NW Gay HIV Stigma and Risks

posted: 04/01/2010

The NW England results of the annual Gay Men’s Sex Survey are now out. ‘Vital Statistics 2008’ gives us the latest information on the prevention needs of gay and bisexual men in the UK and our region.

It also tells us some useful things about HIV stigma across the region, the numbers of men who have never taken a HIV test, and about the numbers who take significant HIV risks.
 

Blackpool – gay hotspot missing
There had to be 20 or more men in a NHS district (Manchester, Liverpool etc) fill in a survey for results from that district to appear in this report.  Unfortunately the gay hotspot of Blackpool only had 17 men fill in the survey, so we can’t say much about gay and bisexual men’s needs there.

Stigma and rejecting men with HIV
This survey asked questions about what undiagnosed men say they would do if a potential sex partner told them he had HIV. Would they change their mind and turn down sex, have sex but be extra careful, have sex just as they planned, or do something else?
 

Men who said they’d reject positive men are showing strong signs of HIV stigma and discrimination. Across NW England half the men said they would reject any HIV positive man for sex. This really discourages diagnosed men from talking and telling any sex partners about HIV.
Things look best for positive men in Manchester and Stockport, but not much better – in Manchester 39% of undiagnosed men say they would reject any positive man for sex.
 

Are George House Trust’s anti-stigma campaigns at Pride helping to cut stigma by rejection locally? It’s difficult to say – in next door Salford the rejection rate is higher – with rejection by almost half the men, like the regional average. HIV rejection is worst of all in Cumbria and Sefton (Merseyside) at 61%, and 56% of undiagnosed men would reject any positive man in Liverpool. [See 19 in the report].

Mixed HIV status relationships
The number of men who have regular partners of a different HIV status is another way of trying to measure how much HIV stigma is about. Sadly it is almost impossible to reach a clear answer from the survey report. In Manchester around 1 in 10 do have a regular partner of a different HIV status. Another 1 in 4 have a partner of the same HIV status, which could be where both men are HIV positive, or both are HIV negative – we just don’t know.

Another 1 in 10 have a regular partner and the man has no idea whether they have the same HIV status or not – a recipe for risking HIV transmission. [See 10 in the report].

Testing or not?
Last year the Health Protection Agency advised that the amount of HIV in Manchester, Salford and Blackpool meant special measures to increase HIV testing are needed and that gay and bisexual men living there should test at least once a year.
 

1 in 5 gay and bisexual men in Manchester have still not tested, ever. Almost as many didn’t test last year but have tested at least once before.

However 28% of Manchester men in the survey have tested HIV positive. That does NOT mean 28% of gay men in Manchester have HIV – just that more men with HIV took part in the survey. A previous study shows the real HIV rate on the scene in the city is about 1 in 10. [See 13 in the report]
 

Risk taking evidence
When men were asked how they rated their chances of passing on or picking up HIV in the next year, 6% think HIV transmission is very or quite likely for them within 12 months.

77% think it is very or quite unlikely, which just shows how many men really are deluding themselves. 63% had also told the survey they had at least one partner with whom they had unprotected sex that year. And 1 in 10 Manchester men reported they had 5 or more partners a year with whom they had anal sex without condoms. [See 14 and 16 in report].
 

We thank all the men who completed either a booklet or the website survey that George House Trust promoted.

NW England 2008 ‘Vital Statistics’ report

Survey questions
UK and English regions reports (including for past years)

Drinking Worsens HIV+ Cardiovascular Risks

posted: 23/12/2009

Heavy drinking increases the risk of cardiovascular disease for men with HIV, a USA study shows. “Hazardous drinking and alcohol abuse or dependence were significantly associated with an increased prevalence of cardiovascular disease as compared with infrequent or moderate drinkers”, they comment.
 

Even 'light-weight' drinking harms more with HIV

What they mean by 'hazardous drinking' may seem pretty light-weight to men on the gay scene in England. They counted anything over 14 alcoholic drinks in one week as hazardous, and six drinks in a single session, more than once a month, as binge-drinking. At Christmas and New Year many men will be drinking well over these.
 

They emphasise that the study shows the risks of heart and other circulation disease harm is there for men with HIV, even after they took account of the usual risks.

We already know drinking is linked to several health problems in people with HIV. These include

• poor adherence to HIV treatments
• liver disease
• worsening HIV disease, as well as a
• bigger risk of cardiovascular disease.

Among HIV negative people, heavy drinking, binge drinking and alcohol dependency, are well known to cause more heart disease and strokes. Is this the same or worse for people with HIV, was the question this study investigated.

