Publications.Thesis Index.kelaher

PhD Thesis - Kelaher, M

Decision-making and HIV risk behaviour among gay men and injecting drug users
Kelaher M (1995)

Abstract:
Increased awareness of HIV transmission has been associated with decreased reports of needle sharing among injecting drug users (IDUs) and unprotected intercourse among gay men. Despite this many IDUs and gay men report occasional incidents of high risk behaviour in certain situations. Psychosocial models are unable to explain why people can avoid HIV risk behaviour in some situations and not in others. The thesis uses a variety of methods to identify high risk situations for HIV transmission behaviour and to examine their relationship to the lifestyles and decision making strategies of gay men and injecting users.

A methodology was developed using multiple computer simulations of injecting events to measure HIV risk among IDUs, and of sexual encounters to measure HIV risk among gay men. This was supplemented by questionnaire data. The results suggested that the response cost of IHV prevention, in terms of craving and needle availability, was primary in determining IDUs preparedness to share needles and that social factors were secondary. The opposite was true for gay men where the mutual attraction between partners was primary in determining the likelihood of unprotected sex and factors related to response cost, that is condom availability, were secondary. There appeared to be cultural determinants of HIV risk behaviour among IDUs and gay men. While more experienced IDUs were more likely to share they minimised their personal risk by going first. This pattern of injecting provides an effective dynamic for transmission with IDUs getting infected at the beginning of their injecting careers and progressively becoming more likely to infect others as their injecting experience increases and they become more likely to be the first to inject. Levels of HIV risk behaviour among gay men varied according to age, stimulant use and safe sex strategy. Overall, the results suggest that prevention of the spread of blood borne viruses among IDUs can be improved by increasing access to clean needles and drug treatment. The results for gay men suggest that improving HIV prevention may require developing interventions which focus on communication between sexual partners and reflect the cultural diversity of the gay community.

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