KEEPING GAY & BISEXUAL MENSAFE:Adam Isaiah Green, Ph.D.***Simon Fraser UniversityCommunity-Based Research CentreBeyond Beh...
THE BUILDING BLOCKS OFMSM HIV PREVENTION1. Assumptions concerning the underlyingpsychology of the sexual actor.2. The rela...
GREEN’S TWO QUESTIONS:1. What have we learned in thirty yearsabout why gay and bisexual men haveUAI?2. What is the histori...
HEALTH BELIEF MODEL“In general, it is now believed that individuals willtake action to ward off, to screen for, or to cont...
BARRY ADAM et al. (2000)“…(UAI is) associated with relativelycomplex issues, such as participants’sexual and affective pre...
TREVOR HART et al.“Education, Black or White ethnicity, andage were not associated with sexual riskbehavior…Findings of th...
GARY DOWSETT et al.“There was no homogeneity that couldidentify a clear point of intervention forbehavior change. Yet, the...
ADAM ISAIAH GREEN“…(S)exual decision-making is rarely a simpleunidimensional process but, rather, grows outof a complex as...
GARY DOWSETT et al.“There was no homogeneity that couldidentify a clear point of intervention forbehavior change. Yet, the...
BARRY ADAM et al. (2000)“…(UAI is) associated with relativelycomplex issues, such as participants’sexual and affective pre...
ADAM ISAIAH GREEN“…(S)exual decision-making is rarely a simpleunidimensional process but, rather, grows outof a complex as...
GARY DOWSETT et al.“There was no homogeneity that couldidentify a clear point of intervention forbehavior change. Yet, the...
META-ANALYSIS of BEHAVIORALINTERVENTIONS FOR MSM“Behavioral interventions have the strongestevidence but have only slight ...
NEW HIV DIAGNOSES: BC MSM
New HIV Diagnoses: Canada MSM(PHAC)
New HIV Diagnoses: US MSM1994-2003
NEW HIV DIAGNOSES:ENGLAND & WALES MSMPaul Birrell and Sarika Desai. 2013. “HIV Incidence in Men Who HaveSex With Men in En...
NEW HIV DIAGNOSES: BELGIUM MSM
NEW HIV DIAGNOSES: NETHERLANDSMSM
PITT MEN’S STUDY 198832% report occasional use of condoms when topping28% report occasional use of condoms when bottoming5...
915   beyond behaviors conference 2013 Adam Green
915   beyond behaviors conference 2013 Adam Green
915   beyond behaviors conference 2013 Adam Green
915   beyond behaviors conference 2013 Adam Green
915   beyond behaviors conference 2013 Adam Green
915   beyond behaviors conference 2013 Adam Green
915   beyond behaviors conference 2013 Adam Green
915   beyond behaviors conference 2013 Adam Green
915   beyond behaviors conference 2013 Adam Green
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915 beyond behaviors conference 2013 Adam Green

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915 beyond behaviors conference 2013 Adam Green

