Market and risk: stages of HIV transmission among men with homosexual behaviors. Medellin, 1993-2006
Posada, I.C.; Gomez Arias, R.D.
Colombia Medica 38(3): 222-236
2007
Document Number: 198921
Background: The people's different responses to HIV prevention programmes have been related to collective patterns of significance that are imposed to their behaviours and affect the success of health interventions. Objective: To understand the social conditions by which men who have sex with men (MSM) face their risks. Methodology: A qualitative study based on the symbolic interactionism was carried out in Medellin, Colombia, between 1993 and 2006. The places where MSM meet were identified and visited. Focus groups with key informants and 100 in-depth interviews were conducted, of which 39 were conducted with MSM. Results: Seven scenarios where MSM face the risk of HIV were identified and studied. In the region, homosexuality continued to be the object of social stigma and MSM must create for themselves special stages, where sexual activity could be less difficult. These conditions had been exploited by the market, which perceived MSM as consumers with payment capacity, and it had generated an expansive offer of stages where MSM acted out several of their fundamental needs but, at the same time, were also exposed to different risks. The scenarios were built as normative systems generated by the market whose structure was imposed to the individual behaviours, frequently restricting their capacity to be protected from the risk of infection. Conclusion: The findings illustrate the complexity of the subjective decisions involved with the personal protection and the management of risks; and they question the paradigm of the rational consumer. On the contrary, the conjunction of the structural vulnerability and the individual vulnerability, in a context of social exclusion, conforms an intricate net that should be assumed in its complexity and integrity by health policies.