Making It Count - Gay HIV Consultation

posted: 19/04/2010

The latest version of the gay / bi men’s HIV prevention and sexual health strategy for England, Making It Count, is now open for your comments. Making it Count, is rewritten and fully updated from the third version, which appeared in 2003.

Making it Count is the planning framework for CHAPS, the multi-agency partnership for HIV prevention and education of gay and bisexual men in England.

The latest edition picks out the key choices facing men who have sex with men that affect HIV transmission rates, and pays attention to what helps motivate men.

It’s designed to bring together education and empowerment, with the values and social norms that will promote the best sex with the least harm among gay men and bisexual men.

This draft doesn’t have the final stamp of approval from the CHAPS partners, but there is broad agreement. They want your views first.

Some of the questions to think about are :

• How well does it meet the sexual health and onward HIV transmission needs of gay / bi men diagnosed with HIV?
• Is positive prevention given enough priority?
• Are men diagnosed with HIV involved enough in positive prevention?

Making It Count 2010 – draft     pdf 840KB

or by direct download from Sigma Research

Deadline for comments      09.00am, Monday 14 June 2010.

Making comments

• phone 020-7820 8022 and speak to Ford Hickson
• email Ford, either with comments made on the pdf or in an email message
• post to Sigma Research, 77a Tradescant Road, London, SW8 1XJ, writing your comments on a paper copy.

Positive Men’s Sex Rights

posted: 09/03/2010

Calls to improve the sexual health of gay and bisexual men living with HIV across England were made at the national gay men’s sexual health conference that has just ended in Sheffield. George House Trust put up a strong case for improving the sexual health support provided for all men living with HIV.
 

Top experts
The conference heard from four George House Trust experts, including young gay Positive Speaker Craig, who came out about having HIV to thousands at the Manchester Pride Candlelit Vigil. In five out of the six conference sessions, our experts led the way. The conference heard that meeting the sexual health needs of gay and bisexual men living with HIV is critical, about positive prevention (involving positive men in reducing onward HIV transmission), calls for widespread campaigns to stop HIV stigma among gay men, and for the greater use of positive speakers to challenge stigma and empower men living with HIV.
 

And positive men too
We’ve been campaigning about these for years. Our efforts are paying off, but improving things across the whole country is slow because we can only persuade and encourage other organisations to do the right thing. At last, CHAPS has now added supporting men living with HIV to the national strategy for gay and bisexual men’s HIV prevention.
 

Status check
With LGF, who are part of CHAPS, we produced our Update Your Status campaign encouraging undiagnosed gay and bisexual men to test regularly for HIV. Testing and diagnosis helps improve the sexual health of men who do turn out to have HIV and cuts the number of gay men diagnosed with HIV too late for the men to get the best out of their HIV treatment.
 

Positive prevention pioneers
In the next couple of months we will hold an national symposium in Manchester for experts in Positive Prevention with gay and bisexual men with HIV. This will start work on the first national CHAPS programme for gay men’s positive prevention.
 

Positive prevention was neglected because the national strategy aimed instead at undiagnosed men. This left out the many positive men who are passionate about reducing HIV transmission. George House Trust wants men with HIV involved in developing the resources, knowledge and skills to maximize sexual health and cut HIV transmission.
 

Work in some countries on positive prevention is well ahead of the UK – for instance Canada already has its national Poz Prevention strategy and has produced a booklet for HIV+ gay men and Ireland has its own booklet.
 

Face to face and working behind the scenes
Most of George House Trust’s efforts directly support people living with HIV. What is not so well known is our important behind the scenes work. This backstage work aims to cut the number of people becoming HIV positive and working for better services to meet the changing needs of people living with HIV across the country. It’s not so glamorous and it often takes time to show results, but work like this is essential to prevent even more gay and bisexual men from needing services in the first place, as well as improving the lives of men who do have HIV.
 

Our behind the scenes work is a form of long term indirect prevention - taking steps to stop even more people becoming HIV positive. Everyone who gets HIV potentially requires a life time of support from services such as ours.
 

Rethinking Gay Men's HIV Prevention

posted: 14/04/2009

Not exactly failing, but not up to the job, is gay men’s health promotion in 2009. A landmark speech by Ford Hickson to the recent CHAPS gay men’s sexual health conference in Brighton exposed the very unbalanced forces driving and holding back the HIV epidemic.
 

Ford, one of the country’s leading HIV experts, told us that sexual risk-taking has all the big guns going for it, and risk reduction has little firepower. We need to make a blunt assessment of what the situation is now, work out a better approach, and stop beating ourselves up because HIV prevention seems to be ‘failing’.

Ford Hickson reminded us of the strong forces pushing sexual risk-taking: 

• The power of sexual pleasure. "If you do not understand sexual risk," he commented, "it is probably because you don’t appreciate sexual desire."
• The rapid growth of the gay scene into "a large business sector supplying services for sexual contact, and places for sex".
• Widespread homophobic shaming and blaming in society, leading to emotional isolation and low mood for many gay men.
• Gay men’s heavy self-medication with alcohol and drugs, which we then use to excuse our risk-taking.
• The general notion that anal sex is the only ‘real’ sex.
• The way bare-backing is pushed and sold. "Gay sub-culture has long legitimised the eroticisation of the unacceptable," and bareback porn is just the latest example.
• Safer sex is everyone's responsibility and this means often no one takes the responsibility. Just as health agencies are failing to take care of gay men, gay men are failing to take care of each other. 
• Our bias is to hope for the best, and we use twisted thinking: we tell ourselves we will be OK and that the risks are smaller than they really are. So we give ourselves the green light to take the chance.

Harm reduction – what weapons work, apart from fear?
Ford dismissed the common view that gay men no longer see HIV as worth avoiding. Ford pointed out that uninfected men’s fear of HIV, and of men with HIV, is excessive.

But many of the ways the HIV sector tries to cut risks are seriously mistaken. He criticised attempts to identify and target ‘high-risk’ individuals – a Jim’ll Fix It approach to HIV prevention. This tries to identify and ‘correct’ men who have unsafe sex. Trying to change the behaviour of men taking the most risks just ignores the reality. HIV risk-taking is very widespread. Each year half of all gay men will fuck without a condom; 1 in 100 will be unlucky, this year; or next year, or one of the years after that. Most of the unlucky ones aren’t taking more risks; anyone taking risks can be unlucky sometimes.

Money for prevention tight

The funding for precaution has been cut, while the numbers of men at risk have ballooned. There isn’t enough money to pay for anything except quick-prevention fixes that ignore underlying causes.

Shutting the prevention stable door after the horse has bolted

We try to stamp out unsafe sex rather than prevent it. Instead of schools teaching gay youth how to avoid learning risky habits before starting their sexual life, we wait and then try to fix adult men’s ‘bad’ sexual habits afterwards.

Prevention aims to get the most out of the money, but ignores many people at the greatest risk, because their needs are more complex and expensive.

Combination of prevention needed
We need a ‘combination of prevention’ that uses every way of reducing risk. Claiming that HIV prevention is failing is just victim-blaming. UK HIV prevention is simply not up to the huge size of the job and the pressures on men to take sexual risks.

For most of us most of the time, taking precautions against HIV during sex is fairly easy. Stopping all men from taking all HIV risks is impossible. Anyone who claims they have the solution to the HIV epidemic is either a liar or a fool.

Improve lives

Ford suggested we should stop measuring success by the number of new infections. Instead success is simply whether the men we work for have a better life. We are not failing because we are can’t hold back the vast forces we face. We are failing only if we do not try.

Ford’s illustrated speech is here. It made a deep impression on the gay men at the conference.