Life involves risk. Everything we do, say, write, Tweet, can cause some sort of risk. Usually, we decide what sorts of risks we are willing to take, or deem acceptable based on past history, available information and guessing. But, what happens when the present no longer resembles the past, and the available information is faulty or outdated? This is what is happening right now to gay males around the world that are trying to assess their risk for HIV infection. Everything has changed, except how we view sexual risk. We are told that gay male sex is the riskiest sex there is, but is this still true?
If you are like us, you have lived your entire life with the existence of HIV. Many of us don’t know a world or sex life without this virus looming somewhere in the back of our heads. Worst of all, accurate, non-biased healthcare information directed at our community from a gay male perspective, has been lacking and mostly non-existent.
What has been ever present is the loud chorus of individuals, LGBT/HIV orgs and government agencies letting us know that our natural sexual activities are putting us at extremely high risk; that our very nature makes us most at risk for HIV infection.
As you know, or should know, the world of HIV has changed with new medications to effectively treat and even prevent the spread of this virus. But, the social notion of what “risk” means has not changed. We think it’s time we discuss what risk means in this new era of HIV.
DEFINING GAY MALE SEX RISK FACTORS
Before we can discuss risk factors and what about them has changed, or not, we must begin with defining them. We used information from the American Centers for Disease Control and Prevention (CDC) for this article.
We at GMJ have always stressed the importance of word choice and how they are used. No matter what the world around us is saying, from both the Left and the Right, words do matter and they still have meaning. When words are used to confuse or hide the truth, people get harmed.
The CDC says :
- Gay and bisexual men have the largest number of new diagnoses in the United States.
- Blacks/African Americans and Hispanics/Latinos are disproportionately affected by HIV compared to other racial and ethnic groups.
- When you live in a community where many people have HIV infection, the chances of having sex or sharing needles or other injection equipment with someone who has HIV are higher.
- Having had more than one sex partner puts you at greater risk.
- If you don’t have HIV, being a receptive partner (or bottom) for anal sex is the highest-risk sexual activity for getting HIV.
- If you do have HIV, being the insertive partner (or top) for anal sex is the highest-risk sexual activity for transmitting HIV.
If all you read or have ever heard are the above statements, you would be correct in understanding that natural anal sex between gay males has the highest risk of HIV infection and transmission. You would also be correct in assuming that just being gay, and/or a gay male of colour puts you at higher risk. As would living in an area with a high concentration of those living with HIV, like our gaybourhoods.
But what about?
Pre-exposure prophylaxis (or PrEP) is a way for people who do not have HIV but who are at very high risk of getting HIV to prevent HIV infection by taking a pill every day.
When taken daily, PrEP is highly effective for preventing HIV. Studies have shown that PrEP reduces the risk of getting HIV from sex by about 99% when taken daily.
Taking HIV medicine as prescribed can make the amount of virus in the body very low (called viral suppression or undetectable). People with HIV who stay undetectable can stay healthy and have effectively no risk of sexually transmitting HIV.
NOTE: The above are the words from the CDC website and not reflective of every government body in the world or even HIV orgs and advocates. We will address that further down.
HAVE OUR RISK FACTORS CHANGED?
Yes, and no. If your knowledge base and understanding of HIV prevention and treatment comes only from what the CDC and those who repeat their texts say, your risk factors have not changed. Mainly because risk factors are just as much controlled by personal perspective as by actions. Your belief that an act is risky can cause you to make different decisions than if you had different information.
This is why claiming to be “clean” and avoiding sex with those living with HIV is so common in our community. But, having unprotected sex with a stranger who claims to be HIV negative is also common.
The truth of the matter is that those living with HIV are not the cause of our continued battle against HIV. It is the fear of being tested and those who don’t know their status that are infecting others.
Nearly 40% of people with HIV don’t know they have it or know but aren’t in care. 8 in 10 new HIV infections come from people not in HIV care!
A NEW WAY OF THINKING ABOUT GAY MALE SEXUAL RISK
As we say, the point of our non-profit and this website is to provide you with the fact based information you need to make the best decisions for your life. We can’t make these decisions for you, force you to do them or have any impact. It is your responsibility to take in new information, learn from it, and make appropriate changes, if need be.
We would like to examine the most glaring high risk factors mentioned by the CDC all throughout their website to see how gay males should be thinking about their risks in our new reality.
The assumption that all gay males are whores with a line out the door of sexual partners has been used against us as a point of fact for decades. At GMJ, we don’t care how many sexual partners you have because we don’t believe it is as high a factor in your risk as we have been led to believe. We have worked with many gay males that have contracted HIV on their very first sexual encounter or with a steady boyfriend.
Almost every gay male has been on some sort of dating app. Grindr is the world’s largest and most popular. The common perception is that those who use these apps are more likely to contract and infect others with HIV more than those who don’t, because they have more partners.
A recent study challenges what we have been taught about multiple partners and dating apps.
The study found that MSM who use Grindr take more sexual risks and have more partners compared with those who do not use the dating app. However, Grindr users were more likely to use pre-exposure prophylaxis (PrEP) for HIV or to be open to using it.
Martin Hoenigl , MD, assistant professor of medicine at the University of California, San Diego, and colleagues enrolled 1,256 MSM in a nested cohort study conducted between December 2018 and April 2019.
