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Framing dilemmas during sex: A micro-sociological approach to HIV risk

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Abstract

Theoretical explanations of HIV transmission within the broader contexts of cultural and social macro-structures have downplayed the significance of interactional mechanisms that facilitate HIV infection at the micro-level. In the process, the framing and ritual constraints of the interaction order – the Goffmanian face-to-face – have been undertheorized. This paper explores interactional mechanisms of HIV transmission through rigorous analysis of micro-dilemmas of HIV ‘health cooperation’ during sex. For this purpose I bring key insights from the social dilemmas literature into micro-sociological analysis of frames and meta-communication. Based on sexual narratives of Mexican gay and bisexual immigrant men in San Diego, California, I find two types of meta-frame switching during sexual encounters: protective versus trusting. I argue that the elaborate framing demands of a sexual event render choice inherently unstable, and that competing choices in connection with HIV risk and protection typically emerge and switch in the course of a single encounter. Moreover, I further argue that switching into trusting frames can be especially risky for those gay immigrant men who intersect with sexual networks that follow individualistic discourses of HIV non-disclosure. I conclude by discussing the HIV prevention implications of this analysis.

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Notes

  1. (Gambetta 1988, p. 217) specifies that ‘when we say we trust someone or that someone is trustworthy, we implicitly mean that the probability that he will perform an action that is beneficial or at least not detrimental to us is high enough for us to consider engaging in some form of cooperation with him’ (Bacharach and Gambetta, 2001; Gambetta, 2005; Gambetta and Hamill, 2005). Needless to say, the micro-interactional process that shapes social actors’ subjective perceptions of such probabilities is what is at issue here.

  2. None of the study participants in this analysis reported any desire to become HIV infected; none was what in the context of some gay sexual cultures is referred to as a ‘bug-chaser,’ a person actively seeking infection. In this sense, it is safe to analytically assume that it is in a study participant's best interest to remain HIV seronegative after a casual sexual encounter.

  3. The goal here is to show how immigrant men's micro-interactional dynamics may intersect with specific macro- or meso-level risky phenomena in the host country. I use a vignette from Austin, an HIV-positive white man, simply for illustrative purposes. It is important to avoid confounding serostatus with national origin, as if American HIV-positive men were ‘perpetrators,’ and HIV-negative immigrant men ‘victims.’ In fact, studies have shown that most HIV-positive men of any race in the United States feel strong responsibility to protect their sex partners (Wolitski and Bailey, 2005).

References

  • Adam, B.D. (2006) Infectious behavior: Imputing subjectivity to HIV transmission. Social Theory and Health 4: 168–179.

    Article  Google Scholar 

  • Bacharach, M. and Gambetta, D. (2001) Trust in signs. In: K.S. Cook (ed.) Trust in Society. New York: The Russell Sage Foundation, pp. 148–184.

    Google Scholar 

  • Bateson, G. (1972 [2000]) A theory of play and fantasy. In: G. Bateson (ed.) Steps to an Ecology of Mind. Chicago, IL: University of Chicago Press, pp. 177–193.

    Google Scholar 

  • Bayer, R. (1996) AIDS prevention – Sexual ethics and responsibility. The New England Journal of Medicine 334: 1540–1542.

    Article  Google Scholar 

  • Bianchi, F.T., Reisen, C.A., Zea, M.C., Poppen, P.J., Shedlin, M. and Penha, M.M. (2007) The sexual experiences of Latino men who have sex with men who migrated to a gay epicenter in the USA. Culture, Health & Sexuality 9: 505–518.

    Article  Google Scholar 

  • Bloor, M. (1995) The Sociology of HIV Transmission. New York: Sage.

    Google Scholar 

  • Carballo-Diéguez, A., Miner, M., Dolezal, C., Rosser, B.R.S. and Jacoby, S. (2006) Sexual negotiation, HIV-status disclosure, and sexual risk behavior among Latino men who use the Internet to seek sex with other men. Archives of Sexual Behavior 35: 473–481.

