1. What new sero-converters in
Toronto are saying about the
contexts of acquiring HIV
Barry D Adam
University Professor
Senior Scientist & Director of Prevention Research

2. Beyond behaviours?
 Reckless sex, illicit drug use and other so-called disorders
continue to be the dominant explanations for gay men’s
experience with HIV and other health outcomes in much of
the public health research literature. This individual,
behavioural, reductionist account of health continues to
frame and shape the main interventions used to address gay
men’s health, thereby supporting and extending the
hegemony of the medical model of understanding illness.
 From the call for this event

3. The resilience turn
 Gleaning narratives of
 Successful coping
 Surviving and thriving
 Overcoming challenges
 Contributing to a culture of praxis to make things better
 The Rise of a Gay and Lesbian Movement (Twayne)
 Experiencing HIV (Columbia University Press)
 Protective Factors Against HIV Risk Behaviour Among Gay and
Bisexual Men (Trevor Hart, PI)
 Pathways to Resiliency: An exploratory study on strength based
approaches to HIV prevention and health promotion strategies
amongst East and Southeast Asian MSM (Alan Li, PI)

4. New sero-converters study
 N = 43
 Drawn from 2 downtown Toronto clinics with highest testing
rates for HIV
 All male
 36 gay, 5 bisexual, 1 heterosexual
 Average age: 32
 28 single, 10 boyfriend/partner, 3 married to a man, 1 married
to a woman
 Education: 8 high school or less, 13 some postsecondary, 22
completed college/university or postgraduate
 Multi-ethnic

5. The syndemics hypothesis
 “additive psychosocial health problems— otherwise known
collectively as a syndemic— exist among urban MSM and
that the interconnection of these problems functions to
magnify the effects of the HIV/AIDS epidemic in this
population” (Stall et al. 2003, 941)
 Childhood sexual abuse
 Depression
 Polydrug use
 Partner violence

6. Abuse questions

7. Abuse/drug use nexus
Abuse = ≥2 (of 5) questions answered sometimes, often, or very true
Drugs = recent use of ≥2 club drugs (K, G, MDMA, crystal meth)
and/or cocaine
14
6
17
6
Abuse & drug use
Drugs only
Neither abuse nor drugs
Abuse only

8. Inside the syndemics profile
I’m always moody and I’m always depressed. I’m
clinically depressed….I take E, MDMA, K and
cocaine. I know it’s a lot….Before I went to rehab I
was doing them every single day. This was when I
was in [city]. I was in a really bad relationship. So I
used drugs to kind of escape it. If I didn’t have like
E when I woke up, I’d break stuff and everything….
she [mother] would come over every weekend to
drink with us and to do drugs with us. Everybody
in my family has been addicted to drugs or alcohol.
253057

9. crystal
 So my ex partner who I was with, we were together for four
years. We were together… when I say seven years we were
also on and off seven years with my fuck buddy. So we were
together for four years and halfway through that we decided
to open up the relationship. Then my partner became HIV+. I
don’t want to say I didn’t care about myself or something like
that because it’s not true. But we continually had unsafe sex
but we also had rules and stuff like that with others. So then
we were supposed to be safe about other people. It turned
out not true because he was using meth. 253356
 I strongly believe that probably the time I got it I probably
slipped up and was on crystal. 297453

10. Drugs/no abuse
 So I came here [from Latin America], I met this guy and he was
positive. My third boyfriend was positive too….I’m somebody
who experience all the drugs and direct all the drugs for sex. So
that help me to understand more about my sexuality.… When I
got infected I was really feeling very lonely and I got in this
sexual addiction I think combined with crystal and just having
sex with different guys…. I was not feeling any connection with
anybody. So every weekend was going to these clubs and after
the bathhouse and fucking and fucking. … when this happened
and if I was on crystal and at that time I was infected, I really let
I think one or two guys fuck me without condom…. My drug
story started in 2005 here and after I broke up with my second
boyfriend. So I experienced being attractive and having all these
success with these guys and like being in this drug thing and
having a lot of sex and just checking my list of all the hottest
guys I have like you know and validating myself I think. 5216

