Gourlay A, et al. – An assessment was conducted of the social and environmental context in which new HIV infections occurred among men who have sex with men (MSM) in London and Brighton. A complex web of factors operating at different levels was reflected in the study cohort. Hence, a need arose for multi–level interventions to reduce the risk of HIV acquisition among high–risk MSM in the UK and similar settings.

Methods

• The scheme of this research was a qualitative descriptive study.
• It included in-depth interviews, performed as a substudy to the UK Register of HIV Seroconverters cohort: An observational cohort of individuals whose date of HIV seroconversion was well estimated.
• An inductive thematic analysis was conducted in NVivo, guided by a socio-ecological framework.
• The eligible candidates were from 6 HIV clinics in London and Brighton. Fieldwork was performed between January and April 2015.
• The recruitment constituted all MSM eligible for the UK Register Seroconverter cohort (an HIV-positive antibody test result within 12 months of their last documented HIV-negative test or other laboratory evidence of HIV seroconversion) diagnosed within the past 12 months and aged ≥18.
• It included 21 MSM, aged 22-61 years, who were predominantly white.

Results

• A complex interplay of factors, operating at different levels, affected the risk behaviours and HIV acquisition.
• Risk was multi-factorial, but the relative significance of factors differed for each individual.
• Individual psycho-social factors, including personal history, recent life stressors and mental health, enhanced vulnerability towards greater risk situations.
• The features of the social environment, such as chemsex and social media, and prevalent community beliefs with regard to therapy and HIV normalisation, encouraged risk taking.