Young Gay Men and AIDS: Report on a Qualitative Study

Prepared for: The AIDS Committee of Toronto
Prepared by: Robert Gray

March 1991


Background:

The AIDS Committee of Toronto (ACT) wishes to identify the AIDS-related educational needs of young gay men in Toronto. This study is intended to examine whether education initiatives designed for gay men as a whole are appropriate for younger men.

Separate studies are planned to look at the same issue among black gay or bisexual men and gay men of Spanish-speaking origin.


Research Objectives

The main objects of this research were to provide direction towards determining:

    • Awareness and familiarity with AIDS in general and with HIV prevention in particular
    • Perceived likelihood of contracting AIDS and the level of HIV risk taking
    • Sources for information regarding AIDS and HIV prevention
    • Awareness, knowledge and image of ACT
    • Reaction to current educational materials, including both posters and pamphlets.

Methodology:

A variety of qualitative techniques and recruiting methods were used in this study. In total, the research consisted of:
    • Two focus groups, divided between younger men (19 and less) and older men (20-24)
    • Two paired interviews
    • Seven individual interviews, four of which were conducted at a meeting of Lesbian and Gay Youth of Toronto (LGYT).

The two groups and one of the paired interviews were held in December 1990 and the balance of the work was conducted during February 1991.

Although a variety of recruiting methods were used, recruiting proved to be very difficult. Flyers were distributed in bars as well as at LGYT and ads were place in XTRA!. The flyers seemed to be more effective than the ads, especially when the flyers were personally distributed.

For all but the LGYT interviews, all participants were screened through Infocus to ensure that they met the age qualification and that they had not been involved in any AIDS-related volunteer work within the past two years. Both the groups and the interviews were held in the focus group facility at Infocus.

The interviews at LGYT were held at the 519 Community Centre on the LGYT meeting night, with recruiting and interviewing all in the same evening.

A Note of Caution:
The findings in this report are based on qualitative research. Because of the small sample size, results are indicative rather than conclusive.




Conclusions and Recommendations:

1. These young men seem to be reasonably well informed about AIDS and HIV prevention and definitely believe themselves to be up-to-date. There was no sense that their age gives them some kind of immunity from HIV. One advantage of their age, though, is that they have not had to change their behaviour in light of AIDS.

2. Awareness of the dangers of unprotected anal sex and needle sharing is universal, although they are less certain about the riskiness of other activities.

3. Oral sex is a particularly confusing area and they acknowledge the difficulty in separating "fact" from "opinion". ACT's revised guidelines do not seem to have been fully accepted and there was simply no mention of activities other than oral and anal sex.

4. ACT itself is reasonably well known, although it was never named right up front by any of these men. Its image is positive but is very hazy and is not based upon a clear understanding of the organization and its function. Consideration should be given to creating greater awareness of ACT specifically in order to provide the current image with a stronger foundation.

5. All indications from a review of a wide range of posters point to a need for reminder advertising aimed directly at young men to help ensure an ongoing commitment to safer sex. Although they see AIDS as a real threat, there is a danger of complacency.

6. The message should attempt to go beyond the purely sexual aspects of HIV prevention to include the much wider ramifications of becoming HIV+ since "what is really at risk is your life in general". These young men believe that a commitment to safer sex reflects a more positive self image and advertising may be able to build on this attitude.

7. Very positive gay imagery that is romantic and erotic without being explicit would likely have the widest appeal. Such imagery is especially needed to reinforce the sexual identity of those young men who are less comfortable with their homosexuality. "Life, Liberty and the Pursuit of Happiness" is a good representation of this kind of imagery.

"Love is probably the better way to fight AIDS."

8. Highly explicit images created a very strong adverse reaction among all of the young men in this study. They are concerned that such images detract from the message rather than reinforcing it.

9. Like the posters, pamphlets need to be eye-catching and should be very clearly targeted towards young men. Explicit content seems to be less of an issue in pamphlets, seemingly because pamphlets are less "public".

