HIV-positive gay men living with HIV in France need better
information about the sexual transmission of hepatitis C, according to a
researcher who interviewed 31 men about their experience of living with hepatitis C.
The moment of hepatitis C diagnosis appears to offer an opportunity
for prevention work – during a period of emotional turmoil, men are open to
absorbing information and reconsidering their sexual choices, according to the
study published in the current issue of Culture,
Health and Sexuality.
With one exception, almost no qualitative research has been published on the
experiences of gay men with HIV who have acquired hepatitis C. As part of a
larger epidemiological study, Jean-Yves Le Talec of the University of Toulouse
therefore interviewed 31 men about how being diagnosed with acute hepatitis C
fitted into their personal history, sexuality and health concerns. The
interviewees all lived in major French cities and were aged between 33 and 58
Interviews were conducted between 2006 and 2008.
All the interviewees said they were “deeply involved in
sex”, with most respondents meeting partners through websites for men with HIV wishing to bareback, sex-on-premises venues and informal networks of
friends who organised sex parties.
Hepatitis C can be passed on during sex that could lead to contact with traces of blood. Acquiring hepatitis C has been associated with unprotected anal sex, fisting, sharing sex toys or pots of lubricant, or injecting or snorting drugs.
All interviewees either occasionally, regularly or
consistently had unprotected anal intercourse with casual partners. Only around
half reported fisting and not all reported having group sex. Drug use was
commonly (but not universally) reported, often to enhance sexual pleasure and
performance, but only one man said he had injected drugs.
Around two-thirds of respondents used the word ‘barebacking’
to describe their sexual practices and presented unprotected sex as a conscious
choice. They generally sought out sexual partners who were also living with HIV
and saw serosorting (choosing partners with the same HIV status) as a way to escape a feeling of responsibility towards
another person. They felt that these choices allowed them to have sex that they
enjoyed, with an acceptable level of risk.
One man commented:
“Well, my sexual
activities give me a way to relax, to let go. It goes so far that it has
probably brought me to consider only practices without condoms, so that I can
find the way to fully free myself and let go.”
On the other hand, a minority of interviewees had a much
less ‘self-controlled’ vision of their sexual practices. They described
unprotected sex in terms of ‘compulsion’ and ‘relapse’.
“There is always the
desire for risky sexual encounters, always this dependence, you see. Just like
a drug addict or an alcoholic who wants to kick the habit, but…”
These men did not present themselves as intentionally taking
risks, but described themselves as not being in full control of their sexual
activity and of now paying the price.
While some of the respondents had been aware of the
possibility of sexual transmission of hepatitis C before their own diagnosis
(often because someone they knew had had it), clear information about
transmission routes hadn’t been available.
Most men’s acute infection was detected, unexpectedly,
during a routine HIV check-up. Few had experienced symptoms and the diagnosis
generally came as a surprise. Doubt, disbelief, anger and a sense of unfairness
were commonly reported.
Men were rarely able to link the infection to a precise
moment, situation, location or partner.
“It’s not clear,
because I still don’t grasp how I got it. I knew it was something about blood,
but I don’t see where there could be blood in my sexual practices.”
After diagnosis, many men lacked libido, reduced their
sexual activity or reconsidered their sexual practices:
“Things are still dead
calm! I haven’t been out anyway since… I had no sex for two weeks. Complete
abstinence, because there is a blockage.”
Most interviewees only felt able to disclose their hepatitis
infection to a few people:
“I talked about it
with my boyfriend who lives with me, then with two or three partners I see from
time to time... This disease is shameful, you know! It’s revealing risky
practices and so on. If I had to disclose hepatitis to my close friends, it
would mean, in their minds, that I still have risky sex, that I’m messing
This man said that it was easier to talk about having HIV
than hepatitis C virus (HCV):
“It may be stupid, but
if HIV is the gay cancer, then you could say that HCV is the junkie cancer, so
it’s somehow similar, isn’t it... I’m queer, I get fucked, I get fisted, no
problem, but I don’t want to be what I’m not. Facing people around me, I’m
worried about the way HCV is perceived in the society. If that wasn’t the case,
I would have spoken more openly about it.”
But with time, the initial emotional turmoil faded away, and
many men felt more optimistic, especially if they had spontaneously cleared the
virus or if treatment was successful. Many men resumed the sexual behaviour
they had had before diagnosis.
“When I was diagnosed
with hepatitis C, I thought that it was perhaps time to settle down and to take
precautions, to be much more careful. But I know it’s going to be hard to do,
yes I know. In real life, I cannot control myself.”
Many men who assumed a barebacker identity had no desire to
change their behaviour or give up on sex that was associated with intense
physical pleasure, social connections and a sub-cultural identity.
“I know full well that
[hepatitis] may happen again, I’m well aware of that, but in principle I’m not
going to change my sexual practices.”
Others did not anticipate a sweeping change of sexual
lifestyle, but intended to make specific changes, such as selecting partners
more carefully or not sharing sex toys.
“I think that we are
going to do less, with much less partners, and above all with much more
precaution and hygiene... We are not necessarily going to change our sex life,
but the way to do things.”
Concluding, the researcher notes there was a brief period
after diagnosis during which some men were open to reconsidering their choices
– healthcare providers should discuss prevention at this time.
“HIV-positive gay men need better information about HCV
transmission associated with unprotected sexual practices, in order to
implement effective risk-reduction strategies, such as wearing gloves when
fisting, paying attention to bleeding, not sharing sex toys, using lubricant,
limiting enema use and asking their partners about their HCV-status. They also
need to be informed about HCV drug-related risk practices (sharing straws when
sniffing, sharing needles when injecting), associated or not with sexual
practices,” he says.
Moreover, the number of HIV-positive gay men who acquire
hepatitis C a second, third or fourth time (see reports from London,
Europe) underline the need to identify effective prevention interventions
for this group.