This article by Gus Cairns first appeared on aidsmap.com here.  

About 40% of men who answered a community survey for HIV-positive gay men in the Netherlands said they took their viral load into consideration in deciding whether or not to use condoms. This represents about two-thirds of those who actually did have unprotected sex.

This published paper adds new data to this study’s original conference presentation at the AIDS Impact conference in 2011.

The survey found that consideration of viral load was almost as common when having sex with partners who also had HIV as when having sex with partners of negative or unknown status. Disclosure and discussion of viral load was far more common with HIV-positive partners, whereas viral load was rarely discussed with partners assumed to be HIV negative, remaining purely part of a unilateral decision.

The study also found that this group of HIV-positive men, who, as part of a community consultation panel providing advice to the Netherlands HIV Association (NHA), might be assumed to be well informed on HIV prevention matters, were as a group by no means convinced that undetectable viral load protected them from transmitting HIV to partners. Not surprisingly, the more confident individuals were that this was the case, the more likely they were to take it into account as part of a decision to have condomless sex.

The study

The NHA’s Open Online Panel consists of 517 women and men living with HIV who are contacted on a regular basis by email to ask their opinion on important topics in HIV. In this case just the 212 gay men on the panel were asked to complete an online survey about unprotected sex and consideration of viral load.  

This paper only looked at the answers from the 177 men (85%) who said they had an undetectable viral load. Of these, all but two were on antiretroviral therapy.

Results: unprotected sex

One hundred and twenty (68%) of the 177 had ever had unprotected anal sex since their HIV diagnosis and of these 73 (61%, or 41% of the whole group) did it without a condom the last time they had anal sex. 

The researchers asked respondents if their last sex had been with a casual or a regular partner and of the 73 who’d had unprotected sex last time,  43 (59%) said it was with a casual partner and 30 (41%) with a regular one.

The 73 were also asked the HIV status of the most recent partner and 38 (52%) said they were HIV negative or status unknown and 35 (48%) that they were HIV positive. Unprotected sex partners were more likely to be ‘buddies’ if they were HIV positive (15 casual, 20 buddies) and more likely to be casual meets if they were HIV negative or status unknown (28 casual, 10 buddies); this is what one would expect, as HIV status is usually not discussed until people have reached  a level of trust.

Results: considering viral load

Of the 120 who had ever had unprotected sex since diagnosis, 75 (63%) said that their viral load was something they had taken into account when deciding to use condoms.

Interestingly, more said they had taken viral load into consideration with HIV positive partners (44% of the 120) than with men who were HIV negative or of unknown status (38% – some men considered it with both positive and negative partners).

Participants were asked to estimate the perceived protective value of having an undetectable viral load on a scale of one (“absolutely no risk”) to seven (“absolute risk”).  The average score was three (low-to-moderate risk) when considering sex with HIV-negative partners and two (no-to-low risk) when considering sex with HIV-positive partners (where the perceived risk was presumably superinfection). Not surprisingly, men who thought the risk was lower were more likely to have unprotected sex and to consider viral load as one of the reasons involved in doing so.

When having unprotected sex with HIV-positive partners, men said they were more likely to consider viral load with buddies (over half the partners) than with casual partners (only one in five). Conversely, when having unprotected sex with HIV-negative partners, nearly 60% said they considered their viral load with a casual partner but only 40% with a buddy.

With positive partners, all but one of the 14 men who said they had considered viral load had explicitly discussed it with their partner before sex. Conversely, only three of the 20 men who had considered viral load when having unprotected sex with an HIV negative partner had discussed the subject.

Conclusions

It looks as if there are two different phenomena going on. With HIV-negative partners, men who considered their viral load are doing so in the main as part of a unilateral process of considering how liable they are to transmit HIV. In the case of HIV-positive partners, the researchers comment that “further qualitative studies are needed to shed light on the perceived added value of considering viral load”, but speculate that it may take place within the context of broader discussions about HIV superinfection and STIs.

This is a small study of quite a specific group: HIV-positive gay men who were already engaged and informed enough to join a community consultation group. They could therefore be ‘early adopters’ of viral load as a factor to take into account when considering sexual risk.

