The increase in new cases of HIV among gay and bisexual men outlined in a recent report by the HSE came as no surprise to those working in the area. The HIV in Ireland 2012 report found a 160 per cent increase in HIV diagnosis among gay and bisexual men between 2005 and 2012, and said the average age of diagnosis had also dropped, from 38 to 32.
Increased testing contributes to the rise, but why are young gay men still such a high-risk group given the virtually global emphasis on safe sex? The key word among medical professionals is “complacency”.
HIV/Aids, once a death sentence, is now a chronic, treatable illness. The virus has stayed the same, but the drugs have improved. However, education about HIV appears to be intermittent, particularly for young men born after HIV peaked as an international talking point.
Open Heart House, an organisation that offers support to people living with HIV, has more than 1,100 members. “There is definitely a complacency . . . People think: ‘I can take a pill and address it.’ The other issue is we haven’t had a campaign for years. I have students in and their lack of knowledge astonishes me,” says Paula Gilmore, the organisation’s chief executive.
Rory O’Neill, a prominent figure in the LGBT community, has spoken out frequently about the stigma surrounding HIV. “This is just my opinion, but I strongly suspect that young people don’t view HIV as quite the horror that we did 10, 15 or 20 years ago. They didn’t grow up with the tombstone ads on TV. They don’t know anyone who has died from it.
“If they do come across somebody who is HIV positive, they are living their life, taking their drugs, and it makes it look like a manageable, chronic condition. I think the younger gays don’t fear HIV in the ways that we did . . . And it’s a big mistake on their part.”
At a busy gay bar in the middle of last week, the crowd is spilling in, a mixture of mostly young gay guys and gay girls and their straight friends. A remix of Daft Punk's Get Lucky is playing, and the smoking section is the perfect illustration of the LGBT scene: a convergence of backgrounds, ages and ethnicities.
Declan (19), one of the young men in the bar, says he doesn’t know anyone with HIV. “If one of my friends had HIV, I’d be really shocked. I’ve never been into casual sex, and that’s one of the reasons because it is seen as a life-ruiner.”
'Like leprosy'
Although there are no physical signs evident if someone has a positive HIV status, Declan says that among his peers there is a belief that you can tell if someone is HIV positive or not. "One of my friends came up to me in [a gay bar] the other night and said 'they definitely have it' about this guy and told me 'you need to be careful'. People think it's like leprosy or something, that you can tell if people have it . . . I've been told it's a big problem, but you don't really have to know about it."
Also in the bar is John (21), who uses Grindr, a geo-location smartphone app for gay and bisexual men to access dates and sexual encounters. He says “70 per cent of the guys” on Grindr ask for sex without a condom. “I’ve got drunk and had sex without a condom . . . twice. If someone told me a year ago you could get all this stuff just one time, I would never have done it. But being honest with you, I didn’t even know.
"After getting tested I'll never do it again. But I didn't know. I'm not stupid, but no one ever told me . . . I've never seen an ad in the mainstream media about gay men and protection, I've only ever seen it in GCN [Gay Community News]."
Another man in the bar is Michael (21). “I don’t know anyone Irish with HIV. For most people, getting chlamydia, syphilis, the curable things, that’s what most people will use condoms for when it comes to penetrative sex. Most people fear getting the smaller things more than the serious things.”
Complacency and lack of information are certainly problems, but the rising number of diagnoses is partly a result of increased levels of testing, which is encouraging. At the annual Gay Health Forum in Dublin last Friday, Mick Quinlan, manager of the Gay Men’s Health Service, detailed its statistics, saying more than 5,850 men attended clinics in 2012, 825 of whom were first-time attendees, an increase of 5 per cent from 2011.
But the age of those seeking testing has shifted dramatically: 39 per cent of new attendees were aged 24 and younger, an increase of 20 per cent since 2011.
At the clinics, HIV testing increased by 39 per cent compared to 2011, yielding 52 positive diagnoses. Correspondingly, more testing means more positives as well as plenty more negative results.
Greater awareness
Despite the complacency issue, gay men have a stronger awareness of sexual health issues. Most get tested frequently, and the promotion of good sexual health and safe sex is visible at community events, in the gay press and in the recent Man2Man campaign, the first HIV and sexual health campaign directed at young men, which began in 2011.
“There is an increase [in HIV diagnosis] and it’s in the gay community,” says Paula Gilmore, “but I would put that down more to that the gay community would be more aware and have more opportunity for testing.
“The stats show that the percentage whose viral loads [the severity of the infection] are much higher were heterosexual men. They also reckon you could add another 30 per cent to current statistics for those who haven’t tested.”
The Man2Man campaign, which is currently securing funding in the hope that it will become a sustained campaign, created new awareness last year.
“There are more men testing, so we’re getting more positives,” Mick Quinlan says. “I’ve been involved in HIV and Aids for a number of years now. The scare campaigns didn’t really work. [The Man2Man campaign] showed successful outreach.
“Younger people do have a certain way of looking at things that can be shocking, but at the same time we’ve seen a huge rise in young men coming to the clinic, so that [message of] responsibility is getting through. It has to be sustained.”
The names of the men in the bar have been changed. For more information on sexual health for men having sex with men go to man2man.ie. For information for those living with HIV, go to openhearthouse.ie