    Article  Google Scholar 

  • Carmel, S. (1990) The health belief model in the research of AIDS-related preventive behavior. Public Health Review 18: 73–85.

    Google Scholar 

  • Carrillo, H. (2002) The Night is Young: Sexuality in Mexico in the Time of AIDS. Chicago, IL: University of Chicago Press.

    Google Scholar 

  • Carrillo, H. (2004) Sexual migration, cross-cultural sexual encounters and sexual health. Sexuality Research and Social Policy 1: 58–70.

    Article  Google Scholar 

  • Carrillo, H., Fontdevila, J., Brown, J. and Gómez, W. (2008) Risk across borders: Sexual contexts and HIV prevention challenges among mexican gay and bisexual immigrant men. Findings and Recommendations from the Trayectos study. Monograph. UCSF/SFSU: http://www.caps.ucsf.edu/projects/Trayectos/monograph/index.html.

  • Centers for Disease Control and Prevention. (2006) HIV/AIDS Surveillance Report no. 18, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006report/pdf/2006SurveillanceReport.pdf, accessed 29 November 2008.

  • Centers for Disease Control and Prevention. (2008a) HIV/AIDS among Hispanic/Latinos, http://www.cdc.gov/hiv/hispanics/resources/factsheets/PDF/hispanic.pdf, accessed 29 November 2008.

  • Centers for Disease Control and Prevention. (2008b) MMWR analysis provides new details on HIV incidence in U.S. populations, http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/pdf/mmwr-incidence.pdf, accessed 29 November 2008.

  • Chng, C.L., Wong, F.Y., Park, R.J., Edberg, M.C. and Lai, D.S. (2003) A model for understanding sexual health among Asian American/Pacific Islander men who have sex with men (MSM) in the United States. AIDS Education and Prevention 15 (SupA): 21–38.

    Article  Google Scholar 

  • Danzinger, R. (1996) An epidemic like any other? Rights and responsibilities in HIV prevention. British Medical Journal 312: 1083–1084.

    Article  Google Scholar 

  • Davis, M. (2002) HIV prevention rationalities and serostatus in the risk narratives of gay men. Sexualities 5: 281–299.

    Article  Google Scholar 

  • Dawes, R.M. and Messick, D.M. (2000) Social dilemmas. International Journal of Psychology 35: 111–116.

    Article  Google Scholar 

  • Diaz, R. (1998) Latino Gay Men and HIV: Culture, Sexuality, and Risk Behavior. New York: Routledge.

    Google Scholar 

  • Dworkin, S.L. and Ehrhardt, A.A. (2007) Going beyond ‘ABC’ to include ‘GEM’: Critical reflections on progress in the HIV/AIDS epidemic. American Journal of Public Health 97: 13–18.

    Article  Google Scholar 

  • Elster, J. (ed.) (1986) The Multiple Self. Cambridge, MA: Cambridge University Press.

    Google Scholar 

  • Fischhoff, B. (1989) Making decisions about AIDS. In: V. Mays, G. Albee and S. Schneider (eds.) Primary Prevention of AIDS. Newbury Park, CA: Sage, pp. 168–205.

    Google Scholar 

  • Fontdevila, J. (2002) Rationalities of risk: Intimate action in the age of AIDS among men on methadone. PhD thesis, Department of Sociology, Columbia University.

  • Fontdevila, J. (2006) Phenomenologies of the akratic self: Masculinity, regrets, and HIV among men on methadone. Journal of Urban Health 83: 586–601.

    Article  Google Scholar 

  • Friedman, S.R., Kippax, S.C., Phaswana-Mafuya, N., Rossi, D. and Newman, C.E. (2005) Emerging future issues in HIV/AIDS social research. AIDS 2006: 959–965.

    Google Scholar 

  • Gagnon, J.H. and Simon, W. (1973) Sexual Conduct: The Social Sources of Human Sexuality. Chicago, IL: Aldine Publishing Company.