As the researchers comment, “future investigations should include the perspectives of HIV-negative MSM in the communication around undetectable viral load and unprotected anal intercourse”, and a wider consultation with less-engaged HIV-positive men would be interesting too. 

They also comment that further investigations are needed to establish the risk of transmitting HIV via anal sex with an undetectable plasma viral load.

They comment: “HIV prevention campaigners need such evidence to take an informed stance in the debate around viral load considerations and urgently so, in light of their already frequent use by MSM.”

Reference

Van den Boom W et al. Undetectable viral load and the decision to engage in unprotected anal intercourse among HIV-positive MSM. AIDS and Behavior, e-publication ahead of print: DOI 10.1007/s10461-013-0453-9, 2013.

In April 2012 I wrote a piece for PositiveLite.com entitled “My Barebacking Journey”. In it I talked about how I had made the decisions not to use condoms since my college days and how this had ultimately led to my testing HIV positive in September 2011. 

A year later, I thought I’d take the opportunity to sit down and put my thoughts over how things have gone over the last 12 months.  Some things have changed dramatically, others haven’t changed at all.  I guess in some respects life is just carrying on just the same as it always has. 

Since I wrote here last, I have come out as an HIV-positive person to nearly everyone I know. Only my parents and immediate work colleagues are in the dark. I managed the “coming out” process carefully; telling a few people, gauging their response, and then telling a couple more, until the deed was done. Surprisingly, for a city of its small size, the public reaction to my condition has been overwhelmingly supportive. Not one person has reacted negatively to it, and the gossip has largely been low key. People whenever I see them, ask me how I am doing, and it has really shown me that the people I call friends really are friends, and I am honoured to have them in my life. 

In November 2012, after my viral load reached a peak of 1.7 million, and my CD4 flicked a margin above the 350 threshold, I took a week off work to start my HAART medication. I was prescribed Truvada and Sustiva, with a view once the viral load was fully suppressed to move on to Atripla.  In order to get a week off work in order to manage any side effects at such short notice, I decided to inform work. After careful consideration of the pros and cons of taking such a step, I decided that it was the right thing to do. I didn’t actually have to say it as it turned out – my manager asked me for a private word and turns out he had guessed it. I suppose a sexually active gay man, talking about having a medical condition which requires a lifetime of medication, kind of drops the hint – and he had put two and two together.  

The reaction I got from him has been fine. No issues whatsoever, and as a result of him being informed of my condition, he has allowed me time off at short notice to attend the clinic for blood tests and regular check ups – something that would have been hard for me to do had he not been aware of the situation. What is more, he has kept it to himself, and not blabbed it to all my work colleagues, so there are no issues there either. 

The question I get asked most now I have started the medication, is how is it going? What about side effects? 

Well the first couple of weeks were a mixture of horror and bizarre experiences.  I wanted to experiment with the drugs – to see how they would impact on my normal life. So I ate my usual meals, drank a few beers before taking them and all that jazz. The first time I took them with beer was like nothing on this earth. I had a couple of pints then popped my pills. Within half an hour, I had gone from merry to totally blotto. I said goodbye to my friends, and staggered home. What normally takes me 20 minutes, took me one hour to walk. I fell through my door, passed out on the sofa with the room spinning! It was as though I’d had twenty pints, not two. A very peculiar experience, it made for a cheap night though! 

Over time I got fed up with not being able to enjoy a couple of quiet beers after a 14 hour shift at work, and it came to a head just before our works Christmas dinner. I spoke to my consultant, and he informed me that I didn’t have to take them at exactly the same time each night; if I wanted to take them immediately before I went to bed, within a four or five window period each night, that would work just as well. So this is what I did, and continue to do. 

I lead life just as I always have done; the only difference is that before I go to bed, I chomp down on my HIV medication. Sure, sometimes if I’ve eaten late at night, the medication triggers some strange vivid dreams, but truth be told, I quite like them! They’re not scary, and on the whole, are very enjoyable experiences. 

