Vitality

Gay Men In The UK Are Being More Careful About HIV, But 23% Have Still Never Been Tested

A new, extensive survey of gay and bisexual men living in England reveals both good and bad news about the efforts to prevent HIV within the especially vulnerable community.

The National Gay Men’s Sex Survey (GMSS) polled 15,360 men who have sex with men on a variety of topics related to sexual behavior from July to October 2014. Among its chief findings was that 77 percent of those polled had obtained HIV testing at some point in their lives, and that 55 percent had done so within the last year. Both figures are an improvement over the 2010 GMSS, which found that 72 percent of men had been tested at least once and 36 percent had been tested in the past 12 months.

Encouraging as that is, the current survey also found 36 percent weren’t aware of their status at all.

"We're concerned that a third of gay men are not definite about their HIV status — particularly as we know that one in seven men who have sex with men are undiagnosed,” said Cary James, Head of Health Promotion at Terrence Higgins Trust, the British charity that commissioned the GMSS, in a statement. “Knowing your HIV status is key to tackling the HIV epidemic, as people who are on treatment are highly unlikely to pass on the virus, so it's really important to get tested. Testing is fast, easy, and confidential."

Couple A new extensive survey of 15,000 gay and bisexual men living in England finds that while many are protecting themselves against HIV, one-third are still unsure of their status. Pixabay, Public Domain

A Clear Picture

The GMSS has been around since 1993, with its first version being an impromptu poll of people attending the London Lesbian and Gay Pride festival. Though the GMSS has continuously remained under the purview of the London School of Hygiene & Tropical Medicine’s Sigma Research, it has since become far beefier in its scope and is now entirely digital. The current iteration of the GMSS, while funded by the Terrence Higgins Trust, is also part of HIV Prevention England, a national health initiative funded by Public Health England.

Few participants were ignorant about the existence of a HIV test, but there were many who weren’t sure how often they should be getting tested.

"Our findings show that not all men having gay sex are accessing sexual health services regularly,” said lead author Dr. Ford Hickson of the London School of Hygiene & Tropical Medicine. “Half of the men we surveyed didn't know that doctors in the UK recommend they test for HIV at least once a year.”

And certain long-standing myths about HIV transmission — for instance, that you can catch it from deeply kissing someone — still endured, with 19 percent not knowing that’s impossible. Twenty-six percent were also unaware that effective and sustained treatment can significantly reduce the chances of an HIV-positive person passing it on, and 37 percent didn’t know that there are preventive medications like pre-exposure prophylaxis (PrEP) that can similarly lower the risk of contracting it.

"Myths about how HIV is transmitted create fear and stigma which can discourage people from finding out their HIV status," said James. "These findings reaffirm the need to normalize HIV testing and bust the most common misconceptions."

“More positively, the vast majority of men are confident they could access an HIV test if they chose to, and HIV testing services in England are very highly regarded among gay and bisexual men," added Hickson.  

In total, 9 percent of the men surveyed were living with HIV. Of these, 42 percent believed that drugs and alcohol had played a role in them catching it. As Hickson notes, there has long been a subculture of recreational drug users, often comprised of gay and bisexual men, that encourages using drugs like methamphetamine to enhance the experience of sex, alternatively known as the “chemsex” or “party and play” scene.

“Combining sex and drugs can easily become compulsive and can increase sexual risk taking,” Hickson said. “That a large proportion of men say alcohol or drugs played a part in their becoming infected with HIV means everyone on the scene and in services needs to think about how we can help men get better sex with less harm."

Of everyone polled, 52 percent had taken some form of illicit drug in the past year, with 17 percent and 15 percent having taken cocaine and ecstasy, respectively.

Another common risk factor for HIV, unprotected anal sex with multiple partners, also remained common. Fourteen percent had sex without a condom with both a steady and casual partner within the past 12 months; one-third had done so with at least one casual partner.

"Studies have suggested that condoms have prevented 80,000 infections since the start of the HIV epidemic. But this survey shows that perfect condom use is not a reality for everyone,” said James. “We must continue to champion safe sex messages to gay men, but we also need to tackle prevention on all fronts if we are to beat this epidemic. That means regular testing, successful treatment and, critically, PrEP —  in addition to condoms."

More than anything else, Hickson hopes the GMSS continues to illuminate the successes made in preventing HIV within the country as well as the remaining gaps that need to be filled.

"Yet again in this survey the gay and bisexual men of England have been incredibly generous with their time and information to help us generate a unique national picture of their HIV prevention and sexual health needs,” he said. “This kind of research is a community effort that could not be done any other way".

The next iteration of the GMSS is planned to run in 2017 and may be part of a larger European study available in 25 languages.

Source: Hickson F, Reid D, Hammond G, et al. State of Play: Findings from the England Gay Men’s Sex Survey 2014. 2016.

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