    Google Scholar 

  • Gambetta, D. (ed.) (1988) Trust: Making and Breaking Cooperative Relations. New York: Basil Blackwell.

    Google Scholar 

  • Gambetta, D. (2005) Deceptive mimicry in humans. In: S. Hurley and N. Chater (eds.) Perspectives on Imitation: From Neuroscience to Social Science, Vol. 2. Cambridge, MA: The MIT Press, pp. 221–241.

    Google Scholar 

  • Gambetta, D. and Hamill, H. (2005) Streetwise: How Taxi Drivers Establish Their Customers’ Trustworthiness. New York: Russell Sage Foundation.

    Google Scholar 

  • Garfinkel, H. (1963) A conception of, and experiments with, ‘trust’ as a condition of stable concerted actions. In: O.J. Harvey (ed.) Motivation and Social Interaction. New York: The Ronald Press.

    Google Scholar 

  • Giddens, A. (1979) Central Problems in Social Theory: Action, Structure and Contradiction in Social Analysis. London, UK: Macmillan.

    Book  Google Scholar 

  • Goffman, E. (1955 [1967]) On face-work: An analysis of ritual elements in social interaction. In: E. Goffman (ed.) Interaction Ritual. Garden City, NY: Anchor Books.

    Google Scholar 

  • Goffman, E. (1974) Frame Analysis: An Essay on the Organization of Experience. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Goffman, E. (1983) The interaction order. American Sociological Review 48: 1–17.

    Article  Google Scholar 

  • Gumperz, J. (1982) Discourse Strategies. Cambridge, UK: Cambridge University Press.

    Book  Google Scholar 

  • Halperin, D.M. (2007) What do Gay Men Want: An Essay on Sex, Risk, and Subjectivity. Ann Arbor, MI: University of Michigan Press.

    Book  Google Scholar 

  • Hardin, R. (1992) The street-level epistemology of trust. Politics and Society 21: 505–529.

    Article  Google Scholar 

  • Herdt, G. (ed.) (1997) Sexual Cultures and Migration in the Era of AIDS. Oxford, UK: Clarendon Press.

    Google Scholar 

  • Hunt, L.M., Schneider, S. and Comer, B. (2004) Should ‘acculturation’ be a variable in health research? A critical review of research on US Hispanics. Social Science & Medicine 59: 973–986.

    Article  Google Scholar 

  • Jacquemet, M. (2005) Transidiomatic practices: Language and power in the age of globalization. Language and Communication 25: 257–277.

    Article  Google Scholar 

  • Janz, N.K. and Becker, M.H. (1984) The health belief model: A decade later. Health Education Quarterly 11: 1–47.

    Article  Google Scholar 

  • Klitzman, R. and Bayer, R. (2003) Mortal Secrets: Truth and Lies in the Age of AIDS. Baltimore, MD: Johns Hopkins University Press.

    Google Scholar 

  • Kollock, P. (1998) Social dilemmas: The anatomy of cooperation. Annual Review of Sociology 24: 183–214.

    Article  Google Scholar 

  • Laumann, E.O., Ellingson, S., Mahay, J., Paik, A. and Youm, Y. (eds.) (2004) The Sexual Organization of the City. Chicago, IL: The University of Chicago Press.

    Book  Google Scholar 

  • Linville, P.W., Fischer, G.W. and Fischhoff, B. (1993) AIDS risk perceptions and decision biases. In: J.B. Pryor and G.D. Reeder (eds.) The Social Psychology of HIV Infection. Hillsdale, NJ: Lawrence Erlbaum Associates, pp. 5–38.

    Google Scholar 

  • Luhmann, N. (1980) Trust and Power. New York: Wiley.

    Google Scholar 

  • March, J. (1994) A Primer on Decision Making: How Decisions Happen. New York: The Free Press.