More importantly, the medication is working. Within 5 months of starting my treatment, my viral load has gone from through the roof, to undetectable and my CD4 is on the rebound.  I feel more energetic that I have at any point since my diagnosis back in September 2011, and I know that provided I keep taking them, and they keep working, then there is nothing to worry about.  HIV isn’t a death sentence any more, it is a life long chronic, but manageable condition.  I think this is the most important message that we need to get out there people who are recently diagnosed, or whom are living with the virus, but not on treatment.  Especially with the continued debate over treatment as prevention – something that I am a strong advocate for.  

However life on HIV treatment isn’t all smooth. Over the months, I have noticed an alarming development. It would appear that I am losing my libido. I have a far lower interest in sex now, than I did before I started HIV treatment. It’s not that I have HIV, as even after my diagnosis I was still an exceptionally horny guy. I still get my moments, but when I look back to how I used to be, the libido has certainly waned since starting HIV treatment. This isn’t a universal issue though; friends of mine on treatment have found their libido actually increased.  It’s clearly something that I need to continue to work through with my medical team. 

So what else has the last year brought? I found myself in a relationship, something that hadn’t happened in a very long time. It was nice; we met in a bar, and things quickly moved onto more, it was during a night out together that I realised I had the dreaded disclosure to do. I plucked up the courage, and told him that I had something to tell him. As with all my friends, his reaction was great. He said that he knew the risks, he knew other people in the city who were HIV positive, and it didn’t faze him. Sadly it wasn’t to last, only a fortnight ago we broke up after three months together. He said that it wasn’t anything to do with the HIV, but as these things go, it always leaves that lingering thought in your mind. Still, such is life, we live and learn and move on. 

Over the course of the year since I last wrote for PositiveLite.com, there have been moments where I wished to the high heavens that I didn’t have this condition; I would be lying if I said otherwise. On balance however, I think that it has made me a stronger person for it. It has given me a greater appreciation of my health; I take a more active role in keeping myself healthy, I’ve cut out the junk food and eat more fresh fruit and vegetables. I drink less alcohol and more water.  As I am an out and proud HIV positive person, I also tackle stigma head on when I hear people talking rubbish in the circles that I socialise in. I strongly believe that it is only by being out and open about our statuses, can we eventually reduce stigma of the condition. If we sweep it under the carpet, or are ashamed of it, then stigma is allowed to grow and rear its ugly head. 

That’s about it really; my thoughts of living with HIV are as they have always been. It’s something that I live with, not suffer from. My journey over the last year, of coming out as an HIV-positive person has led me to meet many other people I already knew who are also in the same position, and I take strength from them, and hopefully them from me. 

You can follow Josh on twitter at @JoshLandalexxx. 

“Some people are going to think, ‘Oh god, why did he not take steps to prevent HIV? Why did he act recklessly, and who the hell does he think he is, I saw people die from AIDS!’” A friend and colleague whose candor is always helpful said this to me over lunch recently, and his words have stuck with me over the past day

Most interestingly, I’ve noticed that those most receptive to my messages are under 30, those 30-50 are generally receptive but ask more poignant questions, and those over 50 are oftentimes, not always but often, openly hostile to my writing on bareback sex and HIV. In the next few months, I’m going to be speaking at several sexual health seminars and symposiums, and I’ve been assessing my own writing and essays on sex, barebacking, HIV, and personal responsibility, and I’ve reached the same conclusion that I originally had when I began writing on HIV and sex; that is, we are inadvertently sustaining HIV infections and continuing this epidemic because we are unable to confront our past honestly and without emotion.

I was born in 1984. Personally, I have no firsthand recollection of Ronald Reagan’s presidency, Ryan White, Arthur Ashe, the AIDS quilt’s beginnings, Rock Hudson, C. Everett Coop, or the obscene neglect the United States government took in relation to HIV/AIDS throughout the entire 1980s.  Rather, all of my knowledge of these things, people, and movements comes from oral histories from LGBT elders that are my friends, exhibits at places like the William Way LGBT Community Center’s stellar John J. Wilcox, Jr., Archival space, named after a man I am heartened to have called a friend, and from textbooks and documentaries. In addition, when I began to go through puberty and learn about the physical and sexual changes taking place in my body, it was the late 1990s, Bill Clinton was president, HIV/AIDS organizations and infrastructure had been in place for over a decade, and my teachers, parents, and mentors knew how HIV was transmitted, how HIV was not transmitted, and HIV’s timeline of progression in the human body.

