Navigating between rules and reality: a qualitative study of HIV positive MSM’s experiences of communication at HIV clinics in Sweden about the rules of conduct and infectiousness

Abstract

The rules of conduct given to people living with HIV in Sweden in accordance with the Swedish Communicable Diseases Act stipulate disclosure obligation to sexual partners and mandatory condom use. Since 2013, treating physicians have the possibility to exempt patients from this disclosure obligation when no considerable risk of transmission is present. This study explored experiences of communication with clinical staff at HIV clinics regarding rules of conduct and infectiousness among men who have sex with men (MSM) living with HIV in Sweden. In-depth interviews were carried out with 10 MSM living with HIV in Sweden. Study participants all reported unmeasurable viral loads. Data were analyzed using qualitative content analysis. Five categories and one theme, "Navigating between rules and reality", were identified. We found that MSM living with HIV had good relationships with clinical staff at HIV clinics. Inconsistencies emerged regarding how they experienced receiving information about the rules of conduct and infectiousness. The findings indicate that lack of sound routines regarding how information and rules of conduct are communicated negatively affects MSM living with HIV and poses potential risks for the individual. The participants' expressed trust in staff at HIV clinics can provide a good basis for improved communication.

Men and sexual and reproductive healthcare in the Nordic countries: a scoping review

“…Reliable: contradictions, unrealistic information and lack of reliable information caused frustration. 34 43 Exaggerated information (ie, understating or overstating the real situation) was associated with unease, confusion and a sense of not being taken seriously. 59 Men wanted to feel welcome when asking questions and wanted honest, consistent and clear answers.…”

“…16 31 32 Differing attitudes towards health-seeking behaviours of men were found. While most HCPs were described as having positive attitudes, being friendly, sensitive and supportive, [33][34][35][36] some were still perceived as harsh and non-responsive. 33 34 These negative attitudes were sometimes perceived by men as discrimination based on their sex, which hindered them, for example, from disclosing victimisation.…”

Men and sexual and reproductive healthcare in the Nordic countries: a scoping review

“…While most HCPs were described as having positive attitudes, being friendly, sensitive and supportive, 32-35 some were still perceived as harsh and nonresponsive. 32,33 These negative attitudes were sometimes perceived by men as discrimination based on their sex, which hindered them, for example, from disclosing victimization. 28…”

“…Reliable: Contradictions, exaggerations and lack of reliable information caused frustration. 33,42 Exaggerated information was associated with unease, confusion and a sense of not being taken seriously. 52 Men wanted to feel welcome when asking questions and wanted honest, consistent and clear answers.…”

Finding a safe space for learning and exploration: A qualitative study of recently diagnosed men’s experiences of peer support for HIV in Sweden

“…Overall, Sweden has a relatively low HIV prevalence rate and in 2016 was the first country to officially achieve UNAIDS and WHO’s 90-90-90 targets [ 19 ]. This has been attributed to policies such as the Communicable Diseases Act, providing antiretrovirals free of cost, high levels of ART adherence, and using interdisciplinary care teams within specialty HIV clinics [ 20 , 21 ]. Despite these efforts, little is known about the quality of life of PLHIV in Sweden, and even less in known about how PLHIV in Sweden use and experience peer support to meet needs that fall outside the sphere of the medical and social service system [ 19 , 22 ].…”