Gay men found to be ignoring AIDS risk
By Ann Lukits
Local News - Tuesday, October 12, 2004 @ 07:00
A powerful “cocktail” of anti-viral drugs that has dramatically prolonged the lives of people infected with HIV could be sending gay men the wrong message about the grave health threat posed by AIDS.
A new study to be released in Kingston this week has found that a growing number of gay and bisexual men in Ontario are engaging in unprotected sex acts with partners whose HIV status is either positive, unknown or deliberately withheld.
The study also found that after a steady pattern of decline, the number of new HIV infections diagnosed in gay men began increasing in 1996, around the time a new class of anti-HIV drugs called protease inhibitors were approved. The drugs drastically reduced the number of HIV-related infections and deaths from AIDS.
Two hundred men from this area took part in the landmark Ontario Men’s Survey, the largest study of gay and bisexual men ever conducted in Canada. The research was led by Ted Myers of the University of Toronto’s HIV Social, Behavioural and Epidemiological Studies Unit and was based on interviews with 5,080 men from 13 communities.
One of the most interesting findings in the 98-page study was that 41.1 per cent of the men surveyed have never known someone who died of acquired immune deficiency syndrome, or AIDS. The disease is caused by the human immunodeficiency virus (HIV), which progressively destroys the body’s ability to fight infections and certain cancers.
Since Health Canada began keeping statistics in 1977, there have been 6,708 deaths from HIV- and AIDS-related illnesses in Ontario. An estimated 56,000 people are living with HIV and AIDS in Canada and 30 per cent of them are unaware they’re infected. About 40 million people are living with HIV and AIDS worldwide.
Marney McDiarmid, education co-ordinator for HIV/AIDS Regional Services and the study’s data co-ordinator for the Kingston region, believes there’s an important link between the rise in new HIV infections and the fact that protease inhibitors have made AIDS almost an intellectual issue for many gay and bisexual men.
“When AIDS was first discovered, people were dealing with what they thought was going to be a short-term thing,” McDiarmid said.
“But now I’m talking to people who have known about HIV and AIDS for their whole lives. Then you couple that with the fact they don’t actually know anyone who has died of AIDS and it’s going to be less real to them. McDiarmid said gay and bisexual men appear to be “negotiating risk” by engaging in unprotected sex with partners who may be HIV positive. The fact that people with HIV are living longer may lull men into thinking that the disease isn’t such a health threat after all, she suggested.
She added that the idea of men taking risks with their health isn’t so unusual when you consider that people “do that all the time with all kinds of things” such as drinking and driving, taking drugs and not wearing a bike helmet.
“As a culture, it’s interesting, we’re negotiating risk every day,” McDiarmid said. “When it’s around HIV and linked with sex, it becomes way more powerful and way more laden.”
The study found that Ontario has the largest number of HIV infections in Canada, accounting for approximately 44 per cent of the total. HIV infections among gay men – or men who have sex with men – declined until about 1996 but have increased since then, according to the study. At the moment, there are approximately 830 new HIV infections reported among gay men in Ontario every year.
Despite massive public education campaigns about the importance of “safe sex” or wearing a condom, about 40 per cent of the men who took part in the Ontario Men’s Survey said they’d had unprotected anal sex with a regular partner at least once in the previous year while about 80 per cent had unprotected oral sex with a casual partner.
The survey also found that men knowingly took risks by engaging in sex with HIV-positive partners or men whose HIV status was unknown.
About 6.9 per cent of men had unprotected oral sex with partners they knew to be HIV positive and 40.8 per cent had unprotected oral sex with partners whose HIV status was unknown. Six per cent of men “assumed” their partner was HIV positive when they engaged in unprotected anal sex, the survey found.
Only a quarter of men who took part in the survey said they always disclose their HIV status to casual partners, 45.4 per cent said they never do and 29.5 per cent said they “sometimes” indicate if they are HIV positive or negative.
But the survey also found that while a large percentage of men – 77.7 per cent – have been tested for HIV infection, they may not be up-to-date about their actual HIV status. Voluntary saliva tests carried out as part of the study indicated that a significant number of men think they are HIV negative but are HIV positive.
Of the 5,080 men surveyed, 3,683, or 72.5 per cent, disclosed their HIV status to researchers. A slightly smaller number, 3,635, or 71.6 per cent, provided a saliva sample. But 15.7 per cent of men whose saliva tested positive for the HIV antibody had reported that they were HIV negative.
According to the survey, the men could have been unaware of their HIV status, had not been tested since becoming HIV positive or could have been given a false report initially.
“The findings confirm that the potential for increasing rates of infection continue,” the study concludes. “This study has confirmed that a proportion of gay and bisexual men are infected with HIV and may not know it or may choose not to or be unable to recognize or report it.”
The Kingston health unit is one of five in Ontario authorized to provide anonymous HIV testing to men and women. Since the anonymous program was started in 1995, only 11 of the 379 tests carried out by the health unit have been positive for HIV.
McDiarmid said the results of the Ontario Men’s Survey suggests that “in a lot of situations men are trying to negotiate risk” but noted that “sometimes the way they do that is based on misinformation or logical errors.
“The feeling on the ground was that although a lot of men are engaging in safer sex, the incidence rates [of HIV] are on the rise and the feeling was that men having unprotected sex is becoming more common,” McDiarmid said.
“The study did show that.”
The study also found that condoms “may not be the perfect solution” to preventing HIV infection.
According to the survey, 13.6 per cent of men reported at least one episode of a condom breaking and 13.9 per cent reported at least one episode of a condom slipping off. About five per cent of men had both happen more than once.
McDiarmid said the condom findings suggest that more education is needed “to try to convince gay guys that that doesn’t mean all condoms don’t work – and to try another.”
The survey results also suggest that more research into a more appropriate condom for anal sex is needed. Existing condoms are more of a “heterosexual tool,” she said. The study recommends “greater attention be given to technologies that might improve and enhance the use and safety of condoms.”
McDiarmid said another way gay and bisexual men “negotiate risk” is by delaying the use of condoms, not realizing that HIV can be transmitted in the fluids that are emitted before ejaculation.
The study found that while bars are still the best place to find gay sexual partners, the second place to look is on the Internet. About 60 per cent of men reported looking for sex in gay bars, 35 per cent used the Internet and 30 per cent tried bathhouses. The highest percentage of Internet searchers were from Sudbury and Thunder Bay.
The study also found that recreational drug use is common among gay and bisexual men. Marijuana and hashish are the most popular drugs, with 45 per cent of men reporting they had used them at least once in the past 12 months. Almost 20 per cent had used poppers [drugs called amyl nitrites that produce a “rush” sensation], 18.6 per cent had used ecstasy, 17.1 per cent had used cocaine and 11.8 per cent had used special K or ketamine.
The goal of the study was to provide Ontario regions with a “snapshot of life within their communities” that will generate discussion and help educators, public-health promoters and policy-makers improve their programs. The data were gathered between January and June 2002 in gay bars, bathhouses and community groups.
In addition to Kingston, men participated in the survey from Hamilton, Kitchener, London, Peel, Durham, Ottawa, Peterborough, Niagara, Sudbury, Thunder Bay, Toronto and Windsor. Toronto and Ottawa accounted for 60 per cent of the men surveyed.
The study is believed to involve the largest number of non-Caucasian gay and bisexual men ever surveyed. Although Caucasians made up 83.9 per cent of participants, Chinese, black, aboriginal and Latin American men accounted for 10.6 per cent.
McDiarmid and seven volunteers recruited the 200 local participants at 19 sites, including bars, dances, churches and community events.
The survey’s official release in eastern Ontario will take place at a community release party featuring the drag comedy troupe, The B-Girlz, on Friday at Shay Foo Foo, 686 Princess St., beginning at 9 p.m.
The survey’s chief investigator, Ted Myers, will also be present to answer questions. Tickets cost $10 and are available at Shay Foo Foo, HIV/AIDS Regional Services at 844A Princess St., Novel Idea bookstore at Princess and Bagot streets, and the Queen’s University bookstore.