When I was growing up, there was no plague where funerals were being attended every week. There were no candlelight vigils, there were no large scale protests interfering with traditional institutions of power and policy in the United States; rather, there was knowledge, there were early concepts of treatment that are still being used today, and there was a local, state, and federal government trying its best, guided and sometimes provoked by activists and advocacy organizations, to respond most effectively to HIV/AIDS.

Instead of learning about HIV through my own experiences or through seeing friends or loved ones suffer or die too early, I learned about HIV as an abstract concept far removed from my own life. Of course, this abstract viral boogeyman was as frightening as it was imaginary; after all, when our own innate fears are coupled with histories, real or not, of our elders and teachers, we manifest these fears in irrational terror and paradoxical behavior, like posting links on Facebook to condom campaign websites but barebacking someone we met on Adam4Adam because he said he was “clean.”

For years, I was terrified of this virus because it had seemingly no effect on me or my own circle of friends and family; rather, it was something that we knew existed, we knew how to prevent, and we knew how it attacked the human body, but this knowledge was predicated on the idea that I was born, luckily, at a time where I did not become a man or a sexual being until long after the early days of the virus spreading rapidly through the gay community. Of course, the only reason HIV/AIDS took off throughout the gay community is because gay men engage in anal sex which allows for easy access for the blood barrier to be crossed between sexual partners because of, often entirely unnoticeable, usually microscopic abrasions and tears around the skin on the penis or inside the anus.

Contrary to the belief of some misguided idiots who think HIV/AIDS was god’s divine judgment toward those of us who like to kiss men, HIV only seemingly “picked” the gay community because of this fact; if straight women were clamoring to engage in anal sex like gay men typically do, they would have been the ones who bore the brunt of HIV/AIDS. Instead, because gay men are the ones who engage in this, admittedly fun, activity, we were the ones who suffered the most during the early days of HIV/AIDS. And, to this day, the LGBT community overall, including transwomen and gay men, are dramatically disproportionately affected by HIV because of this fact.

So, like the Holocaust, the early days of the HIV/AIDS epidemic are a mere idea my generation and the generations after mine have to learn about from our elder peers, from our teachers, or from our books. We have no concept of the human tragedy endured by millions; we have no firsthand account of what things were like. And, this is why our experience as HIV+ people born post-AIDS outbreak is entirely different than that of those who lived during this time as sexual adults. Now, this is not to say that either experience is better or worse; rather, our experiences are equally as valuable and equally deserving of a seat at the table when it comes to outreach, prevention, and care.

Notwithstanding, if we are to successfully combat the tide of rising HIV infections brought on by what older folks like to call “recklessness” but what I like to call “natural human behavior,” we must be willing to honestly look at ourselves and admit that nobody has a monopoly on HIV/AIDS, and the fact that someone lived through something does not automatically give them deference on opinions just as the fact that I am HIV+ most definitely does not give me absolute authority on all things related to HIV. Rather, on the logical and science-based merits should we approach HIV/AIDS today without the baggage and trauma, both experiential on part of our elders and vicarious on part of my generation.

This is the current approach of the more misguided folks in our LGBT elder generation, generally, in relation to HIV: tossing out HIV stigmatic slurs like calling me, literally, a “murderer;” browbeating young men who bareback as “reckless;” advocating condom use over everything else; making people who bareback feel bad about themselves; shrilly obsessing over death when telling 20 year olds about the 1980s instead of honestly admitting that you were at the DCA club also getting topped on the truck bed at the bar; claiming falsely that dental dams are used widely to prevent hepatitis and so should condoms for anal sex; ignoring the fact that part of sexual liberation means engaging in natural human sexual activity like bareback sex; and, ignoring all scientific literature that refutes every single backward notion born out of 1990 and early treatment that effectively was more toxic than HIV itself.

If this approach worked, then we would not be seeing a steady rise in HIV infections.

