Gay men’s sexual choices in a changing HIV prevention paradigm
Using Australian research I will explore how gay men calculate potential risk against their desire to pursue pleasure. Beliefs about HIV and risk are highly contextual and dynamic. The emphasis individuals place on pleasure depends on their assessment of relative risk. Concerns about the consequences of HIV infection depend on perceptions of the effects of treatment on the long-term health of HIV-positive people, whereas concerns about transmission depend on how much the effects of treatments, and knowledge of serostatus, can affect the likelihood of transmission.
Issues of trust – trust in partners, trust in knowledge, trust in medication – are central. However, gay men whose sexual desires tend to be riskier are more likely to take an ‘optimistic’ view when pursuing those particular desires. Rapid changes in HIV prevention will undoubtedly mean gay men will continue to adjust their beliefs about relative risk, and consequently will change their behaviors accordingly to maximize their sexual pleasure. Advances in biomedical prevention offer a challenge to us: While the public health goal is to reduce infections, for many individuals, their personal interest may also be in the opportunities these advances present for maximizing their pleasure, even if the risk of infection is generally increased. Is desire, and the rewards of pleasure, sometimes worth the potential risk? Are individual choices to discard condoms justified? Or are some gay men simply being irresponsible?
