What new sero-converters inToronto are saying about thecontexts of acquiring HIVBarry D AdamUniversity ProfessorSenior Sci...
Beyond behaviours? Reckless sex, illicit drug use and other so-called disorderscontinue to be the dominant explanations f...
The resilience turn Gleaning narratives of Successful coping Surviving and thriving Overcoming challenges Contributin...
New sero-converters study N = 43 Drawn from 2 downtown Toronto clinics with highest testingrates for HIV All male 36 g...
The syndemics hypothesis “additive psychosocial health problems— otherwise knowncollectively as a syndemic— exist among u...
Abuse questions
Abuse/drug use nexusAbuse = ≥2 (of 5) questions answered sometimes, often, or very trueDrugs = recent use of ≥2 club drugs...
Inside the syndemics profileI’m always moody and I’m always depressed. I’mclinically depressed….I take E, MDMA, K andcoca...
crystal So my ex partner who I was with, we were together for fouryears. We were together… when I say seven years we were...
Drugs/no abuse So I came here [from Latin America], I met this guy and he waspositive. My third boyfriend was positive to...
One step removed At the beginning I was using K, not so harsh. Like I didn’t justget into T until I was like 16 or 17…. I...
Reckless sex, illicit drug use redux How do we acknowledge drug use that is Pleasurable, recreational, not harmful Pain...
Outside syndemics: relationships He wanted it open; I didn’t want it open. When I finally agreedto open it, because stupi...
Travel Maybe I got it in Mexico….I was… I don’t know. I was notsafe. I was not… how should I say this? I was not careful....
And other We started with condoms but then… I don’t know. It justbecame… the condom just… I don’t know. I took it off, he...
Balance or dialectic? How do we enhance the health of our communities Including reducing HIV transmission? How do we ad...
How might we create acollectivity that we would wantto belong to? Winning citizenship rights, a great accomplishment, but...
The research team PIs Barry D Adam, University of Windsor & OHTN Greta Bauer, Western University James Brooks, Nationa...
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1045 1 what new sero-converters in toronto are saying

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1045 1 what new sero-converters in toronto are saying

