The Resonance Project

What we heard from gay men and their service providers about: Responsibility 

What we heard from gay men and their service providers about:

Biomedical approaches to HIV prevention have renewed conversations about the responsibility for HIV risk reduction. Both gay men and service providers discussed the burden placed on the gay community for HIV prevention, and how biomedical strategies both entrench and change norms around risk reduction. Both gay men and service providers described what they thought constituted responsible and irresponsible behaviours for gay citizens. They discussed the tension between the idea of shared responsibility for prevention and that everyone needed to look after their own health. Some of the gay men noted the role they played as peer educators, sometimes reluctantly, and the extra burden for prevention placed on positive men.

Community burden

Some of the gay men discussed the sense of betrayal they felt when other gay men (often those they perceived as being younger) were dismissive of HIV risks and didn’t take adequate steps to protect themselves from a disease that devastated the gay community in its early years.

Some service providers noted this collective experience of trauma.

Some of the participants—both gay men and service providers— noted the burden of blame, shame and responsibility, coupled with homophobia, carried by the gay community for HIV prevention. In the quotes below, we can sense the feeling of unjust community burden.

I get upset…because it shows a lack of concern…Having been weaned in community through the AIDS epidemic, having lost two partners to AIDS, volunteering my time… to see somebody putting themself at risk by having anonymous sex, looking for somebody to penetrate them and cum in their ass without any protection...  Pos, 50+, VAN1

The gays have to put on a condom and if they don’t they’re irresponsible and promiscuous... If this were a situation that the general population were dealing with, the science would be way further than it is today. Pos, <35, VAN2

An entire culture of people frequenting hook-up sites specifically geared to bareback sex and… unapologetically doing that. I think that is the generational trauma… They’re saying ‘I’ve used condoms for 20 years and I’m exhausted… Now I’m taking back my liberty’ and they’re using it as a point of pride. INT, 35-49, PSY, VAN

Good citizenship – Judging (ir)responsibility

Participants described what they saw as correct, acceptable behaviours and the duty of good, responsible citizens (wearing condoms, achieving undetectability, getting tested regularly, disclosing to partners, being informed), versus men they perceived as being irresponsible or having a defective character.

We can see in the quotes below that the norms around responsible behaviours was often internalized, not just an expectation placed upon others. And it was reinforced between men of the same serostatus, not just across the serodivide.

I used to spend a lot of time online and doing drugs and that’s why I seroconverted. I didn’t really look into the research behind HIV. I didn’t really look into anything for a number of years after I seroconverted. I just continued to behave irresponsibly and continued to do what i wanted. Pos, <35, VAN2

[Presented with a scenario of a new couple getting tested together before having condomless sex]

  • I think that’s terrific. Pos, 50+, VAN1
  • How responsible of them, great. Neg, <35, VAN1
  • I think these are two volunteers at the HIM clinic. [group laughter] Well-informed. Pos, 50+, VAN1
  • Why isn’t he taking the meds? Everybody’s taking the meds now. What is it about him that he’s not doing it? … A lot of people that I know that use a lot of drugs… don’t take the meds... I’d just wonder what’s going on there. Pos, 35-49, VAN3
  • It just makes it seem like they’re not taking their health seriously…It doesn’t make sense. Pos, 50+, VAN3

In the quotes below, we can see that what many men perceived as irresponsible behaviour – whether it was seeking out a positive guy as a sexual partner, not knowing one’s HIV status or being ignorant about HIV – was seen as offensive, not to be tolerated, a sign of not having a conscience or the result of having suffered some trauma in the past.

[Presented with a mock hook-up ad from squirt.org]

  • He’s a hustler. He’s seeking a positive guy. TO4
  • He says seeking… bi, bear, jocks, truckers, positive guys.  Neg, 35-49, TO4
  • He probably doesn’t know what he wants. He’s probably confused. Neg, <35, TO4
  • A bad person. Neg, 35-49, TO4
  • Or probably has run into some trauma in the past. He just feels that sex actually gives him that satisfaction or something like that. i’m not sure. Neg, <35, TO4
  • I think most people just don’t give a fuck that have it because I know certain people that have it and they just don’t care. It’s like they don’t have a conscience, you know.  Neg, 35-49, TO4

I used to be very tolerant of people’s ignorance about HIV, but I’m becoming less and less tolerant. Pos, 35-49, MTL2

  • I’m uncomfortable with somebody who doesn’t know their status. Pos, 35-49, TO3
  • And doesn’t care to know. Don’t care is pretty offensive. It’s pretty offensive. Pos, TO3

According to some service providers, despite some gay men taking steps to reduce their risk (for example through PrEP), some of these decisions were perceived as being irresponsible.

It’s funny that PrEP looks like such a responsible option for those who can afford it… well-informed people who have access and can advocate for themselves with doctors. But in the media reports, and the way it’s talked about by a lot of service providers, it’s presented as the irresponsible choice, like ‘disco dosing’. When it actually can be such a responsible decision for people.  SP, 35-49, CBO, TO

This service provider is describing how the tension between responsible and irresponsible behaviours played out in the community, and how it might have influenced his work.