  1. 1. KEEPING GAY & BISEXUAL MENSAFE:Adam Isaiah Green, Ph.D.***Simon Fraser UniversityCommunity-Based Research CentreBeyond BehavioursApril 15, 2013
  2. 2. THE BUILDING BLOCKS OFMSM HIV PREVENTION1. Assumptions concerning the underlyingpsychology of the sexual actor.2. The relative importance of sexual pleasurevs. risk containment.3. Attributions of expertise: biomedical, socialscientific, or local/ indigenous?
  3. 3. GREEN’S TWO QUESTIONS:1. What have we learned in thirty yearsabout why gay and bisexual men haveUAI?2. What is the historical trajectory ofrates of HIV transmission among MSM inNorth America, WesternEurope, Scandinavia and Australia?
  4. 4. HEALTH BELIEF MODEL“In general, it is now believed that individuals willtake action to ward off, to screen for, or to control ill-health conditions if they regard themselves assusceptible to the condition. They will also takeaction if they believe the health condition to havepotentially serious consequences; if they believe thata course of action available to them would bebeneficial in reducing either their susceptibility to orthe severity of the condition; and if they believe thatthe anticipated barriers to (or costs of) taking theaction are outweighed by its benefits” (8).-Rosenstock, Irwin, Victor Strecher and Marshall Becker. 1994. “The Heath Belief Model and HIVRisk Behavior Change,” Pp. 5-24 in DiClimente, Ralph and John Peterson (eds.), Preventing AIDS:Theories and Methods of Behavioral Intervention. New York: Plenum Press.
  5. 5. BARRY ADAM et al. (2000)“…(UAI is) associated with relativelycomplex issues, such as participants’sexual and affective preferences, thenature of the relationship betweenpartners, ambiguities about what is trulysafe, and the influence of dominantcultural values and discourse” (25).-Barry D. Adam and Alan Sears, E. Glenn Schellenberg. “Accounting forUnsafe Sex: Interviews With Men Who Have Sex With Men.” Journal ofSex Research. 37:24-36.
  6. 6. TREVOR HART et al.“Education, Black or White ethnicity, andage were not associated with sexual riskbehavior…Findings of this study suggest arelatively robust association between HIVoptimism and high-risk UAI that did notvary by type of sexual position of theparticipant, (or) HIV status of sexualpartner…” (441).-Trevor A. Hart; Carolyn A. James; P. Hagan; Emilie Boucher. 2010. “HIV Optimismand High-Risk Sexual Behavior in Two Cohorts of Men Who Have Sex With Men”.Journal of the Association of Nurses in AIDS Care. 21:349-443.
  7. 7. GARY DOWSETT et al.“There was no homogeneity that couldidentify a clear point of intervention forbehavior change. Yet, the issue of thepleasure and intimacy experienced havingcondomless sex … was very frequentlypresent…as a potent force that men couldnot or did not want to control” (S64).- Alex Carballo-Dieguez, Ana Ventuneac, Gary W. Dowset, Ivan Blan, Jose Bauermeister,Robert H. Remien, Curtis Dolezal, Rebecca Giguere, Marina Mabragana. 2011. “SexualPleasure and Intimacy Among Men Who Engage in ‘Bareback Sex’”. AIDS Behavior. 14:S57-S65.
  8. 8. ADAM ISAIAH GREEN“…(S)exual decision-making is rarely a simpleunidimensional process but, rather, grows outof a complex assemblage of emotional statesand meanings associated with identity and self-worth…(A) low status partner may expand theparameters of acceptable sexual risk in thecontext of sexual exchange with men from ahigher status group” (447).-Adam Isaiah Green. 2008. “Health and Sexual Status in an Urban GayEnclave: An Application of the Stress Process Model.” Journal of Health &Social Behavior. 49:436-451.
  9. 9. GARY DOWSETT et al.“There was no homogeneity that couldidentify a clear point of intervention forbehavior change. Yet, the issue of thepleasure and intimacy experienced havingcondomless sex … was very frequentlypresent…as a potent force that men couldnot or did not want to control” (S64).- Alex Carballo-Dieguez, Ana Ventuneac, Gary W. Dowset, Ivan Blan, Jose Bauermeister,Robert H. Remien, Curtis Dolezal, Rebecca Giguere, Marina Mabragana. 2011. “SexualPleasure and Intimacy Among Men Who Engage in ‘Bareback Sex’”. AIDS Behavior. 14:S57-S65.
  10. 10. BARRY ADAM et al. (2000)“…(UAI is) associated with relativelycomplex issues, such as participants’sexual and affective preferences, thenature of the relationship betweenpartners, ambiguities about what is trulysafe, and the influence of dominantcultural values and discourse” (25).-Barry D. Adam and Alan Sears, E. Glenn Schellenberg. “Accounting forUnsafe Sex: Interviews With Men Who Have Sex With Men.” Journal ofSex Research. 37:24-36.
  11. 11. ADAM ISAIAH GREEN“…(S)exual decision-making is rarely a simpleunidimensional process but, rather, grows outof a complex assemblage of emotional statesand meanings associated with identity and self-worth…(A) low status partner may expand theparameters of acceptable sexual risk in thecontext of sexual exchange with men from ahigher status group” (447).-Adam Isaiah Green. 2008. “Health and Sexual Status in an Urban GayEnclave: An Application of the Stress Process Model.” Journal of Health &Social Behavior. 49:436-451.
  12. 12. GARY DOWSETT et al.“There was no homogeneity that couldidentify a clear point of intervention forbehavior change. Yet, the issue of thepleasure and intimacy experienced havingcondomless sex … was very frequentlypresent…as a potent force that men couldnot or did not want to control” (S64).- Alex Carballo-Dieguez, Ana Ventuneac, Gary W. Dowset, Ivan Blan, JoseBauermeister, Robert H. Remien, Curtis Dolezal, Rebecca Giguere, Marina Mabragana. 2011.“Sexual Pleasure and Intimacy Among Men Who Engage in ‘Bareback Sex’”. AIDS Behavior.14:S57-S65.
  13. 13. META-ANALYSIS of BEHAVIORALINTERVENTIONS FOR MSM“Behavioral interventions have the strongestevidence but have only slight effects on self-reported behaviours, and no evidence shows areduction in the incidence of HIV infection…Efficacy is generally slight, fidelity is ofconcern, and few resources are available tobring individual or multi-session approaches toscale…Stand-alone behavioral interventions arenot sufficient to reduce HIV transmission inMSM” (389).-Patrick S. Sullivan et al., 2012. “HIV in Men Who Have Sex With Men: Successes andChallenges of HIV Prevention in Men Who Have Sex With Men”. The Lancet. 380:388-399.
  14. 14. NEW HIV DIAGNOSES: BC MSM
  15. 15. New HIV Diagnoses: Canada MSM(PHAC)
  16. 16. New HIV Diagnoses: US MSM1994-2003
  17. 17. NEW HIV DIAGNOSES:ENGLAND & WALES MSMPaul Birrell and Sarika Desai. 2013. “HIV Incidence in Men Who HaveSex With Men in England and Wales 2001-10. A Nationwide PopulationStudy”. The Lancet. Infectious Diseases, 13: 279-280NewHIVdiagnoses1640 1780 1970 2240 2450 2440 2640 2470 2440 25502001 2002 2003 2004 2005 2006 2007 2008 2009 2010
  18. 18. NEW HIV DIAGNOSES: BELGIUM MSM
  19. 19. NEW HIV DIAGNOSES: NETHERLANDSMSM
  20. 20. PITT MEN’S STUDY 198832% report occasional use of condoms when topping28% report occasional use of condoms when bottoming50% report NEVER using condoms when bottoming(N=955 MSM)-Valdiserri et al., 1988. “Variables Influencing Condom Use in aCohort of Gay and Bisexual Men.” AJPH Vol. 78

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