10. A straightforward reminder of the guidelines should be considered, perhaps along the lines of "What's Safe, What's Not." Since pamphlets are generally looked to for new information, there is a risk of becoming "stale", which suggests the need to occasionally repackage current information to help it seem "new".




Summary of Findings:

Attitudes Towards AIDS:

One of the key objectives of this study was to determine the level of awareness and familiarity with AIDS in general and with HIV prevention in particular.

On the whole, these young men seem to be reasonably well informed about AIDS and HIV prevention and certainly see themselves as making a continuing effort to keep themselves up-to-date.

In a sense, their level of familiarity with AIDS is dependent on whether they know someone who is HIV+, has AIDS or has died from it -- in other words, the degree to which they have been personally affected by it.

The initial associations they make with AIDS also seem to be influenced by this degree of familiarity:

Those who have been personally affected tend to initially think of the people they know

Those with less direct personal experience wonder about whether they themselves are at risk.

It is not surprising that images of fear and death readily came to mind when these young men were asked for their first thoughts about AIDS. However, the images they had were not of terror or of great personal anxiety, perhaps because they "grew up" with AIDS.

For them, safer sex has always been a reality and they have not had to change their behaviour. They also seemed reasonably confident that they have the knowledge they need to successfully avoid becoming HIV+. A few specifically see themselves as being far more serious about sex and the need for protection than were young gay men 10 or 20 years ago.

"I think of people I know who have AIDS and I think of danger - this is something that you have to be careful about because, ever since I came out, I have had all this safe sex drilled into my head and always been told about what happens when you contract HIV. So when I hear about AIDS, the danger signs go off - 'be careful'."

"I think I know enough to protect myself."

"The best way to fight it is to know about it."


AIDS vs. HIV

For the most part, these young men made a clear distinction between people who are HIV+ and those who have "full blown AIDS". They recognize that infected people may not show symptoms for years, although they are capable of transmitting the virus. They do believe, though, that being infected with HIV inevitably leads to AIDS - "it's just a question of time."

"I know people that are HIV+ but I don't like them to refer to themselves as having AIDS because they don't. There's a great difference between being HIV+ and actually having AIDS. There are a lot of treatments available now. I definitely don't see being HIV+ as the end."

They are also well aware that you cannot "tell" if someone is HIV+ or has AIDS, except perhaps in its most advanced stages. There also is no sense of there being a "typical" PWA, "because it's not a discriminating virus, anyone can get it."

Among a few of the men, there was a tendency to look upon people who are infected or have AIDS as "others", "those people" - in a sense, people who are a group apart. This attitude seems to be related to their own degree of comfort with AIDS. Several clearly stated that they would not be comfortable having sex with someone they knew to be HIV+.

"If I didn't know, I would be as safe as possible but, if I knew, I don't think I would (have sex with that person)."

"It's hard because I know about [AIDS] and how to get it and how not to get it but when you're with someone that has it, it's a totally different thing - fear grips you, just ruins you."

"Because everyone has their own ideas of what is safe and what is not safe and some people do not think it is safe to have sex with someone who has AIDS - period. I think it's up to each individual to make that decision, not the person who has AIDS."

This attitude seemed to be more prevalent among men who have not had much personal experience with AIDS.

The alternative to this view among some of these men is to treat all sexual partners as if they are HIV+, which helps them to "practice safe sex better".


Familiarity with HIV Prevention

Although they see themselves as relatively well informed, they are generally aware that their knowledge of AIDS and HIV prevention is not absolute.

There is no doubt that unprotected anal sex and sharing IV needles are the riskiest activities (although there was no discussion of sharing sex toys). Beyond that, they recognize many "grey areas" in terms of risk, such as the fact that condoms can fail if not used properly.

Oral sex appears to cause the greatest amount of confusion and there was no consensus on whether swallowing cum is risky or not. They have clearly heard a wide range of opinions o n this particular topic. They are not sure how to distinguish between "fact" and "opinion" on this issue and ACT's revised guidelines do not seem to have been fully accepted.

"I'd really like someone to finally come out and say that this is the way it is."


Perceived Threat from AIDS:

One objective of this study was to assess how vulnerable these young men believe they are in terms of becoming HIV+. Although they clearly recognize both the threat and the fact that they are in a high risk group, there was no feeling that getting AIDS is inevitable for them.

"Everyone who has sex is taking a risk ... there's always the risk even if you use condoms, but that's the risk I want to take."

The knowledge of how to prevent HIV infection, although not perfect, was seen by some of these men as giving them a greater chance of avoiding the disease than a straight woman their age who is not aware of the risks.

"I know about AIDS - a lot of my female friends go to bars and get picked up and, because they are on the Pill, they don't use condoms."

On the whole, they do not see themselves to be at either greater or less risk than older gay men, as long as the older men are also having safe sex. There was no sense that their age gives them any kind of immunity from the disease. In fact, safer sex for some is linked with a more positive self image, a sign that you care about yourself.

"I feel that if you are practising safer sex, it means you feel a lot better about yourself."

"I don't understand it - why would you want to take any chances of getting something that could kill you for a half hour's pleasure?"

One indication of their commitment to HIV prevention is that they also assumed that all of their gay friends are having safer sex. They could not see any reason why their friends would be taking risks.

"I would be very surprised and angered if I found out that any of my friends were not (having safer sex). They should know better."

"It amazes me that people can possibly be so stupid because the information is out there and available for everyone to read."

It seems to be the opposite case with their straight friends. As far as they know, the straight people they know are not practicing safer sex.

"Everyone considers it to be a gay thing still, no matter what anyone says ... something that would never happen to them. [With them] it seems like you'll get AIDS just because you're gay, whether you're safe or not."


Identification with Being Gay:

The most prominent factor differentiating the young men in this study is the degree to which they identify themselves as being gay. Their level of comfort with being gay seems to be closely related to age. Those 21 and older seemed to be much less likely to define themselves as gay and were more comfortable referring to themselves as bisexual.

"I like gay people, I'm happy to be their friend but I'm not sure that I want to immerse myself in the community yet maybe because I'm not gay fully."

The younger men, on the other hand, had no difficulty at all in identifying themselves as gay.

Of even more interest is the finding that the older men believed that younger men are more comfortable with their sexuality than they are, even to the point that "it's pretty chic to be homosexual these days".

Consistent with being less sure of their sexuality, the older men in the study tended to be uncomfortable with very public events like the Queen Nation rallies or the Pride Day Parade.

"I don't really consider myself anything. I still have feelings towards girls. I've gone out with more girls than guys ... I can be gay if I need to be gay. If I didn't like this guy [that I'm seeing] so much, I would probably be seeing a girl on the side as well."


Involvement with the Gay Community:

Separately from the issue of gay identity, two related topics were also examined:

    • Where they socialize
    • Whether they feel part of the "gay community"

Most of the men in the study go out to bars or clubs at least occasionally, although no one bar was named more often than any other. The youngest participant - 18 years old - admitted to "sneaking" into bars and also goes to Komrads after hours when it is open to everyone 16 and older.

Reactions were very diverse on whether they felt part of the "gay community". Some of them have a very positive view of the community and were glad to be part of it.

"Calling it the gay community, that's really what it is - a sense of community, of having friends and services and people and groups and organizations that are there for you and their attention is directed towards you. I think it's a nice feeling - a sense of community and camaraderie."

This view, however, was not shared by all of the men in the study. A few did not believe that it was anything more than "just another part of Toronto."

The 18 year old who is living a very closeted life does not feel part of the community because very few people know that he is gay. However, he clearly sees himself as gay although "I haven't really come out yet".

The rest took a more negative view of the community and specifically have not become part of it. There was partly a sense that they gay community has closed off the rest of the world.

"It turns me off to see gay events. What if I want to bring a straight person? Does that mean that no straight people could enjoy this?"

"A lot of my friends live for fashion and going out to bars and typical attitude and all that kind of stuff really bothers me."

Although they go to gay bars and clubs, they believe that the main reason other people go is for sex. This image of promiscuity, linked with an assumption that those people are at a greater risk of becoming infected, definitely contributes to their respective negative impressions of the community.

"If someone has ten partners in a couple of weeks, it's hard to get it through your head that they're going to be okay, which I guess is wrong because if they're safe, they probably will be ... Having a different partner every night bothers me a lot because it seems more of a problem with gay people."


Additional comments on the issue of the "gay community" include:

"I don't really like the word 'gay'. It strikes me that the whole Church St. crowd is gay and the rest of us are quite happily queer and that's the end of the matter."

"I don't really like the gay community, the bar scene anyway. They've all got really snotty attitudes and they're all really queeny ... there's a lot of back stabbing I find, with gay people. I guess it's the sex thing ... they're always after you and then, if you do, they don't talk to you ever again."

An HIV prevention campaign aimed directly at young gay men could also attempt to combat this type of attitude by promoting positive gay imagery.


Sources of Information:

A wide range of sources of information was named, although it is not clear how often each of them get used. These sources included:

    • Newspapers (such as the AIDS Update in the Star) and magazines, although XTRA was rarely mentioned
    • Television, such as "Talking Sex with Sue"
    • Pamphlets and posters, which they tend to associate with the government
    • Various hotline services
    • Community services and groups, like Street Outreach Services, the 519 and LGYT.
    • To a limited degree, gay doctors and other health services.

Friends are also an informal source of information, although AIDS does not seem to be a frequent topic of conversation with most of these young men.

Very few of them received any formal AIDS education at school and they definitely did not include this as one of the sources they used. The only participant who is still in school has received some AIDS education ("a TV thing in an assembly telling us to use condoms") but relies far more on information from LGYT.


Awareness of AIDS Organizations:

Just as with sources of information, a wide variety of AIDS organizations were named but knowledge of most of them was very limited.

ACT was often included among the organizations named, although not usually among the first mentioned. ACT is seen to be somewhat of an umbrella organization but very few of these men thought that they had ever used an ACT service. They seem to trust ACT and their attitudes are positive but are not really based on much experience or knowledge beyond "seeing their symbol everywhere."

"They put out pamphlets and I'm sure they probably organize the videos that go into the schools and all that sort of stuff."

Both AIDS Action Now and Casey House seem to have a somewhat higher profile than ACT. AIDS Action Now was clearly identified with rallies and demonstrations while Casey House was known to be a hospice for people with AIDS.


Reaction to Posters:

Reactions to a wide range of posters produced a very clear consensus - highly explicit imagery is not appropriate for advertising aimed at these young men. Throughout both the groups and the individual interviews, the explicit posters were widely criticized, to the extent of being called "pornographic" and "completely unnecessary".

There was also a certain degree of discomfort with any specifically gay themes, since they could not picture such a poster appearing in public. Even stressing that such posters would appear only in gay settings was not enough for some of them men in the study. This concern was even greater for the explicit posters, since they saw these posters as promoting casual sex.

It seems that the ideal poster for this group would have the following components:

A message to remind them to practice safer sex rather than providing new information (which can be handled by pamphlets) - no one questioned the need for this type of reminder advertising

"Widening" the message by incorporating the idea that both their lives and their lifestyles are at risk

Very positive gay imagery, perhaps even romantic, to help reinforce their sexual identity (remembering that the "older" men where somewhat less likely to see themselves as gay)

Make the use of condoms sexy, erotic and fun (without being explicit), rather than employing scare tactics.

It also seems important not to be seen as promoting casual sex.

"Giving condoms a sort of romantic, erotic feeling is good and taking away the negative stigmas they might have. Condoms are fun, condoms are romantic, you can enjoy yourself if you use condoms."

"I like stuff that's more romantic rather than just the blatant sex because everybody knows what everyone does - you don't have to show it."

One of the suggestions for a poster was to have two young men, fully dressed, cuddling on a couch, looking sexy but not being sexual. The intention was to drive home that kind of everyday thing you could lose by becoming HIV+.

Of all of the posters shown, two consistently received the most positive reactions:

"Life, Liberty and the Pursuit of Happiness"

"Don't Get Hot If You Ain't Got" (BYOC)

and, to a lesser degree,

"Take It Off, Put It On".

The American poster was praised for showing two young men in an erotic but not explicit way as well as for having a very clear message, which was interpreted as going beyond the purely sexual focus of the more explicit posters. One point of view was that this poster would make him think about his partner as well as himself because they care about each other, rather than just having sex.

Specific reactions to "Life, Liberty" included comments such as:

"It's not too explicit but it certainly implies something - they're happy!"

"It takes away the stigma that condoms aren't fun, that they ruin the mood or something like that. The guys look happy."

"It makes you think more when you see two people who love each other that you have to be safe."

The BYOC poster was very familiar since it had appeared on public transit. It was seen as not being limited to gay men since the person in the poster could be either male or female, which addressed their concerns about explicitly gay posters. The only criticism is that some saw it as being directed at people younger than themselves.

"Take It Off" prompted somewhat of a mixed reaction. To some, it was erotic without being explicit, with a very straightforward message. For others, this poster was considered too extreme.

The poster that graphically displays anal sex was viewed as being far too explicit. This type of imagery was seen to detract from the message rather than to draw attention to it.

"Everyone knows where a condom goes and what situations to use it in ..."

"Why do they have to be nude? Why do they have to show a big erection?"

"You don't see it with your eyes but with your hormones."

ACT's "Oral Sex" poster was generally considered too explicit, with even a hint of domination ("one of them is on his knees"). In response to this poster, one young man asked the question "how does showing a sex act fight AIDS?"

A few men recognized that a very hard hitting, shocking message might be more effective than the more romantic approach that they found appealing - "not glamorize it, it's not happiness or life and liberty, it kills you." However, not many of these men suggested taking this approach.

"The message is different - one is trying to get people to use condoms by using humour [Life & Liberty] and the other is scaring people into using condoms [Love is Serious]. The end result might be exactly the same but I think the happy one might be more appealing."


Reaction to Pamphlets:

Pamphlets seemed to be used primarily as a source for new information and as a way of keeping up-to-date with current trends in HIV prevention. As a result, there was a sense that pamphlets have a tendency to become "stale", particularly if they are widely available. To some degree, this is the case with both the Oral Sex and Anal Sex brochures.

"After you have seen [the pamphlet] a few times, you know it all already."

This suggests that there may be a need to occasionally "repackage" the standard safer sex guidelines in order to ensure that they remain "current".

Of all of the pamphlets shown, "What's Safe, What's Not" produced the most positive reaction. They appreciated the sense of humour in the brochure as well as its strong visual impact. There were a few specific mentions of the importance of the message that "most sex is safe". In comparison to the bright colour and humour in "What's Safe", both the Oral Sex and Anal Sex brochures were seen as too stark.

Explicit content seems to be less of a concern in pamphlets than in posters, apparently because pamphlets are not as "public". They need to be eye-catching in order to get attention, which was not really the case with either "Guys Like Us" or "Big Picture, Little Stories". On the basis of the covers alone, these two brochures were not at all identified as being about AIDS and were described as "too drab".

However, both of these pamphlets provide some direction in terms of content. The variety of men shown in "Big Picture", including the older couple, had wide appeal. This reaction is consistent with the attitude among these young men that AIDS is related more to life than to just sex.

Similarly, the idea of the "Guys Like Us" pamphlet was very popular because it is directly targeted to young gay men. Such a brochure could be one source of positive gay imagery designed specifically for younger men.

The "Oral Sex" brochure was seen as being more effective than the poster, because the picture is not as dominant as in the poster. Most of these men, however, had seen the pamphlet before and had not looked at it recently.

The alternative approach of a post card was not well received, mainly because of the proliferation of post cards for all kinds of purposes. The idea had some appeal but it was difficult to judge because the example shown was strongly criticized for not having a specific message.

As with the posters, it is crucial that the language used in pamphlets is language that these men will understand. In reaction to "What's Safe, What's Not", one man referred to the language as making the pamphlet "more personal".


e-mail: Gay Men’s Community Development Coordinator