I don’t want to be shamed into talking about my condomless sex…into thinking that my behaviour is reckless and irresponsible or delusional for thinking that what I’m doing is safe. I want to be supported in my practices because I believe that it’s supported by evidence and research even though it’s not being adopted and recognized by the institutions.’ I think that does lead to the emergence of sub cultures and sexual cultures that are resistant to public health and community but where these things are being discussed and adopted as indigenous kind of practices.  SP, <35, PH, VAN

Here men (generally older) talk about how (generally younger) men had a different set of values. They questioned whether these younger men had a conscience and called them selfish. There were some dissenting voices in the focus groups, who explicitly called out some of the judgemental attitudes they were hearing.

Even though I’m undetectable, I would never take the risk. It’s very upsetting... It’s all bareback, fuck me anyway, you’re undetectable, no rubber... And it’s not guys my age who ask for it. It’s guys who are 20 or 23. What’s their problem? Are they looking for STIs? Do these guys have no conscience? They’re saying ‘who cares if you have AIDS, fuck me anyway.’  Pos, 50+, MTL1

There’s no love like before… It’s like they’ve set intimacy aside... It’s like we older guys are looking for it, but with the newbies it’s just sex, sex sex, no fidelity, then see you later… Sex, fucking, drugs. Pos, 50+, MTL3

There’s a lot of selfishness. Pos, <35, MTL3

What surprises me about the discussion is how much judgement there is. Neg, <35, MTL1

Shared  responsibility?

Some of the gay men noted that negotiation of risk reduction was something that must be shared and discussed as equal partners. Another perspective on shared responsibility was that each person should have the autonomy to decide for themselves what risks they’re willing to accept, do their due diligence, look out for themselves and get educated.

Even if I’m undetectable, it’s not my decision about having sex with condoms. There are two people in the room having sex. It’s not only my decision. Pos, 50+, VAN3

  • I have no problem using a condom... but if the guy doesn’t mention it… Pos, <35, MTL3
  • It’s as much his concern as yours. He’s as guilty as you are. It takes two. Pos, 50+, MTL3

In the quotes below, the idea of individual responsibility is expressed differently. In one case, the sentiment was that the other person needed to look after himself. In the other case, an individual must place responsibility upon himself to do everything in his power to protect himself, and interestingly, in the context of a relationship.

I’ve done my due diligence. I told you I’m HIV-positive… How you digest my status, I don’t care. I hate to sound selfish but everyone needs to be looking out for themselves.  Pos, 50+, TO3

In my doctor’s opinion, theoretically it wouldn’t even be necessary for me to be on PrEP because my partner is undetectable. But I’m the one who chooses to use it. I want the added safety… If it didn’t work after six months, a year or two years, I wouldn’t want to resent him for infecting me or to resent myself for not having done everything I could to protect myself to the best of my knowledge.  Neg, 35-49, MTL2

(Reluctant) peer educators

Participants described (willingly or reluctantly) taking on the role of peer educators or acting as a moral compass, in the face of their sexual partners’ lack of awareness around basic or complex concepts related to risk, transmission, and prevention.

‘What’s up with that? How is it transmitted?’ Hey, listen, it’s 2014, wake up! You can educate yourself on the Internet... There are documentaries that will explain everything to you… Pos, 50+, MTL1

When I get to the point where I have to explain to someone the risks and give them the sheet that my doctor gave me, all of my sexual fun is already gone and I’m in the educator mode.  Pos, 50+, VAN2

I don’t always want to explain what PrEP is and Truvada and HIV and undetectable to some guy I just want to suck my dick [group laughter]. Straight up. Pos, 35-49, TO1

Extra burden on poz men

Some of the gay men living with HIV made special note of the elevated responsibility they shouldered for ensuring that they don’t pass HIV to others. For some of the poz men, disclosing their HIV status was the full extent of their responsibility. The quotes below illustrate the extra burden that some positive men felt, but also a certain resentment.

I feel like a gatekeeper in a way… Now they’re talking about undetectable viral loads. Still, I wouldn’t want to put a negative guy at risk.  Pos, 50+, VAN2

If you’re with a negative partner you’re actually doubly careful and that’s not necessarily a bad thing. But at my age I find it exhausting. Pos, 50+, VAN2

  • I would never feel guilty. I have a friend who always says ‘you know, we’re murderers’. Well you can eat shit! I’m no murderer! If I were to kill somebody, I’d do it with a weapon, not my ass. You understand? Maybe you’re a murderer because you’ve had it for 30 years. my friend has had it for 30 years. and he’s always thought of himself as a murderer. Well you’re fucked in the head! Pos, 50+, MTL3
  • Yikes, okay, that’s intense! Pos, <35, MTL3

Patten S, LeBlanc MA, Jackson E, Adam B (2016). The Resonance Project Community Report: Emerging biomedical discourses on HIV among gay men and their service providers.