With HIV-infection rates on the rise among men who have sex with men in many countries including Canada, public health educators worldwide are struggling to find new ways to coax gay men into having safer sex.
That means getting through “the mess of living as a gay man,” one expert told attendees at the International AIDS Conference this week. More than 26,000 people are attending, including former US president Bill Clinton and Microsofters Bill and Melinda Gates. Gay topics — referred to as MSM for “men who have sex with men” in AIDS-speak, just as barebacking is called UAI, unprotected anal intercourse — form just a chunk of the conference’s massive program.
“We often feel the need as health promoters to get [gay men] to do what’s best for themselves, but the message is often confusing,” said Mike Kennedy, executive director of the Victorian AIDS Council in Australia, at the session on AIDS prevention strategies for gay men.
Kennedy’s organization’s campaign — called Stop The Drama Down Under, a reference to complicated gay lives, Australia’s geographic location and the bodily location where sexually transmitted diseases like to hang out — aims to promote the value of being HIV-negative. Gay men may have the information and the skills to negotiate safer sex — what they need is the motivation.
“We need to share experiences, but not by experts. The campaign does not instruct, outline or suggest,” says Kennedy.
There’s no silver bullet in getting gay men to protect themselves. Of course, in some countries, trying to determine how many people are HIV-positive is challenge enough. A Thailand study recruited gay men, sex workers and male-to-female (FTM) trans people to determine HIV prevalence. By interviewing people in bars, saunas and alleyways — 300 venues in Bangkok alone — researchers found that the percentage of HIV-positive people increased to 28 percent of those studied in 2005; in 2003 only 17 percent tested positive. For those aged 15 to 22, 22.3 percent were infected, suggesting a growing number of new infections.
(Ontario’s chief medical officer of health released numbers this week that HIV infections here rose to 24,251 in 2004, up from 17,656 in 1999. The increase is attributed to people living longer with HIV/AIDS, as well as high infection rates among gay or bisexual men, in African and Caribbean communities and among injection drug users.)
For a campaign aimed at black men in North Carolina 226 opinion leaders were trained to talk up safer sex with peers. After 12 months of the intervention, the team found the percentage of men having unprotected anal sex — believed to be the chief cause of transmission among gay men — dropped to 29 percent. At the beginning of the project, 42 percent of the men interviewed reported having unprotected anal sex.
A project in the Netherlands uses hot-looking animated men, electronic dialogue a quiz, short movies — all installed on a popular gay hookup site — to promote safer sex. After three months there was a small increase in the number of men reporting having safer sex.
At the session, researchers from San Francisco presented a theory of serosorting — a declining HIV rate due to HIV-positive men having riskier sex only with other positive men, while HIV-negative men seeking out only other negative men to have risky sex with — that met with some skepticism. Using data from three clinics, the team discovered a dramatic increase in syphilis and rectal gonorrhea among MSM from 1998 to 2002 — but relatively stable HIV-infection rates. That suggests that many men weren’t using condoms but were somehow able to avoid HIV infection.
“It’s true, we have no information to measure the intentions to serosort,” said lead researcher Hong-Ha Truong. She also admitted that San Francisco is a unique case because gay men tend to get tested; 97 percent have been tested in their lives and about 34 percent were tested in a recent six-month period.