HIV-positive people, risk and sexual behaviour
Introduction
Any attempt to assess the contribution of social science research and prevention policy concerning the sexual behaviour of HIV-infected people has to begin with the admission that information on the subject has until recently been rather limited (Nilsson-Schönnesson and Vincke, 1994, Green, 1995). Before the early 1990s, a few studies provided isolated scraps of knowledge, which were never arranged into a whole. It was only at the 12th World AIDS Conference held in Geneva in 1998 that the issue of sexuality and HIV-infected people received more systematic attention.
We are led to wonder why both scientists and people involved remained quiet for so long. This reticence seems all the more paradoxical in that the matter is a central factor in controlling the epidemic. Regardless of the issue of responsibility, HIV-infected people play a central role in the maintenance of the epidemic.
In the first section of this paper we will try to understand why this subject failed to emerge more quickly as an important topic for research and prevention. In doing so, we suggest studying the emergence and growth of a group that suffered doubly at a time when medical science was developing in leaps and bounds but when the precepts regarding prevention were uncertain and continued to change. Subsequently we will present an overview of what is known about the issue of being HIV-positive and sexual risks.
While we recognise the importance of infected persons in Asia and Africa, no doubt very different from the situation described here in, given the scientific backgrounds of the authors, the inventory of research presented is limited to scientific works on AIDS in developed countries (North America, Europe, Australia). It is of course of major scientific interest to have more comparative research in that field between developing and developed countries.
Section snippets
Dominance of the lethal image of AIDS
When we first were confronted with the outbreak of AIDS, people with AIDS were the sole object of knowledge. In the absence of any form of treatment, AIDS disease was equated with death. The pioneering AIDS Associations were set up to provide the victims with medical, moral and financial support — in a word, to comfort them and “help them to die well”.1
An inventory
These historical notes make clear why it took so long before the sexuality of people infected with what is, after all, a deadly sexually transmissible disease, was studied more in depth. The various recent studies dealing with the sexuality of HIV-infected people show an evolution. In the beginning the focus was on people's immediate behavioural response to finding out they were infected with HIV. Subsequently, sexual behaviour of people in the asymptomatic phase of HIV-disease was addressed
A new dynamic approach in terms of biography
Sexual life is made of interactions with partners within the context of more general active sociability and different psychological and social backgrounds. In a context of uncertainty, the sexual activity of HIV-positive people must adjust to circumstances and changes in their every day life. Dependent on their social and economic situation, they have to deal with variable desires, feelings, affectivity and fears in their interactions with significant others. There is considerable evidence that
Conclusion
In the past, the philosophy behind HIV-preventive action was to change community attitudes and individual conduct by recommendation, based on the principle of reasoned choice and rejecting the notion of forcible intervention. It has to be said that, in a context where a serious epidemic disease was appearing and the temptation existed to reject and ostracise its victims (Kowalewski, 1988, Pollak et al., 1989), this policy succeeded both in altering behavioural standards in the most endangered
Acknowledgements
We would like to express our gratitude to Stuart Michaels and Michael Wright for their supportive advice in editing this article.
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