HIV-positive men may use 'POZ parties' to reduce risk of spread of HIV, but other health risks may be involved

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Sex parties where HIV-positive gay men meet for unprotected sex could help reduce the spread of HIV, but could involve a risk of sexually transmitted infections and superinfection with resistant strains of HIV, according to a pilot study conducted in New York and published in the October edition of Sexually Transmitted Infections.

Although the study is presented in measured language, and is careful to highlight both the potentially positive and negative health implications of sex parties involving HIV-positive gay men, or “POZ parties” as the authors call them, a media release from the publishers of the journal used much more sensational language and led to alarmist headlines such as “POZ parties spread super strain of HIV” in the popular press.

Events such as POZ parties may represent an attempt by HIV-positive gay men to select sexual partners of the same HIV status, so-called “serosorting”. Although there has been extensive research into the sexual behaviour of gay men in recent years, little is known about gay sex parties. Therefore researchers set out to describe the characteristics of men who attend POZ parties, their reasons for doing so, the types of sex they engaged in at such parties, their drug use at these events and their sexual behaviour outside of parties which involved other HIV-positive men.

Glossary

serosorting

Choosing sexual partners of the same HIV status, or restricting condomless sex to partners of the same HIV status. As a risk reduction strategy, the drawback for HIV-negative people is that they can only be certain of their HIV status when they last took a test, whereas HIV-positive people can be confident they know their status

pilot study

Small-scale, preliminary study, conducted to evaluate feasibility, time, cost, adverse events, and improve upon the design of a future full-scale research project.

 

superinfection

When somebody already infected with HIV is exposed to a different strain of HIV and becomes infected with it in addition to their existing virus.

 

strain

A variant characterised by a specific genotype.

 

poppers

Amyl, butyl or isobutyl nitrite, are recreational drugs sniffed during sex to both intensify the experience and relax anal sphincter muscles.

Investigators interviewed a total of 115 men at ten POZ party events in New York in the second half of 2003. The majority of men were white (70%) and 97% said that they had sex exclusively with other men. The median duration of HIV infection was ten years, although this ranged between two months and 20 years. Antiretroviral therapy was being taken by 69% of men and the average age was 42 years. A sexually transmitted infection in the year prior to attending the sex party was reported by a third of men.

Over a third of men said that their primary reason for attending a POZ party was either “don’t have to worry about disclosing my HIV status” (35%) or “like having uninhibited or unrestricted sex” (35%). In addition, 15% of men cited “don’t have to worry about infecting others” as their primary reason for attending the event.

A previous sex party involving HIV-positive men had been attended by 75% of men, most of whom said that they attended their first such event between 2000-03, indicating that such events had gained in popularity in recent years. Men reported attending events in several north American cities and in Europe.

Most of the men (88%) said that they had oral sex with at least one person at a POZ party, with 60% saying that they had unprotected receptive anal sex (with over three quarters of these individuals receiving ejaculate) and 72% saying that they had had unprotected insertive anal sex at such an event (with 69% of these men saying that they ejaculated in their partner).

There was little evidence of drug use at POZ party events. Despite current concern in the United States about methamphetamine and erectile dysfunction drugs fuelling sexual risk taking, the investigators found that only 11% of men reported the use of any amphetamine and only 1% of men said that they used Viagra before or during the party. In addition, the investigators observed little evidence of drug use other than poppers.

The investigators draw a number of inferences from their study. Firstly, the parties they examined appear to be an attempt at “serosorting”. Secondly, drug use is not a dominant feature of these events; and, thirdly, sex parties involving HIV-positive gay men may provide an as yet unrealised opportunity for health promotion.

“POZ parties have the potential to contribute to reductions in the spread of HIV infection through the self-selection of HIV-positive sexual partners”, conclude the investigators. However, the benefits of such “serosorting” could be undermined by the spread of sexually transmitted infections and the “diffusion of HIV superinfection, both among HIV-positive men at POZ parties as well as their HIV-negative sex partners in other venues.”

References

Clatts MC et al. An emerging HIV risk environment: a preliminary epidemiological profile of an MSM POZ party in New York City. Sex Transm Infect 81: 373 – 376, 2005.