HIV viral load and antiretroviral therapy have had an impact on gay men’s sexual practices, with some HIV-positive and HIV-negative men considering viral load before engaging in sexual behaviours which may transmit HIV, according to a new Australian study.
Dr Marsha Rosengarten and Kane Race of the National Centre in HIV Social Research interviewed 56 gay men in Sydney and Brisbane, Australia. All men were involved with the gay community and 23 were infected with HIV.
Following on from earlier research which showed an increase in unprotected anal intercourse amongst gay men, the authors reported that gay men are employing "individually tailored risk minimisation strategies" in engaging in sexual practices. Before having anal sex without a condom, the men assess a range of factors such as:
- the willingness of the partner to have sex without a condom
- viral load results
- practices associated with reduced risk (e.g insertive sex if HIV negative)
- an assessment of age or sexual experience of the partner
- inferred or stated serostatus of the partner
- location of pick-up
According to the authors, men who engaged in unsafe sex employed an understanding of ‘shared responsibility’ for unprotected sex.
Undetectable viral load in the blood provided some HIV-positive men with a reduced sense of ‘infectivity’ although men with high viral load have maintained a sense of infectiousness associated with the pre-HAART era.
The authors found that most of the men with undetectable or low viral load engaged in some form of unprotected anal sex. However, they rejected the theory that undetectable viral load is ‘causing’ unprotected anal sex because only in discordant relationships did viral load directly impact on the decision not to use a condom. Rather, the authors suggested, viral load is one of several factors (including a greater sense of health and vitality) producing "an increasingly diverse gay sexual culture". The authors noted that most HIV-negative men did not engage in debates about the implications of low or undetectable viral load for sexual practice.
In their recommendations, the authors argued that HIV education needs to take into account the widespread use of individualised risk minimisation practices used by gay men. Futhermore, they recommended that the medical profession must be made aware of the impact of viral load results on the sexual practices of gay men.
Reference
Rosengarten M et al. Touch wood, everthing will be ok: gay men’s understandings of clinical markers in sexual practice. National Centre in HIV Social Research, monograph 7/2000.