Like the rest of the population, gay men are at risk from sexually transmitted diseases. Gay men, however, remain the group at the greatest risk of getting infected with HIV in the UK. They are also at higher risk from sexually transmitted diseases.
Estimation of current HIV incidence rate among men who have sex with men is difficult. The often long period of time between the infection and diagnoses can make predicting the incidence rates hard. Also, some of the new infections will have occurred abroad either in the course of travel or before moving abroad. The great majority of new infections in this risk group will, however, have been acquired in the UK, and there are indications of rises in behaviours associated with increased risk among men who have sex between men in the UK.
There is also some evidence to suggest that the increased availability of drug combination therapy has reduced people’s anxieties about contracting HIV. Terence Higgins Trust estimate that a third of people with HIV do not know that they have been infected. At the end of September 2004, 32,412 men who have sex with men have been diagnosed with HIV.
On the basis of these figures gay men have been criticised for being promiscuous and taking unnecessary sexual risks. However, evidence suggests that some gay men have been very sensitive and responsive to safer sex promotion, and condoms are widely and properly used. The high rate of infection reflects a complex relationship between a lack of information in the early days of the epidemic, patterns of sexual activity, the risk of infection and prevalence of the virus among gay men.
The primary mode of transmission of HIV between men is through anal sex without a condom. For young gay men there may be particular problems with trying to practice safer sex. Some young gay men may not feel secure about obtaining or using extra strong condoms for anal sex because if they are seen purchasing or in possession of them it might be interpreted as a disclosure of gay identity. They also rarely have the benefit of sex education in school in which sexual behaviour between same-sex partners is discussed. This can make it very hard for young gay men to feel comfortable about negotiating safer sex.
Research also suggests that some younger men feel that HIV and AIDS is an “old man” disease, and therefore if they have sexual relations with men under the age of 30, they are not at risk from HIV. The emphasis on HIV also gives younger men a sense of complacency about other STDs, which can be “cured” and therefore are not so important to avoid.
The majority of PCTs have recognised the importance of providing explicit, targeted safe sex support, and HIV prevention strategies to their local gay male community. Research is on-going to identify the best methods for preventing HIV infection, and sexually transmitted disease infection.
There is a considerable body of evidence about this area of LGB health. Below is a sample of some of the most recent research that might directly be relevant to the health sector. It is relatively easy to source further research in this area: