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Sexual Behaviour and Risks of HIV Infection

Michel Hubert

The EC Concerted Action Programme on Sexual Behaviour and Risks of HIV Infection

Michel Hubert

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We thank the Commission of the European Communities for sponsoring the workshop on "Sexual Behaviour and Risks of HIV Infection", Muriel Dunand for running the scientific secretariat for the meeting, Gabrielle Leyden for the English texts and Véronique Eloy for her organizational assistance.

1European research on sexual behaviour has been underdeveloped for many years. The arrival of AIDS has put this field of research in the limelight again since it has been shown that the sexual transmission of HIV is the main mode of contamination. As a result, studies on sexual behaviour using different research protocols have started up very actively in several European countries.

2The "concerted action" programme that the Centre d'etudes sociologiques of the Facultés universitaires Saint-Louis will be coordinating for four years from January 1, 1991 is a unique opportunity to reinforce European research on sexual behaviour in the AIDS era and to display the diversity and richness of many European studies that are already under way. Concerted actions are one of the instruments of the Commission of the European Communities to encourage scientific cooperation in biomedical and health research (particularly in the fields of AIDS, cancer and age, environment and life-style related health problems). After selecting, on the basis of a call for tenders, networks of researchers that were constituted to perform a particular project, the Commission of the European Communities funds all that is necessary for running the networks (technical and scientific support, exchange of personnel, exchange of data, meetings, publications, etc.). Each collaborating research centre, however, has to find the necessary local resources to generate the data that will feed the concerted action.

3Some of the tasks of this particular concerted action on "Sexual Behaviour and Risks of HIV Infection" will be:

  • to draw up a well-informed inventory of current scientific research on sexual behaviour in Europe that is relevant for the study of the risk of HIV infection and meets the methodological requirements to be taken into account for international comparisons; this inventory should include the questions under study, the conceptual frameworks underlying the research and the methodologies used.

  • to try to make comparative analyses of existing data in order to learn from similar trends and/or to reveal particularities in some countries;

  • to confront and evaluate methodologies and conceptual frameworks, and promote those that seem to be the most relevant;

  • to give the opportunity to researchers from different backgrounds and specialities to meet and contribute to a better understanding of sexual behaviour in a context of risk;

  • to discuss what can be inferred from research on sexual behaviour for designing and assessing preventive strategies, providing health care service, epidemiological modelling and demographic predictions, as well as the way research can be better articulated with action.

4In brief, this concerted action on "Sexual Behaviour and Risks of HIV Infection” could contribute to create the conditions of a European scientific community on sexual behaviour in the context of the risk of HIV infection, i.e. a climate of confrontation of knowledge, methodologies and conceptual frameworks that could last beyond the duration of the concerted action programme.

5This book contains the proceedings of a workshop that the Commission of the European Communities asked the Centre d'etudes sociologiques to organize and that was held in Brussels on 5 to 7 April 1989 to discuss with representatives from about twenty potential collaborating centres a proposal for a concerted action programme on "Sexual Behaviour and Risks of HIV Infection". The proposal on which the participants agreed was then submitted to and approved by the Commission.

6At the workshop it was proposed that the concerted action would focus on three key research questions, namely,

  1. What is the prevalence of sexual behaviours associated, either positively or negatively, with the risk of HIV infection in the different segments of the population?

  2. How do these behaviours change over time?

  3. What factors account for changes in these sexual behaviours?

7The goals of the first two questions are basically descriptive, whereas that of the third one is basically interpretative, to the extent that it centres more on understanding the phenomena under study.

8The distinction between descriptive and interpretative aspects of the research is mainly pragmatic, since it might be easier to get researchers to agree on what descriptive aspects have to be studied than on the interpretation to be given to the facts observed at a time when most conceptual frameworks are being revised. It is also a methodological distinction in the sense that descriptive and interpretative aspects do not necessarely require the same type of methodology. But it is clear that descriptive and interpretative aspects of the research are closely interconnected and must not become autonomous.

9One of the tasks of the concerted action programme will be to look at the hypotheses, variables and indicators that are used by the different collaborating centres to study the above key questions. For instance, "the prevalence of sexual behaviours associated, either positively or negatively, with the risk of HIV infection" is often measured by counting the frequency of protected and unprotected sex with non-mutually-exclusive partners using indicators such as the number of different sexual partners, the type and frequency of sexual intercourse (anal/vaginal, receptive/active, etc.), sexual preference (hetero-, homo-, and bisexuality) and the use of condom in these different situations. During the concerted action, the ways these indicators are defined by the different European teams will have to be studied and evaluated (what does "having sex" means in the different research? what is the period of observation of the sexual practices - last month, last three months, last year, the whole life? etc.) in order to determine the advantages and limits of the different definitions and approaches, as well as the conditions under which an international comparison of data would be possible.

