Voices behind fears: looking at logic of sexual habits

TALKING POINT

BY NATHAN RILEY

I have a gay friend whose late-night romps with casual partners take place after he gets high. At dinner, he told us that nobody would lie about their HIV status. We were dismayed and argued vigorously in favor of assuming your partner is positive.

Researchers at NYU’s Steinhardt School of Culture, Education, and Human Development are taking a different slice on this problem. They don’t focus on the truth or falsity of my friend’s belief, but instead are eager to discover why he believes it. This is important. Our arguments with my friend didn’t take. He simply shut up, but I am convinced he didn’t change his mind. He just thought his friends were being difficult, giving him a hard time.

His belief doesn’t exist in a vacuum — it’s tied to other ideas and desires that make casual encounters appealing. Dr. Perry Halkitis and his colleagues are seeking insights into the psychological basis of their decision-making logic. To be blunt, they want to know why some men have unprotected sex casually.

The object of their research, said Dan Siconolfi, assistant director of Project Desire, is to “allow their voice to be heard.” Young gay men have an opportunity to talk calmly about HIV, and their sexual habits. It also gives this group an opportunity to explain why the safe-sex message isn’t working.

The research is a reaction to the continued increases in unprotected sex and with it spiking rates of HIV infection. The latest numbers are only the latest chapter in a long-standing problem. Rather than wringing their hands, the researchers at Project Desire are actually doing something. Funded by the city’s Department of Health and Mental Hygiene, they started with a street survey of 540 youth and then followed up with intensive interviews with 54 of the original group of men. The researchers are listening carefully to this high-risk population. The objective is to make a fresh assessment of a chronic problem.

The interview techniques aimed at uncovering the gay men’s inner voices. For example, they track the sentences with the word “I” looking for clues about what each man thinks about himself. “I should” or “I could” sentences offer clues about personal attitudes while “I don’t know” sentences may be related to the inability to stop activities that cause anxiety and are unsafe. Twenty-seven years into the epidemic, this project is trying to attach words and intentions to the attitudes and feelings of young gay men. In this sense, the researchers believe they are starting with a clean slate in developing effective prevention messages.

One reason for probing an interviewee’s inner voice is the likelihood that fear is an explanation for much of the casual unprotected behavior. This theory contrasts with pop psychology claims that young people have lost their fear of HIV. Yet, too much fear can lead to a psychological paralysis that interferes with avoiding the disease.

Halkitis believes for many young people, “It’s overwhelming to talk about becoming positive.” He sees this group of young people living with constant stress, and the project hopes it will discover a way for them to talk about the desires they have by removing the stonewall erected by fear. “Young gay men are having unprotected sex because it gives them something,” Halkitis said.

There are many possible explanations. Sex without condoms give a feeling of intimacy, or it’s an accommodation to the perceived demands of potential partners in the gay world. Many people coming out, Halkitis said, find the “demands of the gay world just as harsh” as those encountered in the straight world they thought they left behind.

“The pressures are still there, and in some case the pressures are worse,” explained Rob Moeller, the project’s director. “Your identity is a reflection of who you think you are and what you think other people think you are,” he said, citing one of iconic psychologist Erik Erikson’s seminal insights.

The interviews are currently being reviewed by the Project Desire staff to discern what they can learn and generalize from the reactions of the young men intensively studied.

There is every reason to believe that young men are responding to pressures and views that aren’t clearly understood. The object of the project is to create safe-sex messages that resonate with the concerns of 21st-century young gay men. The messages, which will be crafted in conjunction with the city health department, will be tested on focus groups. The goal is to have results available within about a year — the schedule is on track to begin having an impact by then.

This last point — having safe-sex messaging out there within a year or so — distinguishes this effort from other HIV-prevention research. The goal is not peer-reviewed academic publication, but rather approaches that can be tested on the ground. Halkitis and his team are convinced that young gay men, given an unfettered opportunity to talk about their desires, their sex, and their fears will help them shape a message that can save the lives and wellbeing of a new generation.