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Articles tagged with: condoms

Nov03

Eight changes in HIV prevention

Thursday, 03 November 2016 Written by // Guest Authors - Revolving Door Categories // Social Media, As Prevention , Gay Men, Treatment Guidelines -including when to start, Research, Health, International , Treatment, Living with HIV, Opinion Pieces, Revolving Door, Guest Authors

As he leaves his role as CEO of GMFA, Matthew Hodson takes stock of how HIV prevention work has changed during his tenure there.

Eight changes in HIV prevention

Matthew when he first started at GMFA.

This article by Matthew Hodson previously appeared at FS Magazine, a publication of GMFA, here.

A child who was born on the day I started at GMFA would now be old enough to join the army or get married – two rights that British gay men didn’t have back then. I’ve been with GMFA about half of my adult life. After 17 years with GMFA it’s time for me to move on.

It’s been at various times wonderful and gruelling and frustrating and inspiring – and sometimes all of these at the same time. If I didn’t walk now, to take up a wonderful opportunity to work for the NAM, providers of aidsmap, I would end up being carried out in a box… or dragged out kicking and screaming.

So, as a parting shot, here are a few observations about the changes I’ve witnessed over the last 17 years.

HIV treatment works

When I joined GMFA I had been diagnosed with HIV for about eight months. At my interview I probably pretended to be cooler about that diagnosis than I actually was at the time. This was near the beginning of the era of effective treatment but before we believed with confidence that someone who was diagnosed promptly, and who was able to access treatment, would have a similar life expectancy to someone who was uninfected.

Back then the knee-jerk response for health promoters was that HIV meds were ‘highly toxic’. Since that time dosing has got much better, so the side effects that used to be all too common are now mercifully rare. I think that some who were involved in HIV prevention, and others who cared passionately about it almost missed the days when death was the price that may be paid for not using a condom – it made the messaging that much simpler. For myself, I’m hugely grateful for the drugs that keep me alive. I have to go to fewer funerals now in my late 40s, than I did throughout my 20s and 30s. HIV is now very treatable and this needs to be trumpeted loudly.

Undetectable means uninfectious

Not only does HIV treatment give you a realistic expectation of a long life, it also means that it’s very, very unlikely that you will pass on the virus to your sexual partners. New data has just been released from a major international study looking at mixed HIV-status couples and, after almost 60 thousand acts of unprotected sex, not a single person got HIV from a partner who had an undetectable viral load. For all those who routinely sexually reject people who are open about their HIV status – your strategy is dumb. You are more likely to get HIV from sex, even protected sex, with someone who thinks that they’re uninfected, but isn’t, than from unprotected sex with someone who’s been diagnosed with HIV and is courteous enough to tell you about it.

PrEP works

The number of gay and bisexual men who acquire HIV each year in the UK has remained fairly stable. This isn’t good enough. The proportion of men who haven’t been diagnosed is dropping, due to successful work to increase testing rates, and the vast majority of those diagnosed are undetectable on treatment (and therefore uninfectious). By now we should be seeing a drop in new infections – but we’re not. Blame Grindr, blame chems, blame Taylor Swift if you want but it’s clear we need to have more in our prevention armoury if we’re going to end HIV. PrEP could make that difference. The time is now.

…But we still need condoms

PrEP is going to be great for those who, for whatever reason, are not able to maintain consistent condom use but, in addition to my advocacy for PrEP, I remain a big cheerleader for condoms. PrEP doesn’t offer any protection from other STIs, and gonorrhoea is getting harder to treat. PrEP is expensive, which is the main reason it hasn’t already been rolled out. Studies show that those who are greatly motivated to use it take it often enough for it to be effective but that isn’t going to be everyone. I only want to add to our prevention armoury, I don’t want to take anything away.

Stop blaming

OK, I just made a lame blame joke (sorry Taylor, love you) but really, the blame game doesn’t help. It’s all too easy to see HIV as something that happens to other people, whether that’s older people, younger people, sauna users, proud pervs or whatever other category you feel you don’t fit into but secretly enjoy judging. Truth is, those of us living with HIV have probably made some good choices and some bad ones in our lives. So has everyone else. That judgey-blamey thing? Not helping.

There is no one reason why people get HIV

As I said at the top, I’ve been in HIV prevention for a long time. Every couple of years there’s some new moral panic about something that is supposedly behind the number of new infections. I’ve lived through bareback porn, bug-chasing and now chemsex. The truth is, we are complicated and so are our sex lives. Of course taking drugs that reduce your inhibitions and make you feel all horned up may result in some people having unprotected sex who wouldn’t otherwise. And yes, if all the porn you see is bareback, perhaps that’s going to feel more natural to you than protected sex, etc, etc. But there is no one single reason why men have sex which puts them or their partners at risk of HIV.

…and there’s no magic bullet

And because there’s no single reason why gay men take risks, there is no single answer that’s going to end all new HIV infections. All we can do is chip away at the mountain of challenges by ensuring that gay men have access to condoms and that we are encouraged to test early and often, by fighting for access to PrEP, by making sure that everyone knows how HIV is and isn’t transmitted, by giving support to gay men so that they don’t end up having sex that’s not safe enough for them because someone pressured them into it, or because they were drunk, high, lonely or sad. On their own, none of these will be enough to end HIV. Together they just might be.

Support GMFA

I’ve probably spent more hours in GMFA’s offices or working on GMFA’s projects than I’ve spent with any single human being. I’m still passionate about the work that GMFA does. I believe it’s vital that gay men have access to the kind of frank, direct and reliable information that GMFA provides, through its website and FS, its campaigns and groupwork. I believe GMFA does this better than anyone else. Unfortunately much of this work isn’t funded. I’m English enough to feel embarrassed asking for money when it’s contributing to my own salary. Now that I am no longer on the payroll I can say without hesitation: this work is too valuable to be lost. So if anything that you have read on this site has been valuable to you, organize a bake sale, shake a tin, run a marathon or set up a standing order. These services will be lost without funding.

GMFA has taught me so much and I’m enormously proud of the work that I have achieved here, and grateful to all the supporters, volunteers and colleagues who have inspired me with their talent, passion and dedication. GMFA will always have my support. I hope that it has yours too. It’s been immense.

Goodbye for now.

Matthew Hodson

Matthew finished his role as CEO of GMFA on 19 August 2016. Ian Howley, took over as Interim CEO. To make a donation or set up a standing order to GMFA, visit www.gmfa.org.uk/donate.

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