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Study unearths the reasons gay men risk HIV
  or why anyone risks HIV sexual transmission, as these reasons are universal
Gus Cairns
Wednesday 5 April, 2006
A new study has revealed a fascinating insight into the reasons why gay men take the sexual risks that lad them to catch HIV.
INSIGHT, presented at the 12th conference of the British HIV Association (BHIVA) in Brighton, is conducted by the Health Protection Agency (HPA), which aims to tease out differences in the behaviour and motivations of gay men who catch HIV and ones who stay negative.
The HPA's Dr Gillian Elam took a group of 75 gay men who had tested positive within two years of a previous negative test and compared them with 159 men whose most recent test was negative, again within two years of their previous negative one.
Unsurprisingly she found that the HIV positive ones had taken more sexual risks. Eight out of10 of the positive guys had had unprotected sex as the passive partner since their last test, and seven out of 10 as the active partner: just under half of the HIV negative guys had done the same.
But it was the interviews Elam did with a subset of men about their reasons for having unsafe sex that were really revealing. They showed that gay men have a multiplicity of reasons for taking sexual risks, so that no one prevention strategy will fit all.
Elam divided gay men into various groups. First there were men who'd caught HIV within a steady relationship. A common theme was that condoms were seen as a barrier to intimacy, love and trust.
People made comments like "We've got this thing in the makes it feel like a takes away a lot of the emotion."
There were steady partners who thought each other was negative. Here the risk was when men thought their partner was monogamous and he wasn't, or where they decided to drop condoms too soon in a relationship to really establish trust. A common theme was that people didn't think they or their partner were the 'type' to get HIV.
One said: "It shouldn't have really been me ... my friends...have lots of sexual partners and take drugs ... I'm the most reserved out of the people I know."
There were couples where one knew he was positive from the start, and the negative guy decided to risk unsafe sex. Here having unprotected sex was a conscious trade-off between the risk of HIV and the need for intimacy. People also rationalised that repeated negative test results meant they were 'immune'.
Then there were couples where one partner caught HIV and the other felt suddenly distant from them.
One said: "There was no 'fuck me without a condom, I want to be positive sort of thing'. It is the intimacy ... We had that intimacy and then it was just suddenly taken away."
Another group were people who caught HIV through casual sex. Elam divided these into guys who'd intentionally not used condoms and ones where they felt they should have done, but had allowed unprotected sex to happen without one in the heat of the moment.
Intentional non-users were seeking positive things through not using condoms: they saw it as a signal of love and trust, at least potentially. Elam commented that the need for 'love and trust' and for 'submission, sleaze and adventures' often went together.
One said: "There's sort of hope for something," meaning that having bareback sex was a sort of signal that he was emotionally available.
Men rationalised their way into unsafe sex. Younger guys told themselves that if a partner was well-groomed and 'fit' he wouldn't have HIV. Older guys told themselves that HIV would not have such a negative impact because HIV would have no worse an impact than other facets of ageing.
Then there were the 'accidental' non-condom-users. There were guys who normally tried to use condoms but who had accidents, not in the sense of condoms splitting, but in giving up their normal safer-sex behaviour in the heat of the moment.
Some talked about wanting to please a particularly attractive or confident partner. This was the group who were most likely to talk about depression, drink and drugs as being factors in HIV infection.
One said: "Depression really influenced my sexual behaviour... You go out, you want to be abused almost... you might as well let anybody do what they want to do to you."
Elam said there were themes common to all. Many men talked of condoms reducing intimacy, about not being the 'sort' who caught HIV, and about negative test results giving a sense of false security. Many 'tops' thought they were at no risk, not lower risk
Above all was the sense that giving people more information about HIV risk wasn't the answer. Elam's interviewees had high levels of knowledge about HIV transmission.
If there was a common theme, it was that catching HIV often involves a conscious decision to trade safety for the possibility of love, approval and fun.
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