 So, let’s stop damaging the lives and futures of young people today by taking a step back and stop forcing other people to obsess over our own memories, effectively refusing to allow these men and women to experience life on their own without the specter of a de facto Holocaust; the time of this period is over. We have antiretroviral treatment with no side effects that literally both gives us life expectancy into our 70s while simulanteously preventing us from being able to transmit HIV whatsoever (when we adhere to this medication); we are not dying, we are living. And, we are not frightened anymore because now that some of us have seen HIV for what it is. In particular, we know that HIV is a virus that will kill us if left untreated but that it is also a virus that is, today, incredibly manageable with the right governmental approach toward treatment availability like exists here in Philadelphia.

Human tragedy should never be swept under the rug or forgotten. And, we should strenuously remind folks that these things went on, that good men and women died needlessly and far too soon. But, we should not predicate our public health efforts and prevention efforts on the idea that we should force people to remember our dead friends or a tragic decade that future generations had nothing to do with. After all, if this fear-based approach was effective, nobody would get HIV anymore.

The fact that I’m writing this and HIV+ refutes that hypothesis.

This article originally appeared on Josh’s own blog here.

Whether it’s the miserable weather in Philadelphia right now or it’s the fact that I feel like I’m rapidly approaching that point in my life where I’m about to become a solidly single adult man without any prospect of getting married “young,” I am in a contemplative mood about my own sexuality, romantic attachments (or lack thereof), and my own mortality. Certainly, I recognize that this might sound histrionic or hysterical; after all, by all estimates, I have a solid forty years ahead of me at least as a talking primate. Notwithstanding, as each day passes, this biological alarm sounds louder and louder in my head. What is wrong with you? Why can’t you find someone? Why do you keep just having sex with strangers? Why do you act like this is fun when, really, you’re constantly alone even when you’re in a room full of people? What is wrong with you (again)? 

Recently, I went on a few dates with a, in my eyes, beautiful man with perfect teeth and an ethics system in line with Immanuel Kant. We talked for hours about our positions on public policy, about our education, about our families. And, I was incredibly attracted to him; after all, although he was a few years younger than I am, a fact that goes against my typical dating behavior, he was charming. In particular, he seemed to stay in constant motion much like I try to do. We sat in the cafe that I’ve been coming to for over a decade, a business that I’ve seen shutter its doors twice before settling, seemingly, on the right formula in its current state. In fact, I remember coming here as a young gay teenager, shaking like a leaf as I walked around Philadelphia’s Gayborhood, nervously looking for other people like me.

At last, when I found this place in 2001, a cafe where I felt safe, the clientele was seemingly gay, and I was comfortable enough to look at other men I found attractive while still being able to stay away in my own aloofness, I planted in that place. Over a decade later, I sat there with this man and every part of me wanted simply to hold his hand and to convey that things were going to be alright; that the stress he was talking about was something that he would soon get over, that he deserved to be happy, and that he simply had to be open to happiness in order to be happy.

At that moment, I realized that I was trying to talk to myself from years ago; that the selfish way I had sexualized this man and developed feelings for him was really part of myself kicking and screaming in furious idiocy against the mistakes that I have made in my own life. I was, seemingly, begging for another chance, pleading with fate, time, or god himself to allow me to save myself one last time.

“Please, have mercy, understand that I really mean it this time, please just let me try this again,” were the words I meant to say when I was trying to be engaging, interested, and aware of my date. Of course, in life, there exist no real second chances; we have no ability to have a gimme, a do-over, or a revision. Instead, we have to build upon the scar tissue that we inflict on ourselves, either in our heads or in our hearts. More specifically, we cannot erase these wounds or somehow wipe them away completely; rather, we must work around them or build, clumsily, on top of them, layering ourselves with experience after experience, painful circumstance after painful circumstance, joyous laugh after joyous laugh. Truly, there exists no do-over, and while there are things I painfully wish I could regret, I cannot, for without these circumstances, I would not be feeling these things as I do now.

“Our sexuality builds on itself; it is not just the same thing over and over,” said Conner Habib, the brilliantly self-aware and analytical gay porn star I saw speak yesterday at an event sponsored by Philadelphia’s Gay and Lesbian Latino AIDS Education Initiative at the William Way LGBT Community Center. And, like my sexuality, my identity is not the same thing over and over; instead, it keeps building on top of itself. Like sitting with that young man in the cafe, I sat at the William Way LGBT Community Center surrounded by my past. In particular, I sat next to the bathroom that I raised the necessary funds to build before I lost my job for my drunkenness and past active alcoholism, a “secret” that critics of mine routinely gossip about or snipe about, typically drunkenly or bitterly, to themselves.