So the US investigators studied 4743 HIV positive and negative men veterans from the USA armed forces. Just over half the men (2422, 51%) were HIV-positive. Both HIV-positive and HIV-negative men were likely to be hazardous drinkers, or to binge drink, or be dependant on alcohol - alcoholics.

HIV negative more likely to have some drinking risks

The HIV negative men were statistically more likely to have several traditional risk factors for cardiovascular disease than HIV positive men. These risks include

• having high cholesterol,
• diabetes,
• high blood pressure and
• being overweight.

HIV positive men have more of these usual drinking risks

HIV positive men were statistically more likely to

• smoke,
• have hepatitis C, and
• have liver disease.

So the study shows HIV-positive, but not HIV-negative men, who are hazardous drinkers or alcohol dependent have a higher risk of cardiovascular disease.

Similar drinking risks shared by positive and negative men

For both HIV-positive and HIV-negative men, these traditional risk factors 

• being older,
• higher cholesterol,
• high blood pressure, and
• smoking

were also significantly associated with more cardiovascular disease.

Affect of HIV on drinking men

They then looked more closely at how HIV itself affects the risks for men with HIV, by taking out of the equation the traditional risk factors for cardiovascular disease.

HIV and drinking – more heart failure, heart disease, cardiovascular disease, strokes
 

They found that hazardous drinking for men with HIV was significantly linked with heart failure; that alcohol dependency was linked to heart disease, and that past alcohol consumption (defined as one or more drink, ever), increased the risk of stroke. Binge drinking increases the risk of cardiovascular disease for those with HIV. [The source quotes how strong these statistical significances are].

“Among HIV-infected veterans, there was a significant increase in the prevalence of cardiovascular disease for hazardous drinking and alcohol abuse”, write the investigators. They suggest that this could partly be explained by the increases in lipids associated with heavy drinking. However, they also note that previous research among this group of US veterans “also demonstrated a temporal and dose-response relationship between alcohol consumption and medication adherence.”

“The effect of alcohol may be more pronounced among those infected with HIV”, conclude the investigators.

How does your own drinking measure up?

One of our earlier articles includes useful weblinks to drink calculators to help you check how much you are drinking and it also tells you where you can get help to cut your drinking down.

Drinking is a common way for men with HIV to manage stress and to socialise, but there is quite a price to pay down the line. As men with HIV live longer because of better HIV treatments, it is more likely men with HIV will die earlier than necessary of alcohol-related cardiovascular disease, [heart attacks, heart failure, strokes, blocked arteries], than of HIV.

Men with HIV who tick these risk boxes, as well as drinking, worsen their life prospects

• smoker
• overweight
• older
• have higher cholesterol
• high blood pressure
• have hepatitis C
• have liver disease
• diabetic.

The more you tick, the higher the risk of harming health and life.

British Heart Foundation page on cardiovasular disease and how to cut your risks

Source

Reference Freiberg and others. The association between alcohol consumption and prevalent cardiovascular diseases among HIV-infected and HIV-uninfected men. J Acquir Immune Defic Syndr 2009.
 

Gay Euro-break Risks

posted: 23/12/2009

A study of HIV rates among gay men in some European cities shows much higher rates of HIV than in England. HIV transmission is a bigger risk for men taking popular foreign city-breaks, because men often let down their guard when on holiday, and it is often difficult to discuss sexual risks, unless you are fluent in other European languages.
 

The study used anonymous oral HIV tests and a simple questionnaire on the gay scene in Barcelona, Spain; Bratislava, Slovakia; Bucharest, Romania; Ljubljana, Slovenia; Prague, Czech Republic; and Verona, Italy – similar to a study on the gay scenes of Manchester, London and Brighton, a few years ago.

Manchester and Barcelona

In Manchester and the other English cities study we found 1 in 10 gay men had HIV (and around 3 out of 10 men with HIV did not yet know this). In this new European study Barcelona had a far higher rate of HIV – 17%, not far off twice the rate in the English cities. In Verona, Italy, the rate was 12%. However in Prague the rate was 3%. HIV rates were much higher in Southern Europe than in Eastern Europe.
 

Men reported different amounts of HIV risk taking in the European cities. 67% of men in Barcelona and by 36% of men in Prague reported using condoms with a casual partner. Men in Barcelona and Verona had the highest number of reported casual partners (a mean of 16 and 12 respectively), with lower numbers reported by men in Eastern Europe (a mean of 6 and 8 respectively).
 

NW gay men importing HIV

Looking at NW England’s HIV statistics, we know that Spain was where at least 52 people got HIV, followed by Portugal (20), France (13) and Germany (13), and Italy (12) and the Canaries (8).
 

