><ul><li>minimise the risk of passing on HIV, manage disclosure and </li></ul><ul><li>HIV stigma, and maximise pleasure. </li></ul><ul><li>These men were invited to take part in the development of </li></ul><ul><li>campaign content and imagery. This included discussion </li></ul><ul><li>groups, community forums, interviews and a one-day ‘video </li></ul><ul><li>stories’ workshop. </li></ul>
    2. 3. <ul><li>Content and context is also - </li></ul><ul><li>Guided by the evaluation by Blue Moon, in particular the </li></ul><ul><li>recommendation to build on ‘the facts’ serious of previous </li></ul><ul><li>campaign work. </li></ul><ul><li>(This evaluation found that ‘the facts’ engage, and </li></ul><ul><li>therefore have the opportunity to persuade. This approach </li></ul><ul><li>hands responsibility to the individual and maybe harder to </li></ul><ul><li>reject on the grounds that it is not patronising.) </li></ul><ul><li>Developed in line with the Positive Life/ ACON ‘Risk Reduction Framework’ . </li></ul>
    3. 4. <ul><li>Content and context </li></ul><ul><li>Specifically - </li></ul><ul><li>Sero sorting amongst some HIV positive gay men in order to engage in UAI has been reported in research including TOMS (2009), PASH (2010), Periodic Survey (ongoing), Quickie Report (2007) as well as international research. </li></ul><ul><li>Research also shows that gay men make assumptions about sero status of casual sex partners (HIV Seroconversion Study: Newly Diagnosed Men in Australia (2007-2009); PASH (2010)). </li></ul><ul><li>Disclosure as a means of selecting partners in order to have UAI, reduce risk and enhance pleasure has been reported in PASH (2010) and also in Positive Life community consultations and campaign evaluations. </li></ul>
    4. 5. <ul><li>Aims - </li></ul><ul><li>Support informed decisions about sero sorting by HIV </li></ul><ul><li>positive men to minimise HIV transmission </li></ul><ul><li>Ask men to challenge assumptions about HIV status of </li></ul><ul><li>unknown casual partners and enhance the knowledge, skills </li></ul><ul><li>and understanding of men who sero sort or are considering </li></ul><ul><li>sero sorting </li></ul><ul><li>Inform men about the importance of STI testing and </li></ul><ul><li>strategies to prevent further transmission (in particular </li></ul><ul><li>syphilis) </li></ul><ul><li>Increase awareness that hep C is a sexual health issue for </li></ul><ul><li>some gay men </li></ul><ul><li>Consider ways to respond to questions or concerns about </li></ul><ul><li>HIV re-infection. </li></ul>
    5. 6. <ul><li>Aims (continued)- </li></ul><ul><li>Use online dating sites to deliver social marketing messages, and, via links, direct access to resources that support sexual negotiation and help to build skills and confidence about managing risk and discussing HIV status (e.g. Barebackrt, Recon, Manhunt). </li></ul>
    6. 7. <ul><li>Target audience - </li></ul><ul><li>Sexually adventurous HIV positive gay men who sero sort </li></ul><ul><li>(or are considering sero sorting) and their partners (casual) </li></ul><ul><li>Assist and support - </li></ul><ul><li>Peer workers in individual or group settings </li></ul><ul><li>Community and health-care professionals </li></ul><ul><li>HIV positive gay men negotiating sex with HIV negative </li></ul><ul><li>gay men </li></ul>
    7. 8. <ul><li>Resources - </li></ul><ul><li>Campaign specific website – www.wrapped or raw.org.au </li></ul><ul><li>Booklet (pocket size) – ‘WRAPPED OR RAW (POS-POS SEX) WANT THE FACTS’ </li></ul><ul><li>Re-branding of KNOW THE FACTS –Syphilis and GET </li></ul><ul><li>THE FACTS Sex and Hep C </li></ul><ul><li>Banners Manhunt, Barebackrt, Recon </li></ul><ul><li>Videos – restricted access on YouTube, Manhunt </li></ul><ul><li>Advertisements (community media- SSO, SX) </li></ul><ul><li>Poster (sex-on-premises venues)-decision support tool </li></ul><ul><li>Community and online forum </li></ul>