    Google Scholar 

  • Marks, G., Burris, A. and Peterman, T.A. (1999) Reducing sexual transmission of HIV from those who know they are infected: The need for personal and collective responsibility. AIDS 13: 297–306.

    Article  Google Scholar 

  • McKeganey, N. and Barnard, M. (1992) AIDS, Drugs and Sexual Risk: Lives in the Balance. Buckingham, UK: Open University Press.

    Google Scholar 

  • Messick, D.M. and Brewer, M.B. (1983) Solving social dilemmas: A review. Review of Personality and Social Psychology 4: 11–44.

    Google Scholar 

  • Mizrachi, N., Drori, I. and Anspach, R.R. (2007) Repertoires of trust: The practice of trust in a multinational organization amid political conflict. American Sociological Review 72: 143–165.

    Article  Google Scholar 

  • Morales, E. (1990) HIV infection and Hispanic gay and bisexual men. Hispanic Journal of Behavioral Sciences 12: 212–222.

    Article  Google Scholar 

  • Morin, S.F., Carrillo, H., Steward, W.T., Maiorana, A., Trautwein, M. and Gómez, C.A. (2004) Policy perspectives on public health for Mexican migrants in California. Journal of Acquired Immune Deficiency Syndrome 37: S252–S259.

    Article  Google Scholar 

  • Muñoz-Laboy, M., Castellanos, D. and Westacott, R. (2005) Sexual risk behaviour, viral load, and perceptions of HIV transmission among homosexually active Latino men: An exploratory study. AIDS Care 17: 33–45.

    Article  Google Scholar 

  • Offer, C. et al (2007) Responsibility for HIV prevention: Patterns of attribution among HIV-seropositive gay and bisexual men. AIDS Education and Prevention 19: 24–35.

    Article  Google Scholar 

  • Organista, K.C., Carrillo, H. and Ayala, G. (2004) HIV prevention with Mexican migrants: Review, critique, and recommendations. Journal of Acquired Immune Deficiency Syndrome 37: S227–S239.

    Article  Google Scholar 

  • Parker, R.G. (1994) Sexual cultures, HIV transmission, and AIDS prevention. AIDS 8: S309–S314.

    Google Scholar 

  • Parker, R.G. (2001) Sexuality, culture, and power in HIV/AIDS research. Annual Review of Anthropology 30: 163–179.

    Article  Google Scholar 

  • Parker, R.G. and Aggleton, P. (2003) HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Social Science & Medicine 57: 13–24.

    Article  Google Scholar 

  • Parker, R.G., Herdt, G. and Carballo, M. (1991) Sexual culture, HIV transmission, and AIDS research. The Journal of Sex Research 28: 77–98.

    Article  Google Scholar 

  • Poppen, P.J., Reisen, C.A., Zea, M.C., Bianchi, F.T. and Echeverry, J.J. (2005) Serostatus disclosure, seroconcordance, partner relationship, and unprotected anal intercourse among HIV-positive Latino men who have sex with men. AIDS Education and Prevention 17: 227–237.

    Article  Google Scholar 

  • Putman, R. (2000) Bowling Alone: The Collapse and Revival of American Community. New York: Simon & Schuster.

    Google Scholar 

  • Ruiz, J. (2002) HIV Prevalence, Risk Behaviors, and Access to Care Among Young Latino MSM in San Diego, California and Tijuana, Mexico. Presented at Plenary Session of the Universitywide AIDS Research Program Conference, March 2002. Oakland, California.

  • Sanchez, M.A., Lemp, J.F., Magis-Rodriguez, C., Bravo-Garcia, E., Carter, S. and Ruiz, J.D. (2004) The epidemiology of HIV among Mexican migrants and recent immigrants in California and Mexico. Journal of Acquired Immune Deficiency Syndrome 37: S204–S214.

    Article  Google Scholar 

  • Schutz, A. (1970) Reflections on the Problem of Relevance. New Haven, CT: Yale University Press.

    Google Scholar 

  • Stall, R. and van Griensven, F. (2005) New directions in research regarding prevention for positive individuals: Questions raised by the seropositive urban men's intervention trial. AIDS 19: S123–S127.

    Article  Google Scholar 

  • Strathdee, S.A. and Magis-Rodriguez, C. (2008) Mexico's evolving HIV epidemic. Journal of the American Medical Association 300: 571–573.

    Article  Google Scholar 

  • Sztompka, P. (2006) New perspectives on trust. American Journal of Sociology 112: 905–919.

    Article  Google Scholar 

  • Tannen, D. (ed.) (1993) Framing in Discourse. Oxford, UK: Oxford University Press.

    Google Scholar 

  • Tilly, C. (2005) Trust and Rule. New York: Cambridge University Press.

    Book  Google Scholar 

  • Treichler, P.A. (1999) How to Have Theory in an Epidemic: Cultural Chronicles of AIDS. Durham, NC: Duke University Press.

    Google Scholar 

  • Uslaner, E.M. (2002) The Moral Foundations of Trust. Cambridge, UK: Cambridge University Press.

    Book  Google Scholar 

  • Van Campenhoudt, L., Cohen, M., Guizzardi, G. and Hausser, D. (eds.) (1997) Sexual Interactions and HIV Risk: New Conceptual Perspectives in European Research. London, UK: Taylor & Francis.

    Google Scholar 

  • Voss, T. (2001) Game-theoretical perspectives on the emergence of social norms. In: M. Hechter and K.D. Opp (eds.) Social Norms. New York: Russell Sage Foundation.

    Google Scholar 

  • White, H.C. (1995) Network switchings and bayesian forks: Reconstructing the social and behavioral sciences. Social Research 62: 1035–1063.

    Google Scholar 

  • Wolitski, R.J. and Bailey, C.J. (2005) It takes two to tango: HIV-positive gay and bisexual men's beliefs about their responsibility to protect others from HIV infection. In: P.N. Halkitis, C. Gómez and R. Wolitski (eds.) HIV+ Sex: The Psychological and Interpersonal Dynamics of HIV-seropositive Gay and Bisexual Men's Relationships. Washington, DC: American Psychological Association, pp. 147–162.

    Chapter  Google Scholar 

  • Yamagishi, T. (1994) Social dilemmas. In: K.S. Cook, G.A. Fine and J.S. House (eds.) Sociological Perspectives on Social Psychology. Boston, MA: Allyn and Bacon, pp. 311–335.

    Google Scholar 

  • Yamagishi, T. and Yamagishi, M. (1994) Trust and commitment in the United States and Japan. Motivation and Emotion 18: 129–166.

    Article  Google Scholar 

  • Zea, M.C., Reisen, C.A., Poppen, P.J., Bianchi, F.T. and Echeverry, J.J. (2007) Predictors of disclosure human immunovirus-positive serostatus among Latino gay men. Cultural Diversity and Ethnic Minority Psychology 13: 304–312.

    Article  Google Scholar 

  • Zierler, S. and Krieger, N. (1997) Reframing women's risk: Social inequalities and HIV infection. Annual Review of Public Health 18: 401–436.

    Article  Google Scholar 

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Acknowledgements

This research was supported by Grant #R01HD042919 from the National Institutes of Health for which Dr Héctor Carrillo was the principal investigator. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institute of Child Health and Human Development or the National Institutes of Health. The author is grateful to all the participants who made this analysis possible. The author would like to express his gratitude to Héctor Carrillo and Steven Epstein for their insightful comments. The author also wishes to acknowledge very helpful advice from the editors and two anonymous reviewers.

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  1. Department of Sociology, California State University Fullerton, 800 North State College Boulevard, Fullerton, 92834, CA, USA

    Jorge Fontdevila

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Fontdevila, J. Framing dilemmas during sex: A micro-sociological approach to HIV risk. Soc Theory Health 7, 241–263 (2009). https://doi.org/10.1057/sth.2009.2

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