  1. 1. What new sero-converters inToronto are saying about thecontexts of acquiring HIVBarry D AdamUniversity ProfessorSenior Scientist & Director of Prevention Research
  2. 2. Beyond behaviours? Reckless sex, illicit drug use and other so-called disorderscontinue to be the dominant explanations for gay men’sexperience with HIV and other health outcomes in much ofthe public health research literature. This individual,behavioural, reductionist account of health continues toframe and shape the main interventions used to address gaymen’s health, thereby supporting and extending thehegemony of the medical model of understanding illness. From the call for this event
  3. 3. The resilience turn Gleaning narratives of Successful coping Surviving and thriving Overcoming challenges Contributing to a culture of praxis to make things better The Rise of a Gay and Lesbian Movement (Twayne) Experiencing HIV (Columbia University Press) Protective Factors Against HIV Risk Behaviour Among Gay andBisexual Men (Trevor Hart, PI) Pathways to Resiliency: An exploratory study on strength basedapproaches to HIV prevention and health promotion strategiesamongst East and Southeast Asian MSM (Alan Li, PI)
  4. 4. New sero-converters study N = 43 Drawn from 2 downtown Toronto clinics with highest testingrates for HIV All male 36 gay, 5 bisexual, 1 heterosexual Average age: 32 28 single, 10 boyfriend/partner, 3 married to a man, 1 marriedto a woman Education: 8 high school or less, 13 some postsecondary, 22completed college/university or postgraduate Multi-ethnic
  5. 5. The syndemics hypothesis “additive psychosocial health problems— otherwise knowncollectively as a syndemic— exist among urban MSM andthat the interconnection of these problems functions tomagnify the effects of the HIV/AIDS epidemic in thispopulation” (Stall et al. 2003, 941) Childhood sexual abuse Depression Polydrug use Partner violence
  6. 6. Abuse questions
  7. 7. Abuse/drug use nexusAbuse = ≥2 (of 5) questions answered sometimes, often, or very trueDrugs = recent use of ≥2 club drugs (K, G, MDMA, crystal meth)and/or cocaine146176Abuse & drug useDrugs onlyNeither abuse nor drugsAbuse only
  8. 8. Inside the syndemics profileI’m always moody and I’m always depressed. I’mclinically depressed….I take E, MDMA, K andcocaine. I know it’s a lot….Before I went to rehab Iwas doing them every single day. This was when Iwas in [city]. I was in a really bad relationship. So Iused drugs to kind of escape it. If I didn’t have likeE when I woke up, I’d break stuff and everything….she [mother] would come over every weekend todrink with us and to do drugs with us. Everybodyin my family has been addicted to drugs or alcohol.253057
  9. 9. crystal So my ex partner who I was with, we were together for fouryears. We were together… when I say seven years we werealso on and off seven years with my fuck buddy. So we weretogether for four years and halfway through that we decidedto open up the relationship. Then my partner became HIV+. Idon’t want to say I didn’t care about myself or something likethat because it’s not true. But we continually had unsafe sexbut we also had rules and stuff like that with others. So thenwe were supposed to be safe about other people. It turnedout not true because he was using meth. 253356 I strongly believe that probably the time I got it I probablyslipped up and was on crystal. 297453
  10. 10. Drugs/no abuse So I came here [from Latin America], I met this guy and he waspositive. My third boyfriend was positive too….I’m somebodywho experience all the drugs and direct all the drugs for sex. Sothat help me to understand more about my sexuality.… When Igot infected I was really feeling very lonely and I got in thissexual addiction I think combined with crystal and just havingsex with different guys…. I was not feeling any connection withanybody. So every weekend was going to these clubs and afterthe bathhouse and fucking and fucking. … when this happenedand if I was on crystal and at that time I was infected, I really letI think one or two guys fuck me without condom…. My drugstory started in 2005 here and after I broke up with my secondboyfriend. So I experienced being attractive and having all thesesuccess with these guys and like being in this drug thing andhaving a lot of sex and just checking my list of all the hottestguys I have like you know and validating myself I think. 5216
  11. 11. One step removed At the beginning I was using K, not so harsh. Like I didn’t justget into T until I was like 16 or 17…. It just escalated….Whenyou’re high... your outlook on the world after a few months ofbeing stuck in that scene constantly like almost everyday, your brain gets diluted. You start looking at the worldvery differently. You just start looking at yourself differently.You start not caring about yourself. You lose these sort ofthings. It’s almost like you put yourself in situations to try toharm yourself. I know that I’m not the only one who’sexperienced this. I know that this is in general when it comesto drugs and that scene. You put yourself and miserybecomes company, right? Before you know it, you’resurrounded by that….I was selling drugs. It was like I endedup going to jail. They busted down my door. It was hectic.294606
  12. 12. Reckless sex, illicit drug use redux How do we acknowledge drug use that is Pleasurable, recreational, not harmful Painful, isolating, dangerous, out of control? How do we contribute to a culture of praxis to enhance thehealth of our communities?
  13. 13. Outside syndemics: relationships He wanted it open; I didn’t want it open. When I finally agreedto open it, because stupid is in love, the agreement was safesex no matter what, lube, condom and they’ve got to benegative. If they say they’re positive, don’t even go nearthese people. If they say they don’t know if they’re negativeor positive, don’t go near these guys. I’ll do the same thing.Even if they say they’re negative, condoms and lube. I stuckto the deal for the full 17 months and I came to read andunderstand that he basically said I have nothing to worryabout, it’s my life, it’s my body, what do I care. For the full 17months he was doing positive guys, negative guys, barebackcondom and no condom. 278487
  14. 14. Travel Maybe I got it in Mexico….I was… I don’t know. I was notsafe. I was not… how should I say this? I was not careful.5282 Well I was in New York, my first time in New York. I went witha friend. We had an acquaintance there that he played with inprevious occasions. But he’s a top. It seems like tops don’tseem to care as much. We had a threesome. He came inme….I immediately fired an email off to him to find out if hewas. I didn’t initially get a response and then explained that ithad to do with my meds treatment, if I could pinpoint it better.That’s when he admitted that he was and not on meds. 5274
  15. 15. And other We started with condoms but then… I don’t know. It justbecame… the condom just… I don’t know. I took it off, hetook it off and it just became bareback. 269589 I don’t know how that happened. Otherwise I would feelguilty, blame myself. 5284 I was sexually assaulted….I don’t have enough evidence tofucking put him away either. I filed a policereport, everything….. I had the guy over for like an S&M toyssession sort of thing, like no sex or anything like that. 5294
  16. 16. Balance or dialectic? How do we enhance the health of our communities Including reducing HIV transmission? How do we address syndemics? Can we document and promote a culture of resilience? Personal, social, community levels How do we face trauma, trouble, turmoil Not to affirm yet another construction of the pathological gay men But find pathways to better quality of life?
  17. 17. How might we create acollectivity that we would wantto belong to? Winning citizenship rights, a great accomplishment, but notenough Rise of neoliberal ethic of the marketplace Rational, consenting, contract-making individual with no interestor concern for the well-being of community, care for thevulnerable, or relation to “unmasculine” realms of feeling. Hyper-individualism—isolation, disconnection App-based sexual consumerism disconnected from work andsocial lives Whitman’s aspiration for a community of adhesive comrades
  18. 18. The research team PIs Barry D Adam, University of Windsor & OHTN Greta Bauer, Western University James Brooks, National HIV & Retrovirology Laboratories Co-Is Vanessa Allen, Public Health Ontario Chris Archibald, Public Health Agency of Canada Jean Bacon, Ontario HIV Treatment Network Colin Kovacs, Maple Leaf Clinic Lynne Leonard, University of Ottawa Frank McGee, Ontario Ministry of Health and Long Term Care Eric Mykhalovskiy, York University Sean Rourke, University of Toronto & OHTN Paul Sandstrom, National HIV & Retrovirology Laboratories Rita Shahin, Toronto Public Health Zavare Tengra, Hassle Free Clinic Funded by CIHR

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