Witchhunting is the new barebacking

A great Q&A with three UK HIV charities appeared in the Dec 10-16 2009 issue of Time Out London. I can't find the transcript online so I've copied it out here. If anyone can find a link to the article on Time Out's site, I'd be happy to direct folks there. In the meantime:

Back to bareback?
The HIV charities state their position on 'barebacking'.

Two weeks ago, in the run-up to World AIDS Day, Time Out's Gay & Lesbian Editor Paul Burston called for clearer safer sex messages to help stem the rise in HIV infection rates among gay men. One concern was that bareback porn videos and websites were helping to normalise and even fetishise unprotected anal sex, and that younger gay men in particular were often woefully misinformed about HIV. It was also suggested that HIV organisations weren't clear enough about 'barebacking'. This week, we let the charities have their say. Our questions were: Does your organisation have an explicit view on barebacking? How do you get this message across, and do you think it's adequate? Here are their answers...

GMFA

'Bareback sex is the most common way that gay men pass on HIV, which is why condom use is at the heart of our HIV prevention work. Our position, as stated on our website, is that condoms are the surest way to protect against HIV infection.

'Some gay men who have bareback sex try to reduce their risk of catching HIV with other methods, such as only being a top (ie. active) or only sleeping with men whom they believe have the same HIV status. It's important to provide accurate information about such strategies, however our position is that these methods are not enough to prevent exposure to HIV and we do not recommend them as a strategy for staying HIV negative.

'Condom use is clearly advocated throughout our work, which includes our website, booklets, postcards, groupwork, and our magazine for gay men. Our aim is to provide accurate, honest and accessible information and we work with some 200 volunteers, most of whom are gay men, to achieve this. However there is no single campaign or message that will work equally for all gay men. We continue to explore new ways of reaching gay men, in particular young gay men, and communicating the seriousness of HIV infection and the importance of maintaining safer sex.'

Nationals AIDS Trust

'Bareback sex carries significant risk of HIV, so at NAT we always recommend using a condom. With 1 in 20 gay men in the UK living with HIV (1 in 10 in London), the chances are that most gay men will have sex with someone with HIV at some point and condoms remain the best way to protect yourself and your partner. As a policy and campaigning charity, we don't run health promotion campaigns ourselves, but we do campaign for more effective HIV prevention and we believe condom use must be a central part of that.

'One of our partnerships is with Men at Play, an adult website that always promotes safer sex and condom use. What is great about Men at Play is that they show how using condoms can still be sexy.

'HIV is preventable, but with over 2,700 gay men diagnosed last year, it's clear more needs to be done. There's a real need to step-up education about HIV and the importance of condoms, especially among young gay men.'

Terrence Higgins Trust

'People who bareback need to know the risks, even if both partners have HIV. Hepatitis C rates are rising fast amongst positive gay men, as is syphilis. If you're positive, Hep C can be as devastating as HIV, and hard to treat. At THT we talk constantly with gay men about the risks of Hep C and other STIs. We've run campaigns reminding them not to make assumptions about whether someone has HIV. We work with saunas to help them provide information, as well as condoms. And for 25 years, in as many different ways as we can, we've been reminding people that using a condom is the best way to prevent HIV.

'But we know we need to do more. Young gay men in particular, who've been let down by sex education in schools, need and deserve better information. We need to talk across the community about barebacking and risk. Getting HIV or Hep C is not "hot". But it's not just about HIV organisations. We all have a responsibility - bar owners, the gay press, people who make porn, and every one of us - in working to beat the virus. So thank you for starting this debate. We welcome it.'

I'm really curious to know what folks think about these answers. People who work at gay or HIV organisations, regular gay dudes like me and others looking in on the situation from outside. I'd love to read some responses in the comments section below.

A few of my own thoughts, for whatever they're worth:

1. HIV transmission rates are higher among young guys in some places, but not in all places. In some cities, the highest new infection rates are among an older cohort. Plus, this can change over time, even within a span of a year or two. It's also not consistent across ethnicities. For example, click on the graph below showing age breakdowns of new infections among White, Black and Hispanic men who have sex with men in the US: (Source: CDC Fact Sheet - HIV and AIDS Among Gay and Bisexual Men, Aug 2009)


2. By focusing on the public education system, Terrence Higgins Trust is (surprisingly) the only one of the three charities to consider structural factors that might be impacting condom usage and transmission rates among gay men.
   


3. These three agencies seem to shy away from explicitly adding homophobia to the equation. Being afraid to even hold hands in the street, murder, relentless bullying at school, having to hide your same-sex love or HIV+ status on a daily basis...
   


4. If the type of porn you fantasize and get off with necessarily translated into reality, I'd qualify as a fairly kinky heterosexual guy with a reputation for attending group orgies at college fraternities and sororities. We can't censor people out of their fantasies and into the behaviour change that Public Health wants. Of course I crave, fantasize about and even fetishize condom-less sex. Find me a human on the planet who doesn't.


5. No mention of viral load? Extremely effective though condoms are, convincing a certain minority of guys to consistently use them is proving harder than we'd hoped and will likely never happen. Somewhat easier, it would seem, would be to make HIV and STI testing services extremely efficient and then work with these higher risk guys to offer services such that they'll actually want to access them - followed up by universal medications coverage to keep everyone's viral load low. Is it ideal? No. Will it reduce transmission? Yes. Is it a magic bullet solution? No. Is it better than simply throwing more pamphlets at this crowd? Yes.
   

But then, those are just my loud-mouth opinions, many of which I'll no doubt disagree with by tomorrow. I'm also not seeking to devalue the achievements of these three great organisations. I refer frequently to GMFA's online resources myself and admire how much further ahead the UK seems to be in terms of making testing accessible to gay guys and providing quality services to folks who test positive. As the Terrence Higgins Trust spokesperson notes: the debate itself is what is needed. I'm just throwing in my off-the-cuff two cents in an irreverent bloggy kind of way.

More importantly, what do you think?