11. One step removed
 At the beginning I was using K, not so harsh. Like I didn’t just
get into T until I was like 16 or 17…. It just escalated….When
you’re high... your outlook on the world after a few months of
being stuck in that scene constantly like almost every
day, your brain gets diluted. You start looking at the world
very differently. You just start looking at yourself differently.
You start not caring about yourself. You lose these sort of
things. It’s almost like you put yourself in situations to try to
harm yourself. I know that I’m not the only one who’s
experienced this. I know that this is in general when it comes
to drugs and that scene. You put yourself and misery
becomes company, right? Before you know it, you’re
surrounded by that….I was selling drugs. It was like I ended
up going to jail. They busted down my door. It was hectic.
294606

12. Reckless sex, illicit drug use redux
 How do we acknowledge drug use that is
 Pleasurable, recreational, not harmful
 Painful, isolating, dangerous, out of control?
 How do we contribute to a culture of praxis to enhance the
health of our communities?

13. Outside syndemics: relationships
 He wanted it open; I didn’t want it open. When I finally agreed
to open it, because stupid is in love, the agreement was safe
sex no matter what, lube, condom and they’ve got to be
negative. If they say they’re positive, don’t even go near
these people. If they say they don’t know if they’re negative
or positive, don’t go near these guys. I’ll do the same thing.
Even if they say they’re negative, condoms and lube. I stuck
to the deal for the full 17 months and I came to read and
understand that he basically said I have nothing to worry
about, it’s my life, it’s my body, what do I care. For the full 17
months he was doing positive guys, negative guys, bareback
condom and no condom. 278487

14. Travel
 Maybe I got it in Mexico….I was… I don’t know. I was not
safe. I was not… how should I say this? I was not careful.
5282
 Well I was in New York, my first time in New York. I went with
a friend. We had an acquaintance there that he played with in
previous occasions. But he’s a top. It seems like tops don’t
seem to care as much. We had a threesome. He came in
me….I immediately fired an email off to him to find out if he
was. I didn’t initially get a response and then explained that it
had to do with my meds treatment, if I could pinpoint it better.
That’s when he admitted that he was and not on meds. 5274

15. And other
 We started with condoms but then… I don’t know. It just
became… the condom just… I don’t know. I took it off, he
took it off and it just became bareback. 269589
 I don’t know how that happened. Otherwise I would feel
guilty, blame myself. 5284
 I was sexually assaulted….I don’t have enough evidence to
fucking put him away either. I filed a police
report, everything….. I had the guy over for like an S&M toys
session sort of thing, like no sex or anything like that. 5294

16. Balance or dialectic?
 How do we enhance the health of our communities
 Including reducing HIV transmission?
 How do we address syndemics?
 Can we document and promote a culture of resilience?
 Personal, social, community levels
 How do we face trauma, trouble, turmoil
 Not to affirm yet another construction of the pathological gay men
 But find pathways to better quality of life?

17. How might we create a
collectivity that we would want
to belong to?
 Winning citizenship rights, a great accomplishment, but not
enough
 Rise of neoliberal ethic of the marketplace
 Rational, consenting, contract-making individual with no interest
or concern for the well-being of community, care for the
vulnerable, or relation to “unmasculine” realms of feeling.
 Hyper-individualism—isolation, disconnection
 App-based sexual consumerism disconnected from work and
social lives
 Whitman’s aspiration for a community of adhesive comrades

18. The research team
 PIs
 Barry D Adam, University of Windsor & OHTN
 Greta Bauer, Western University
 James Brooks, National HIV & Retrovirology Laboratories
 Co-Is
 Vanessa Allen, Public Health Ontario
 Chris Archibald, Public Health Agency of Canada
 Jean Bacon, Ontario HIV Treatment Network
 Colin Kovacs, Maple Leaf Clinic
 Lynne Leonard, University of Ottawa
 Frank McGee, Ontario Ministry of Health and Long Term Care
 Eric Mykhalovskiy, York University
 Sean Rourke, University of Toronto & OHTN
 Paul Sandstrom, National HIV & Retrovirology Laboratories
 Rita Shahin, Toronto Public Health
 Zavare Tengra, Hassle Free Clinic
 Funded by CIHR