Since 2001, cases of hepatitis C virus (HCV) sexual transmission have been reported in France, among HIV-positive gay men who do not inject drugs. An earlier study focused on the incidence of acute hepatitis C and risk factors associated with HCV transmission. The present study, based on in-depth interviews, aimed to highlight the biography, the sexual practices and the experiences of gay men infected with HCV. Beyond an apparent uniformity, the group of interviewees illustrates a variety of situations, life stories and health pathways, depending on their age. These well-adjusted gay men were used to engaging in unprotected sexual practices, but before their diagnosis they largely ignored HCV-transmission risk, which was associated in their mind with a pejorative drug addict image. Once diagnosed with acute hepatitis C, they experienced a critical and emotional period during which they were open to discuss their sexual practices and reconsider risk-reduction procedures, without being willing to give up on their satisfying sex life. Health educators should consider labelling hepatitis C as an STI in order to disrupt its negative image and to help HIV-positive gay man raise their awareness of HCV-transmission risks and implement better risk-reduction strategies.
Twenty-three patients were eligible for the qualitative study. Thirteen interviews were carried out. All patients were 20-60-year-old MSM. The median time between PEP and HIV diagnosis was 3.3 years (interquartile range (IQR)=0.9-4.9). Many participants reported negative PEP experiences: awkward access to the PEP clinic, uneasiness and shame in the hospital setting, unpleasant interaction and moral disapprobation from the medical staff, treatment intolerance and prevention messages that were 'inconsistent with real life' CONCLUSION: Our data highlight PEP management failures among its target population that may have compromised any subsequent attempts to seek out PEP. Practitioners should be more aware of MSM sexual contexts and practices. PEP consultations should provide the opportunity to discuss prevention strategies with highly exposed HIV-negative subjects, which may include pre-exposure prophylaxis.
L’étude Hepaig-quali repose sur un ensemble d’entretiens menés auprès d’hommes gais séropositifs pour le VIH, atteints d’une hépatite aiguë C. Elle montre l’étroite intrication qui existe entre pratiques sexuelles et usage de drogues, permettant à ces hommes d’atteindre un objectif de plaisir sexuel incluant des rapports non protégés. La consommation de diverses substances psychoactives et stimulantes (illicites ou non) accroît leur endurance et leurs performances sexuelles, tout en leur procurant un bien-être global. Ces « plaisirs chimiques », auxquels ils ne sont pas prêts à renoncer, prennent place dans le contexte post-sida de la médecine et des traitements, qui a forgé l’idéal d’un patient responsable pour soi et autodiscipliné, et dans le climat moral de stigmatisation de l’abus de drogue et de l’addiction. En conséquence, les programmes de santé devraient tenir compte de leur identité et de leurs besoins d’hommes gais séropositifs et promouvoir une réduction des risques sexuels tenant compte de l’usage de drogues.
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