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In Canada, prejudice and discrimination against gay men persists. Despite the progress in recent years in the social recognition of gay men, society still treats homosexuality as something "unnatural". Many gay men react to this by denying or concealing their sexual orientation. As a result, they keep their distance from the gay community and do not have access to the support that it provides. They are not exposed to the safer sex messages that the gay community has promoted since the onset of the epidemic. Difficulty in accepting one's sexual orientation has a profound impact on one's psyche, well-being, self-esteem and quality of life in general. It causes considerable isolation and psychological distress. Moreover, many studies have demonstrated that low self-esteem, fear of rejection, isolation and mental health problems are linked with unsafe practices among gay men.
The main risk for HIV infection among gay men (and other men who have sex with men) is unprotected anal intercourse with an HIV-positive partner. Many gay men have changed their behaviour to avoid unprotected anal intercourse with casual partners or with those whose HIV status is unknown to them. This change in sexual behaviour is undoubtedly an important factor in explaining the significant decrease in new HIV infections among gay men. Between 1997 and 1999, 48.5% of new positive test results affected men who have sex with men, whereas prior to 1996, this proportion stood at 77%2.
But recent research suggests that the decrease in new HIV infections should not be considered a permanent gain. The proportion of new positive test results among men who have sex with men increased to 53.6% in 2000 and then decreased to 48.3% in 2001. In the first half of 2002 this percentage was 51.4%3. Results from the Montreal Omega Cohort Study indicate that from 1997 to 2001, an increasing trend in unprotected anal intercourse is seen among casual partners. Sexually transmitted disease data may be used as a marker for unsafe sexual behaviour. Preliminary data for 1999-2000 show increased reports of rectal gonorrhea among adult males in Toronto and Ottawa compared to earlier years, and a potential outbreak of syphilis among men who have sex with men in Calgary. These data suggest increases in unprotected sexual encounters among men who have sex with men4.
Trends in the incidence of HIV among gay men are being closely monitored by professionals involved in intervention and by many epidemiologists. It is feared that a slackening of safer sex practices among this population could occur, coupled with a second wave of HIV infections. It has been suggested that young gay men take greater sexual risks because they have not witnessed the ravages of AIDS to the same degree as their older counterparts, because they have not lost friends and lovers to this disease and because they believe that choosing a sexual partner as young as themselves provides protection against HIV infection. It has also been suggested that a level of nonchalance about HIV has set in among gay men since the development of new drugs that treat HIV/AIDS (combination therapies). A recent study has shown that the level of risk a gay man is prepared to take in his sexual practices corresponds to his belief that new anti-HIV drugs are a cure5. Research conducted over the past 15 years with gay men has made it possible to link several psycho-social factors with risky sexual behaviours. They include: age, level of education and level of income.
Certain social conditions, including discrimination, intensify the vulnerability of individuals to HIV infection. Belonging to a marginalized group reduces an individual's capacity to protect himself against HIV infection. Societal prejudice against gay men continues to be linked with a worrisome number of suicides among gay teenagers. Much work remains to be done to create better conditions where gay and bisexual persons are better able to adopt and maintain lower-risk sexual behaviours. Effective approaches to prevention among gay men have been implemented in countries where homosexuality is accepted6. For this reason, it is important to support institutional or community-based interventions that enable gay men to develop skills for coping with their stigmatized sexual orientation. Particular attention should be paid to young people, as well as to those gay men for whom ethnicity and sexual orientation can be a twofold stigma.
With respect to HIV specifically, it is necessary to continue to disseminate accurate information on the ways HIV is transmitted and how best to protect against infection. It must be emphasized that new anti-HIV drugs have serious side effects, and that they are too new to conclude that they will be the definitive treatment for HIV/AIDS. Additional prevention tools such as microbicides and vaccines should also be developed.
There are precautions that men who have sex with men can take to reduce the risk of HIV infection. They include using a new condom with each sexual encounter and using sterile needles and other injection drug equipment if they are injection drug users. For more information on how to prevent HIV infection, please contact the Canadian AIDS Society at 1-800-499-1986 or visit our web-site at <www.cdnaids.ca>.
HIV/AIDS and Gay Men. © Canadian AIDS Society. Published 07/27/2007. Updated 02/22/2010. Web. Retrieved 03/07/2014 from http://www.cdnaids.ca/hivaidsandgaymen