Recent News on Gay Men and HIV

In the past couple days, I’ve encountered two interesting news articles pertaining to current trends in HIV epidemiology among men who have sex with men.

Science Daily has published the article “Lack Of HIV Prevention For Male Sex Workers In The Caribbean Could Fuel AIDS Epidemic.”

The following two paragraphs are a quotation from the article:

“Male sex tourists, largely from the United States and Europe, may be fueling an HIV/AIDS epidemic in the Caribbean, and efforts to stop the epidemic will be severely hampered unless HIV prevention dollars are diverted to help male prostitutes, a new study suggests.

“Additionally, the study should serve as call to action for the tourism industry to implement HIV/AIDS prevention programs for tourists and tourism employees, said assistant professor Mark Padilla of the University of Michigan School of Public Health. The Caribbean is second only to sub-Saharan Africa in HIV/AIDS cases. The disease has been described as primarily heterosexual, Padilla said. However, Padilla's book shows that sexual contact between Caribbean male sex workers and male tourists may be a much larger contributor to the HIV/AIDS epidemic there than previously thought. Currently, prevention dollars in the Caribbean serve primarily heterosexuals, and this particular population of male sex workers who have sex with tourists is largely neglected. That population of male prostitutes grows larger as the traditional, agricultural jobs dry up. Funding comes from a variety of sources: governments, multilateral organizations such as the World Health Organization, and private foundations.”

The Oregonian has published “Guessing about HIV may keep epidemic going.” The following are quotations from the article:

“More than two decades after the first warnings that condoms prevent the spread of HIV, an increasing number of gay men are instead betting their lives on vague conversations and verbal assurances from their partner before having unprotected sex.

“The Centers for Disease Control and Prevention reports that nationally, the number of HIV and AIDS diagnoses among men who have sex with men increased 11 percent from 2001 to 2005. Researchers in Oregon and elsewhere say one reason could be that men attempt to sort themselves. HIV-positive men limit their partners to others with HIV; those without the disease avoid sex with those who have it. But some experts say it's more of a guessing game because too few men directly ask or answer, "Do you have HIV?"

“Serosorting is a shaky prevention strategy for healthy men, not so much because men lie to their sexual partners -- most don't, especially not those who are HIV positive. Instead, HIV prevention specialists say, men afraid of rejection or who are embarrassed to talk about sex dance around the topic, behavior also seen in heterosexuals. Gay and bisexual men might drop hints about taking medication, for example, and hope their partner understands they mean HIV medications.

“Some men, aware that anal sex is riskiest for the receptive partner, assume it's that person's responsibility to ask for a condom. Other men who say they're negative cite outdated HIV test results. And 1 in 4 people infected with HIV doesn't know it.”

HIV and Gay Men

A recent article on Science Daily, “Different HIV Rates among Gay Men and Straight People not fully explained by Sexual Behavior,” discusses recent research pertaining to the continued disparity of rates of HIV infection when comparing gay men (really "men who have sex with men," regardless of whether gay-identified or not) with heterosexuals in the U.S. For example, though a much lower proportion than in the 1980s and early 1990s, men who have sex with men still comprise just over half of new HIV infections in the U.S.

What’s interesting about the research reported on is that it doesn’t attribute the difference in infection rates to different rates of unprotected sex. In fact the research indicates roughly comparable rates of unprotected sex and numbers of partners for unprotected sex by homosexual men and heterosexuals. (I emphasize unprotected because there’s no given comparison for total numbers of partners for protected or unprotected sex. Given what I know of the gay community, I’d also find it hard to believe that the total number of partners per year is comparable for homosexual men and heterosexuals on average, even if the average number of partners for gay men is likely far down from the pre-AIDS heyday of the bath house scene.)

Instead, the research emphasizes different rates of infection for unprotected receptive anal versus vaginal intercourse (in itself, not particularly new news) and what they refer to as “role versatility.” Because many gay men practice both inserting and receptive roles in anal intercourse, it’s easy for gay men to become infected, especially through the receptive position, but also to pass it on to other men, especially when practicing the inserting position. Obviously, there is no analogous situation for heterosexuals, whether practicing vaginal or anal intercourse.

One thing the research doesn’t seem to take into account is the higher baseline infection rate for men who have sex with men. For men who have sex with men, the reality is that any given sex partner is more likely to be HIV-positive than is the case for heterosexuals. My own experience researching HIV prevention has indicated that in the community I studied, gay-identified men were much more knowledgeable of HIV prevention than others and much more likely to take safer sex practices seriously (even if this doesn’t mean they always practiced safer sex), but in cases where individuals did have unprotected sex, the chances that they did so with an HIV-positive individual were much higher than the corresponding chances for heterosexuals.