    8. 9. <ul><li>Context - </li></ul><ul><li>Campaign resources will be available: </li></ul><ul><li>on line (campaign specific website, and social networking </li></ul><ul><li>websites – YouTube, Manhunt, Barebackrt, Recon) </li></ul><ul><li>print resources - limited distribution (sex-on premises </li></ul><ul><li>venues) [and] </li></ul><ul><li>distribution to and by GPs , peer workers, community and </li></ul><ul><li>health-care workers </li></ul>
    9. 13. <ul><li>Decision support tool - </li></ul><ul><li>reiterates the ‘preconditions’ </li></ul><ul><li>to sero sort and minimise </li></ul><ul><li>risk of HIV transmission </li></ul>
    10. 15. Introductions
    11. 16. <ul><li>Participants from the target focus group reported the campaign – </li></ul><ul><li>re-affirms their standing on pos-pos sex (‘reflects reality’) </li></ul><ul><li>touches on subjects they ‘think about’ or ‘sometimes </li></ul><ul><li>discuss’ when negotiating sex </li></ul><ul><li>offers an image (videos) of gay men that speaks to their </li></ul><ul><li>experiences </li></ul>
    12. 17. <ul><li>And – </li></ul><ul><li>‘ allows gay men to use their own judgement based on their </li></ul><ul><li>experiences and the facts’ (not patronising) </li></ul><ul><li>gives permission for the discussion to take place on </li></ul><ul><li>negotiating sex without condoms between HIV positive gay </li></ul><ul><li>men (personal stories also ‘normalise pos-pos sex’) </li></ul><ul><li>resources (booklet and poster) are useful tools to assist pos </li></ul><ul><li>guys to explain issues such as viral load, disclosure and </li></ul><ul><li>other risk reduction strategies to HIV negative partners. </li></ul>
    13. 18. <ul><li>Non-target group - </li></ul><ul><li>Responses reflect those reported by the target group (e.g. </li></ul><ul><li>experiences and issues are real). Significantly, one </li></ul><ul><li>participant reported ‘while you sometimes may not agree with </li></ul><ul><li>it [i.e. opinions of those represented in the videos], it’s honest </li></ul><ul><li>and upfront’. </li></ul><ul><li>Videos were particularly liked for their ‘grass roots quality’ </li></ul><ul><li>(unscripted), ‘differing perspectives’ (e.g. length of time of </li></ul><ul><li>diagnosis, different cultural backgrounds), ‘honesty’. </li></ul><ul><li>Participants liked the campaign’s ‘capacity to invite </li></ul><ul><li>discussion and challenge [HIV] stigma’. (The video stories </li></ul><ul><li>were a constant reference point in both focus groups.) </li></ul><ul><li>Guys represented in the campaign were seen as ‘potential </li></ul><ul><li>role models’ and counter to ‘the stereotypes (i.e. buffed and </li></ul><ul><li>nude gay men)’ found in some campaigns (‘they are guys </li></ul><ul><li>you can identify with’). </li></ul>
    14. 19. <ul><li>Conclusions - </li></ul><ul><li>Successful HIV prevention and education need to: </li></ul><ul><li>fully accept the changing realities in gay men’s sexual lives, </li></ul><ul><li>which have become more complicated than just saying ‘use </li></ul><ul><li>a condom every time’ </li></ul><ul><li>recognise there are different limits and boundaries for gay </li></ul><ul><li>men in different sexual circumstances </li></ul><ul><li>consider choices made about ‘ditching condoms’ and offer </li></ul><ul><li>options to support a more informed risk reduction (e.g. </li></ul><ul><li>provide the facts on group sex, hep C, syphilis, viral load). </li></ul>
    15. 20. www. wrapped or raw .org.au