10This kind of comparative work will be broadened, during the concerted action programme, to include other aspects of the study of sexual behaviour in the context of the risk of HIV infection. Thus, when studying the risk exposure of individuals to HIV infection, we notice that unprotected sexual relations are not risky per se but have a greater risk if they occur in important foci of infection. So far, the distribution of HIV is not random but still tied, to a certain extent, to specific areas of society, just as the choice of sexual partners is not random. If we view people as being characterized by a combination of demographic and social attributes, it seems obvious that some couplings are more likely to occur than others. Possible determinants for partner selection include age, social status and lifestyle factors (such as the visiting of meeting places, etc.).

11The formation of sexual networks is largely dependent on these principles of partner selection. Identified sexual networks can then be described in terms of density of sexual contacts, density of unprotected sexual intercourse, overlap with other networks, distance from known risk groups, etc. If combined with a differentiated knowledge of the spread of the epidemic, they can provide decisive information in the attempt to define more precisely the probability that the individuals are exposed to the risk of HIV infection.

12In this context, the analysis of sexual behaviour changes focuses, for each sexual network, on two types of precautions: those aimed at reducing the number of situations of exposure (they range from frequenting certain establishments or milieux less often to engaging in sex only within the confines of a stable, faithful couple, an intermediate strategy being to reduce the number of one's partners) and those that interrupt transmission of the virus ("safer sex").

13However, if the aim of the concerted action programme is, among other things, to deliver useful information for designing and assessing preventive strategies, we should not only concentrate on such a socio-epidemiological analysis of risk exposure but also study the many ways that individuals manage or do not manage the risk of HIV infection in their primary and secondary relationships. Behind the taking or not taking of precautions lie various rationales that may seem consistent or inconsistent from the standpoint of "objective" risk exposure but must be understood if we want to have a comprehensive view of sexual behaviour and sexual behaviour changes. Each individual, at the different stages in his lifecourse, is the scene of contradictory tensions between which he has to arbitrate continously. People who fear AIDS try to resolve the tension between their desires for certain types of emotional and sexual relationships and their fear of AIDS. The subject's internal complexity has to be studied, as well as the dynamics of sexual interaction during which this particular complexity will be confronted with the partner's own contradictory tensions. Understanding the complex negotiation in which the partners engage, either explicitly or implicitly, can explain why a given individual may adopt radically different types of risk-management behaviour depending on his/her partner and, among other things, the stage of their relationship, type of communication, degree of confidence and relative power over each other that they develop.

14There is no solution for AIDS prevention if one does not accept the diversity of situations and risk management approaches and, consequently, the diversity of strategies of change that the individuals construct. From that point of view, the question of what may motivate behavioural change is no longer tackled from the standpoint of generalities. Instead, appropriate, specific hypotheses for each situation can be found. It is possible that most of the "levers of change" defined in the literature by the scientific hypotheses may have no relevance for certain categories of people or interactions, whereas they may apply to others, under certain conditions.

15During the concerted action programme the specific conditions of efficacy and how the hypothesis could be included in a prevention strategy will also be discussed, taking into account the various experiences and backgrounds of the involved researchers.

16Beside the discussion of a proposal for a concerted action programme on "Sexual Behaviour and Risks of HIV Infection", the Brussels workshop gave the participants the opportunity to engage in preliminary scientific exchanges. It was also an occasion to see to which methodological and conceptual issues the researchers from the different parts of Europe were the most sensitive.

17This book includes the main contributions that were given during the workshop. In the first goup of contributions, some conceptual perspectives were drawn for the understanding of sexual behaviour changes. Jean-Paul Moatti and Michaël Poliak discussed the limits of traditional models, in particular the Health Belief Model, about determinants of behaviour in the case of sexual HIV transmission, whereas José Nieto gave the guidelines of an anthropological analysis of sexual behaviour changes in the context of AIDS. Methodological issues in the study of sexual behaviour were the second focus of the meeting. Peter Davies presented the sexual diary as an innovative way of describing the sequences of sexual action and analysing the influence of context (both physical and situational) on behaviour. The comparison of self-administered, telephone and face-to-face surveys was also covered by Jon Martin Sundet's presentation of the Norwegian experience, Robert Tielman's discussion of the Dutch research diversity and Kaye Wellings'comments on the British survey of sexual attitudes and lifestyles.

18Let us hope that this volume will be followed by several others that will focus on the main issues of current research on sexual behaviour and reflect the dynamics of scientific confrontation that the forthcoming European concerted action on "Sexual Behaviour and Risks of HIV Infection" will permit.

© Presses de l’Université Saint-Louis, 1990

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