Throughout the sex-positive seminar, Habib talked about the importance of, for communication’s sake, taking the physical off the table entirely and, instead, focusing on our growth as sexual beings, what sexuality looks like in our minds and in our hearts. And, I talked with a few people near me during a breakout session about how our sexuality has developed, and how, personally, my own is now outwardly boring compared to my past sexuality.

More specifically, I realized that young man that I once was, the one who went overboard in relation sex, drugs, and alcohol in order to stay in constant motion, is not dead as I let myself to believe. Instead, he is simply the scar tissue upon which I’ve become a “grown up.” And, upon this foundation full of very interesting stories, some emotionally devastating, others life-affirming, and still others hilariously slapstick, I navigate the world as a sexually active gay man, coming into contact with my past every single day, letting these memories wash over me, sometimes allowing them to churn for a moment and dissipate swiftly or, like today, letting them bubble quietly and constantly.

And, while these wounds are no longer open, they have scarred my identity to a point where I must build upon them or no longer advance personally as a man. Indeed, as I get older everyday, I confront the stubborn reality that there really is no “around” but instead there are plenty of “throughs.” Whether or not others recognize this about themselves is a whole other matter altogether; at the end of the day, though, one thing is obvious.

I have no other option than moving forward, both sexually and emotionally.

This article originally appeared in Josh’s own blog here.  

The Canada-wide survey Male Call interviewed 1,235 men who have sex with other men  (MSM)  - and the results have now been published. It’s been described as “one of the most innovative, ambitious and comprehensive studies ever of this demographic.” It contains quite a few surprises.                      

Why the survey? “Men who have sex with men are the most  vulnerable to HIV, and yet – until now – a clear sense of the attitudes, opinions,and behaviours of many in this group have been missing',” says Dan Allman, Assistant Professor at the University of Toronto’s Dalla Lana School of Public Health. “With responses from both rural and urban areas, in all regions of the country, our survey provides new directions for health policies and programs that can serve this group, prevent further HIV infection and improve overall health and well‐being”.           

The Male Call Canada telephone survey captured mens’ attitudes, opinions and behaviours on topics such as sexual identity, homophobia, general and mental health, condom use, HIV testing and disclosure, the criminalization of HIV and transactional sex. By employing a method in which respondents chose when and where to anonymously call into a toll‐free telephone line, researchers were able to collect responses from men aged 16 to 89, and from an impressive 40 per cent of Canadian postal codes.

The campaign had a celebrity endorsement. PositiveLite.com interviewed gay soccer player David Testo who gave his name to promoting the campaign in January 2012 – you can read my interview here. Testo’s involvement apparently generated a huge upswing in the number of respondents.

The Male Call website contains a series of attractive fact sheets  (designed incidentally by poz Toronto artist Raymoind Helkio, who also designs for PositiveLite.com.) The fact sheets make for fascinating reading, or those with more time can go to the full report here.

In one of the more startling revelations, 49% of men surveyed agreed with the statement “I would not have sex with a man who is HIV-positive even if I am very attracted to him.”

Here are some other fascinating tidbits . . . 

On casual sex, 67% of MSM surveyed reported having had some in the last six months.  How much?  6% of men reported 20 or more partners in that same period, 18% had 6-19 partners, 37% had 2-5 partners, 22% had only one casual sex partner and 17% had none.  52% of partnered men reported having casual sex.

Attitudes to Condoms

Here’s what people agreed with . . 

• The benefits of using condoms outweigh the disadvantages 88.1%
• I would only have anal sex with an HIV positive man if we used condoms 69.4%
• It feels good to wear a condom because I feel safe 67.8%
• I feel guilty when I don’t use a condom 57.7%
• Condoms make sex less pleasurable 48.6%
• The intimate act of giving or receiving cum is lost when using a condom 48.4%
• When a person brings out a condom I feel physically aroused 32.1%
• Safer sex is less important now that HIV treatments are available 10.2%

74.8% of Male Call participants had been tested for HIV and 34.5% of participants had been tested in the previous six months. 6.6% reported having HIV, 26.2% reported they were unaware of their status.

