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APHA Scientific Session and Event Listing

Claudine Offer, MPH¹, Olga Grinstead, PhD, MPH¹, Ellen Goldstein, MA¹, Edward Mamary, DrPH, MS², Nicholas Alvarado, MPH¹, Jason Euren, BA¹, and William Woods, PhD¹. (1) Center for AIDS Prevention Studies, University of California, San Francisco, 50 Beale St, Ste 1300, San Francisco, CA 94105, 415-597-4972, Claudine.Offer@ucsf.edu, (2) Health Science Department, San Jose State University, One Washington Square, San Jose, CA 95192

Background: HIV prevention has recently prioritized prevention with HIV-positive individuals. The Seroconversion Narratives for AIDS Prevention (SNAP) study sought to explore interpersonal and structural attributions of seropositive gay and bisexual men in San Francisco.

Methods: The SNAP study elicited narratives from 28 recently infected seropositive gay/bisexual men that described the circumstances of their seroconversion. In a thematic analysis we explored participants' ideas relating to responsibility for HIV prevention based on the following criteria: 1) participants directly mentioned responsibility for risk-reduction behaviors, or 2) they implied the assignment of responsibility by using words such as “blame.” We examined attributions before and after seroconversion.

Results: When participants reflected on their sexual practices before seroconversion, they attributed responsibility for preventing HIV transmission primarily to themselves as HIV-negative people. Within these pre-seroconversion attributions, we noted themes including: a sense of risk-taking, consequences, and feelings of regret. When participants discussed current perspectives as HIV-positive men, they attributed responsibility to either HIV-positive people or both HIV-positive and HIV-negative people. Themes emerged including personal pledges about HIV prevention and a strong sense of burden regarding responsibility. Factors such as lack of sexual experience, substance use and survival surfaced as structural barriers to enacting beliefs and ideas about responsibility for HIV prevention.

Conclusion: These results demonstrated a significant shift in the attribution of responsibility to HIV-positive individuals after seroconversion. Our findings indicate the need for HIV prevention programs that address barriers to individual-level HIV prevention while remaining sensitive to the burden of responsibility that HIV-positive individuals already experience.

Learning Objectives: