Gay men in the UK employ a wide range of precautionary tactics and behaviours to avoid harms during sex – using condoms is just one of the ways in which men protect themselves and their partners. Avoiding sex with partners of a different HIV status, knowing their current viral load, using lubricant for intercourse and regular testing were all widely cited behaviours.
The data come from the 2014 Gay Men’s Sex Survey, released yesterday. The report also highlights gaps in men’s knowledge about HIV and suggests that alcohol plays as big a role as ‘chemsex’ in men acquiring HIV.
A total of 15,360 men who have sex with men, living in England, completed the online survey in 2014. The majority were recruited through gay hook-up apps and websites (44%) or social media accounts associated with Terrence Higgins Trust and gay community organisations (40%).
Risk reduction behaviours
Men were asked, “Which of the following would you say are part of your approach to reducing the potential for harm from your sex life?” They were offered a list of behaviours and tactics and could tick as many as they wished.
For men who did not have diagnosed HIV, the most widely used tactics were:
- Using lubricant for intercourse (77%)
- Trying to avoid sex with people who have HIV (63%)
- Sometimes declining sex partners (56%)
- Using condoms during insertive anal intercourse (53%)
- Avoiding sex until an STI is cured or managed (53%)
- Knowing current HIV status (53%)
- Using condoms during receptive intercourse (50%)
- Regularly testing for STIs (41%)
- Talking about HIV and/or STIs with potential sex partners (39%)
- Using PEP (34%)
- Dating potential sex partners ‘until we get to know each other better’ (30%)
- Avoiding using poppers during receptive intercourse (21%)
- Avoiding receptive intercourse altogether (19%)
- Avoiding insertive intercourse altogether (12%).
The ranking for men with diagnosed HIV was broadly similar, but with a number of notable differences. “I make sure I know my current viral load” was one of the most popular behaviours, cited by 72% of men with HIV.
Whereas 63% of HIV-negative men said they avoided partners who have HIV, 27% of HIV-positive men avoided partners who do not have HIV.
While around half of HIV-negative men cited condom use as a precautionary behaviour, only around a third of men with HIV did so.
Regular STI testing, avoiding sex until STIs were treated and talking about sexual health with partners were all behaviours more frequently cited by men with HIV.
Knowledge gaps
Most men completing the survey had good levels of knowledge about HIV. But there were some notable gaps.
While 96% knew that HIV treatment improves the health of people living with HIV, only 74% were aware that effective HIV treatment also reduces the risk of HIV being passed on.
99% knew that HIV testing exists, but only 88% were aware that recent infections may not be detected in the first few weeks and just 50% were aware of guidelines recommending annual HIV testing in gay men.
But one of the most striking findings, reflecting a need for HIV prevention to continue to educate on the most basic facts about HIV, was that just 81% were confident that HIV cannot be passed on during kissing, including deep kissing.
Alcohol plays as big a role as drugs in HIV acquisition
Men living with diagnosed HIV were asked, “How large a part do you think alcohol played in your acquiring HIV?” They were asked a similarly worded question about recreational and illicit drugs.
Whereas 31% said that alcohol played a part in their HIV infection, 23% thought other drugs played a part. Men diagnosed more recently, in the previous year, were more likely to attribute their infection to drug use, with 31% doing so.
But more than half of men (58%) said that neither drugs nor alcohol played a role in them becoming HIV positive.
The survey also confirmed that use of the drugs associated with ‘chemsex’ is a minority pursuit, reported by limited numbers of men (in the previous four weeks, 5% had used mephedrone, 3% GHB and 2% crystal meth). These men were much more likely to live in London and have diagnosed HIV than non-users.
In contrast, 89% of respondents had drunk alcohol in the previous four weeks.
Hickson F et al. State of Play: findings from the England Gay Men’s Sex Survey 2014. Sigma Research, 2016. (Full report freely available).