Gay men still rely on disclosure to avoid HIV

The second most common strategy (after condoms) used by HIV-negative gay men in the UK to avoid HIV infection appears to be to trust that prospective partners who are HIV positive will invariably disclose their status – and then reward their honesty by refusing to have sex with them.

This is one of the less encouraging findings of the 2002 Gay Men’s Sex Survey Out and About, compiled from questionnaires and online survey responses from 16,871 gay men in the UK during 2002, processed during 2003, and published in December.

Of the participants whose most recent HIV test was negative, two-thirds (65.3%) said they would expect an HIV-positive man to disclose his status before having sex. Even more men who had never tested for HIV had the same expectation (77%). In contrast only just over a third of HIV-positive men expected that a partner would disclose their HIV status.

44% of HIV-negative or untested men said they would not want to have sex with the man who’d just disclosed his HIV status to them – and this rose to 56% of men who had never had an HIV test.

Report authors Sigma Research comment: “Expectations that men with HIV will tell a prospective sexual partner their HIV status are still widespread. Over a third of men not tested [HIV] positive both expected a positive partner to disclose their status prior to sex and would not want to have sex with them if they did.

“In this climate, it is difficult to see what incentive men with HIV have for disclosing their status.”

Young gay men were particularly likely to have this expectation. 84% of respondents under 20 expected that an HIV-positive partner would disclose his status, compared with 62% of men in their 30s. They were also much more likely to say they would not have sex with a man they knew to be HIV-positive; 62.1% of under-20 year olds said this as opposed to 38% of men in their 30s and 34.7% of men in their 40s.

Another finding from the survey was to confirm, as in previous years, that HIV-positive men were much more likely to have been involved in the behaviour most likely to transmit HIV, namely having unprotected sex with someone they knew to have a different HIV status.

More than one in four HIV-positive men said they’d had unprotected sex with someone they knew or were fairly certain was HIV negative.

In contrast one in eleven men who’d recently tested negative, and one in 20 men who’d never tested, had had unprotected sex with someone they knew or were fairly certain was positive.

Only 7% of respondents declared that they had tested positive for HIV in contrast to 9.8% of those answering the 2001 survey. The difference is partly due to the inclusion in the survey for the first time of Scotland and Northern Ireland, which are both lower HIV prevalence areas for gay men – only 2.1% of the 1134 Scots responding had tested positive for HIV, and 1.8% of the 156 respondents from Northern Ireland. In contrast 13.4% of the 4233 Londoners had tested HIV positive.

The report also included as valid for the first time responses from men who had never had sex with another man, but expected to do so over the next year, which would also bring down the overall HIV prevalence.

HIV-positive men were therefore statistically far more likely to have sexual encounters with HIV-discordant partners than HIV-negative or untested men. When it came to any incident of unprotected receptive anal sex, regardless of a partner’s HIV status, HIV-positive men were still more likely to report at least one incident during 2002, but not overwhelmingly so. 48% of positive men reported this happening versus 42% of men whose most recent test was negative and 33% of untested men. The figures for insertive anal sex were 45%, 43.6% and 33.5% respectively. Given that a majority of HIV-negative men still believe HIV-positive men will disclose their status before sex, they could be underestimating the number of times they have risked HIV infection with other men.

Londoners were the least likely to report having unprotected anal sex (c. 36%) versus c. 46% of people in Northern Ireland. This, plus other findings such that Northern Ireland respondents were up to 50% less likely to be ‘out’ than respondents from other areas, indicate that Northern Ireland may be a region in particular need of sexuality and sexual health education interventions.

The ‘outness’ findings may bear out the findings of other surveys that men who are fully socialised as gay - and therefore presumably more likely to be informed about HIV risks – are more likely to be HIV-positive.

As Sigma comment, this seems to indicate that “a strong, gay identified population” is not “a prerequisite of effective community HIV prevention.”

This implies that HIV prevention experts have yet to find a way round the uncomfortable paradox that helping men feel better about being gay may also lead to them being less anxious about risking HIV infection.

Other findings from the survey include:

• 21% of HIV-positive men reported having 30 or more partners in 2002 compared with 11.6% of all participants.
• HIV-positive men were slightly more likely to be in a long-term relationship (65% versus 57% of negative and untested men) and their relationships lasted longer (average 2.5 rather than two years).
• The average age gay men reported starting to have sex with men was 16, and starting to have anal intercourse was 17. This contrasts with ages of 14 for any sex and 18 for vaginal sex for heterosexual men. Sigma Research comment: “This is congruent with gay men having been denied opportunities to ‘date’ or ‘court’ while a teenager and being left to enter the adult world of sexuality without support or guidance.”