Expectations

Male Call participants were asked “When is the best time for an HIV-positive man to disclose his HIV status to a new sexual partner?”

• before any penetrative sex (e.g. oral or anal) without a condom 56.2%
• when they first meet 25.9%
• before any non-penetrative sex (e.g. mutual masturbation) 11.9%
• before any penetrative sex (e.g. oral or anal) with a condom 0.9%.

Knowing a Partner's Status

These question relate to the importance of knowing a partner’s HIV status  before engaging in the following sexual acts

• 96.3% before unprotected anal sex.
• 84.4% before protected anal sex.
• 75.4%  before oral sex.
• 43.3% before mutual masturbation

Shared Responsibility

• 98.4% agreed that both sexual partners are equally responsible for preventing HIV transmission.
• 87.4% agreed with the statement “In order to know a partner’s status for certain, it is an individual’s responsibility to ask his partner his status.”
• 49.0% agreed with the statement “I would not have sex with a man who is HIV-positive even if I am very attracted to him."

Positive men

Turning now to the questions pertaining to HIV-positive men, 88% of HIV-positive participants rated their mental health as good to excellent. 87.3% rated their physical health as good to excellent.

68.3% of HIV-positive participants slept less than 8 hours per day. Only 31.7% reported 8 hours of sleep or more.

What do HIV-positive participants worry about? I worry about, they say...

• Being discriminated against and stigmatized because of HIV.82.5%
• Being rejected by gay and bisexual men in my community because I am HIV-positive 67.7%
• The fear of being prosecuted by someone for not disclosing that I am HIV-positive 51.6%
• Not understanding medical information about HIV 30.2%

On the issue of criminalization, the survey generated headlines like this one from the Sun and this one from the Globe and Mail because it appeared to find a large number of men who supported criminalization. In fact 83% of all men indicated non-disclosure before anal sex should be a crime, with 42% believing failure to disclose is criminal in the case of oral sex, while 17% opposed criminalization of non disclosure in any circumstances.

Here are some more disturbing numbers, straight from the report . . 

The Globe and Mail Story headlined with the worrisome title “HIV-AIDS non-disclosure should be a crime, study of gay and bisexual men finds.“  However the news is not all bad. PositiveLite.com asked Richard Elliott, Executive Director, the Canadian HIV/AIDS Legal Network, for a comment.  Here’s what he said:

“Unfortunately, some important details of the Male Call study about HIV and men who have sex with men got lost in summation and a simplistic headline (“HIV-AIDS non-disclosure should be a crime, study of gay and bisexual men finds”, Apr. 11).  The result, I fear, is to simply perpetuate some knee-jerk and widespread stigmatizing attitudes about people with HIV and unjust applications of the criminal law.

"The study data in fact showed the following: men were virtually unanimous in supporting early disclosure of HIV and a strong majority expected a casual sex partner to disclose if he has HIV, but they were also virtually unanimous in agreeing that there both partners have equal responsibility for HIV prevention. Less than one-third of study participants thought criminal prosecutions for not disclosing HIV status are effective public policy when it comes to preventing the spread of HIV. In fact, the study data suggest public health harms: 62% think that criminal prosecutions increase stigma and discrimination against people with HIV, close to half agree that such criminalization deters people from seeking HIV testing and indeed 18% agreed that, given the current legal context of possible prosecution, it’s better not to get tested for HIV.

"But perhaps most significantly, the headline seriously oversimplifies the issue in suggesting that the strong majority of gay men and other men having sex with men support criminal prosecution for HIV non-disclosure. In fact, only 42% held this view without qualification. An equal number felt criminalization is not justified in some circumstances. Of these men, 70% said there should be no prosecution in cases where a condom is used – a sensible position that, regrettably, the Supreme Court of Canada rejected in its most recent pronouncement a few months ago. Similarly, 58% think criminal charges for not disclosing are not warranted in cases of oral sex. These more nuanced views quite properly reflect the available science we have about the exceedingly low risks of HIV transmission in such circumstances."