The majority of participants (86.5%) were not using PrEP, the researchers reported. Almost half (48%) reported opening Grindr during the previous 7 days, for a median time of 144 minutes.
Among Grindr users, 18.7% reported PrEP use compared with 8.7% of participants who did not use Grindr. Furthermore, among Grindr users who were not using PrEP at the time of the study, 24.6% agreed to begin using it compared with 14% of nonusers.
“This result probably contributed to the fact that — surprisingly, despite higher risk behavior, despite higher rates of newly diagnosed chlamydia and gonorrhea infections — we found fewer new HIV infections among Grindr users than non-Grindr users,” Hoenigl said during the news conference.
Gay male anal sex has been our boogey man even before the discovery of HIV. The act is considered to be unnatural, against god, dirty, and even worse by those who are not gay males, and unfortunately by some who are. All of this in spite of the large percentage of straights who have admitted to practicing anal sex.
Anal sex, within itself is considered an extremely high risk activity between gay males, but is it? We have found multiple causes that increases one’s potential to contract HIV through anal sex, that are not directly related to the activity, but in preparation for it. The best examples are douching and anal/rectal shaving before sexual intercourse.
In this new era of HIV knowledge we must examine anal sex risk in conjunction with PrEP and those living with HIV being undetectable. If we don’t, what is the point of having these medications?
- When we say that worlds matter, that includes the 99% statistic the CDC uses regarding PrEP. For some, even that 1% is too much of a risk, especially having fear being drilled into his head everyday of his life. The truth is, NOTHING IS 100% effective from a medical perspective, and no government agency is going to say so. It is not that PrEP isn’t effective, or that there are large numbers of guys who claim to fail while using it. User error is the cause, not the medication.
The CDC also mentions taking PrEP as directed everyday. It does not mention that PrEP on Demanding Dosing is just as effective, easier to remember to take, has less side effects and is cheaper.
- Uequalsu has been a huge game changer in our understanding of, not only HIV treatment, but also prevention. But, it took the CDC until 2017 to acknowledge the facts and science behind this discovery. Much later than some other countries and HIV organizations.
The first public document concluding that effective treatment rendered a person no longer sexually infectious was the Swiss Statement of 2008, authored by Dr. Pietro Vernazza and published by the Swiss Federal Commission for Sexual Health. The bold and revolutionary statement was ahead of its time, yet widely criticized and denounced by the field. After the Swiss Statement, there was a groundswell of groundbreaking clinical evidence, including HPTN 052, PARTNER, and Opposites Attract. However, even after the final reports of HPTN 052 and PARTNER were published in July 2016, with the exception of a few pioneering NGOs like Terrence Higgins Trust in England, the studies were typically promoted independently and were subject to the politics, biases, and inaccuracies of HIV information providers
Even the language the CDC chose to adopt leaves many gay males questioning the facts about those who are undetectable. Using the phrase effectively no risk in regards to HIV transmission is just like saying “BUT” after you say something positive. It effectively negatives everything that comes before it. And like we mentioned above, when gay males have been purposely terrified for almost 40 years, telling them something is effectively no risk, is not going to be enough to make them feel safe. ZERO RISK is the fact behind those living with HIV and are undetectable. NO RISK is what gay males need to hear and read, because it is the truth.
Why is U=U Important?
Prevention.org is the originator of the hash-tag (UEQUALSU) , but not the science, policy or even prevention/treatment of HIV, but their recognized website states:
A groundswell of research confirms that when a person living with HIV is on effective treatment, it will reduce the level of HIV to “undetectable” levels which protects their health and makes them incapable of transmitting HIV to their sexual partners, or what we call “Undetectable = Untransmittable: U=U“. As a prevention strategy, this is often referred to as Treatment as Prevention.
The U=U message is an unprecedented opportunity to transform the lives of millions of people with and affected by HIV and to radically transform the field:
- Improves the lives of people living with HIV by dramatically reducing the shame and fear of sexual transmission and opening up possibilities for conceiving children without alternative means of insemination.
- Dismantles HIV stigma on the community, clinical, and personal level.
- Encourages people living with HIV to start and stay on treatment, which keeps them and their partners healthy.
- Strengthens advocacy efforts for universal access to treatment, care, and diagnostics to save lives and bring us closer to ending the epidemic.
It’s a game changer for people living with HIV and for the field that people on effective treatment cannot transmit HIV, but it’s still widely unknown. U=U and our partners are changing the narrative.
WHAT IS TRUE RISK FOR GAY MALES?
We believe that your risk for contracting HIV, or any other STI, for that matter, is relative to your knowledge and information about the illness.
Joe believes that “good people” don’t contract HIV. So, when he had unprotected sex with the preacher’s son, he was very surprised when he contracted HIV. The other male told him that he was “clean”.
Paul, loves sex parties and Grindr. His libido is high and he enjoys being single. Don’t ask him how many sexual partners he’s had in his life or even the last 6 months because he can’t tell you, and doesn’t even care. Paul has a great doctor who prescribed him PrEP, which he takes as directed. He also enjoys having sex with guys who are HIV positive and undetectable. Paul is currently still HIV negative.
We have great new tools to treat and prevent HIV, but if we don’t use them or believe they work, it is like living in the early 1980’s all over again. We must begin to think differenly about our sex, make decisions based on facts and science and never fear. But most of all communicate with our partners. Testing is key but you can’t rely only on his word.
Be smart and have great sex!