Gay men in England need to take good care to neither export nor import HIV while enjoying themselves abroad.
 

image credit

Source

HIV bio-behavioural survey among men who have sex with men in Barcelona, Bratislava, Bucharest, Ljubljana, Prague and Verona, 2008-09. Eurosurveillance 48: 41, 2009.
 

Bare Porn Costs - African HIV

posted: 01/09/2009

A documentary ‘Hardcore Profits’ that was shown last night on BBC2 laid bare the cost of porn for Africans. HIV infections and rape follow directly from viewing western bare (condomless) porn. It’s available dirt cheap, almost everywhere. The porn industry has yet to acknowledge its part in driving up the global HIV epidemic.

The documentary maker Tim Samuels tells us -

The moment porn truly stopped being fun came in a remote Ghanaian village – mud huts, barefoot kids, no electricity. The BBC series I was making about the impact of porn, had led me, via Los Angeles (LA) to Ghana. One of the unforeseen consequences of globalisation is the shocking effect that western porn is having in parts of the developing world.

The village has no electricity, but that doesn't stop a generator from being wheeled in, turning a mud hut into an impromptu porn cinema – and turning some young men into rapists, with villagers relating chilling stories of assaults taking place straight after the film's end. In the nearest city, other young men are buying bootlegs copies of the almost always condom-free LA-made porn – copying directly what they see and contracting HIV. The head of the country's AIDS commission says porn risks destroying all the achievements they've made. It's a timebomb, he says.

The concerns aren't theoretical – I met young fathers with HIV whose only sex education came from LA, women living in the villages subject to post-screening abuse, and even a shy teenage virgin who has written to a porn outfit in California asking to star in their films (his return address was care of the local church in Accra).

The porn producers aren't deliberately pushing their products into Africa. But the tide of black market DVDs on sale at street markets and hardcore clips viewable at internet cafes is almost unstoppable. Surely this multibillion-dollar industry needs to take some responsibility for the human costs?

Bare porn as sex education
Since the only sex education some people in places such as Ghana are getting is via porn films, there is a decent argument for the porn industry to produce more films where performers use condoms. In LA, where the majority of the world's porn is still shot, only one company routinely makes such films. The condom-only policy adopted following an industry HIV outbreak five years ago lasted just months.

Massive profits for mobile phone companies and hotel chains

If the ambition is to put more condom-using porn into circulation, which will then more likely end up in those street markets or cafes, some serious multinationals could throw their corporate weight behind this. Hotel chains – among the biggest broadcasters of adult material – have not used their immense clout to insist on greater condom use – much to the dismay of the porn-star STD-testing clinic in LA.

Mobile phone firms are also surreptitiously making jaw-dropping amounts of money from showing adult content on their handsets. Could their ideas of corporate responsibility take on a latex dimension? Might it actually be that ridiculous for the porn industry itself to adopt a spot of corporate responsibility? These are, after all, major businesses replete with HR departments and plush offices nestling next to mainstream film companies. Bankroll sex safe campaigns, harness the allure of their top stars, maybe even make bespoke films for the developing world which educate as well as titillate. Doing nothing, and leaving western porn to march untrammelled into Africa and other places, is a deeply unattractive prospect.

Tim Samuels's 2 part series, Hardcore Profits, started last night (Monday 31 August) on BBC2; part 2 is 9pm next Monday. You can watch part one online on BBC iPlayer here. The part of the documentary about porn's impact in Ghana starts about three quarters of an hour into the one hour long programme.
 

Source

German Risk Statement

posted: 27/04/2009

We have had the Swiss Statement, now their neighbours, the Germans, have issued their own on the risks of HIV transmission from people taking HIV treatment successfully.

The Swiss told us last year that people on HIV treatment, if they meet certain conditions, can be considered uninfectious. Now the largest HIV voluntary sector organisation in Germany, Deutsche AIDS-Hilfe, has issued a paper largely supporting this statement.
 

The German paper describes sexual transmission, where the HIV-positive partner is

• adhering to effective combination therapy,
• has had an undetectable viral load for the last six months and
• has no sexually transmitted infections,

as ‘unlikely’ and describe this as being as effective as using condoms. They add that it is also important that there is no other damage to either person’s mucous membranes.

Stable, long-term different-HIV-status relationships
Both the German and Swiss organisations say their statements are relevant to stable, long-term relationships where one partner has HIV. After the couple has made a decision, based on good information and advice, regular viral load testing and sexual health check-ups are recommended.
 

HIV is sometimes found in semen even though it is undetectable in blood.

However, Deutsche AIDS-Hilfe argues that relying on effective treatment as a means of HIV transmission prevention is a realistic HIV prevention approach, and that individual couples already  make decisions about the level of risk they take.

Read the English language version of the German statement

Swiss statement report