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Medical Forum / Diseases and Disorders / AIDS / December 2007by Peter Saxton
By Peter Saxton http://www.gaynz.com/articles/publish/25/article_5373.php Tuesday 18 December 2007 Location: Article & News Index >> Features >> Health & HIV >> Safe Sex An STI has just rated you as "HOT"... Posted in: Safe Sex By Peter Saxton - 13th December 2007 Email this article Printer friendly page The sexual landscape has changed. Sexual networks are now different. Gay and bisexual men who don't adjust to these circumstances could soon get a nasty surprise... People often think of STIs at a micro or personal level - "I haven't changed how I have sex therefore my risks of acquiring an infection are the same as they've always been". But another way to understand patterns of STI acquisition (and therefore individual risk) is to take a macro or population perspective. That is, what other people are doing, and who they're doing it with. STIs thrive in certain conditions and not in others. After being introduced into a population, STIs survive in a community of linked people if there is a small core of very sexually active individuals. These men act as an engine room of epidemics, because the sexual connections they forge make it easier for STIs to spread quickly and deeply through the network. It's the size of this core, and the way they're linked to other men, that helps shape the course of a sexually transmitted disease epidemic. It determines the pathways of transmission; where it will meet resistance (high levels of condom use, low rates of sexual partner change, early diagnosis) and where the weak points are (low levels of condom use, rapid partner change, late diagnosis or undiagnosed infections). In the 1970s and early eighties, STIs were rife among gay and bisexual men. In 1984, 38% of a cohort of gay men in Sydney reported a history of syphilis alone. From the mid-1980s and early nineties, gay communities took up condoms against HIV in one of the most effective public health responses in history. Not surprisingly, condoms partially acted as a "circuit breaker" for other STIs as well, and rates of most STIs declined through this period. In other words, STIs exploited gay men's high sexual connectivity in the seventies, but the uptake of safe sex helped prevent the same STIs from repeating this assault on our communities a decade later. As we know, many men who were both highly sexually connected and who didn't use condoms for anal sex also acquired HIV - rates of HIV went from zero to almost 50% in just 5 years among a cohort of high-risk homosexual men in San Francisco. Before the arrival of new treatments for HIV in 1997, many men who'd had a lot of unsafe sex became unwell and died. Thinking about STI transmission from an ecological perspective, the high mortality of men in these core groups removed them from the sexual network and effectively shrank the size of the epidemic's "engine". Rises in condom use, and the withdrawal of many highly sexually connected gay men from sexual networks because of AIDS, were largely why STI epidemics were declining among MSM during those latter years. So how have things changed? What does the landscape look like now? Can this help explain why we're seeing resurgences of STIs in homosexual men around the world, including New Zealand? Post-1997, the new HIV treatments (which have been a great success in terms of improving positive men's lifespan and wellbeing) and Internet dating (which increases choice and the frequency of exchanges in the sexual marketplace) have without doubt combined to create a new STI environment among gay and bisexual men. Men infected with HIV are living longer and are having active sex lives. The Internet is creating new opportunities for hooking up; enlarging the core group, and altering how these men locate and mix with other, less sexually active men. It potentially completely rearranges the patterns of connectivity between men who are infected with an STI and men who are susceptible to infection. STIs adore these conditions - it's as if we've built more bridges and superhighways and added new on ramps and off ramps. With Internet networking and HIV treatments here to stay, the implications for individual and community health are the same: Everyone needs to be more vigilant with condoms and sexual health checks, whether you're positive or negative. This is especially true for energetic guys who have a lot of sexual partners - the "fast lane" lads. But it also applies if you stick to a small number of partners, because it's practically impossible to know whether your partner's partner's partner is very sexually active too. In fact no matter which end of the sexual partnering spectrum you're at, you might unwittingly be only two degrees of separation from a guy whose preferences are quite different from your own. Greater vigilance isn't a moralistic response. It's about self-preservation - acknowledging how STIs spread through sexual networks, and how we can adjust to thwart them. This is a difficult message to sell, because the consequences of HIV infection aren't as visible these days, and men often won't reveal that they've had (or have) an STI. In the 2006 Gay Auckland Periodic Sex Survey (GAPSS), 40.8% of men reported a lifetime history of at least one STI, with 8.0% reporting an STI in the previous 12 months. The most common of the recent STIs were gonorrhoea and chlamydia (both 3.3% in the last year), with around 1% reporting syphilis. On the bright side, gay and bisexual men are generally diligent about sexual health checks - 43.2% claimed to have had one in the previous 12 months, being lower among men with fewer sexual partners, men aged 40 and over, and Asian men. As we head into summer, you can make a big dent in your own risk and the risk of everyone who'll ever be sexually connected to you if you take two simply precautions - use a rubber for anal sex, and go for a full sexual health check. No matter who you are... Peter Saxton Peter Saxton, Senior Researcher at the NZAF Research, Analysis and Information Unit, delivered a plenary paper at the NZ Sexual Health Society Conference in August on the re-emergence of STIs and HIV infection among MSM in the post-HAART, post-Internet-dating environment. Slides from his conference paper can be viewed at this link: http://nzshs.org/content/nzshs/24/2-24.htm The report of the 2006 Gay Auckland Periodic Sex Survey can be viewed here: http://www.nzaf.org.nz/files/2006%20GAPSS%20Report.pdf Peter Saxton - 13th December 2007 Related Links: Source: Collective Thinking 1997 - 2007 http://www.GayNZ.com http://www.gaynz.com/articles/publish/25/article_5373.php by Peter Saxton >In the 1970s and early eighties, STIs were rife among gay and bisexual >men. In 1984, 38% of a cohort of gay men in Sydney reported a history [quoted text clipped - 16 lines] >them from the sexual network and effectively shrank the size of the >epidemic's "engine". I started to lose the will to at this point. Would someone who's read the full article tell me who did it? I assume it's some sort of murder mystery. One tiny problem with the HIV theory is that the killer virus takes so long to show itself. Take me, for example: I was diagnosed HIV+ almost thirteen years ago, however I show no symptoms. Perhaps I'm a special case: I'm superman in disguise. However, even the HIV witch doctors' bible dictates symptoms of HIV take several years to appear in infected individuals. Don't you think a virus with such a long and silent incubation period would have affected highly sexed gay communities far more than it did? And according to official figures, HIV infections have continued to increase year after year here in the UK, despite the huge take up of condom usage and anal sex abstinence. One alternative theory is that gay men in the 1970s overloaded their immune systems with drugs and a range of reoccurring STIs/STDs.  Signature<http://www.hiv-poz.co.uk/> Moible: +447939991519 4721 days and counting... Martin wrote... >>know, many men who were both highly sexually connected and who didn't >>use condoms for anal sex also acquired HIV - rates of HIV went from [quoted text clipped - 9 lines] > the full article tell me who did it? I assume it's some sort of > murder mystery. I read the whole article and was impressed by the author's willingness to state the unpleasant facts that would get U.S. HIV/AIDS researchers fired for discussing. Especially later (snipped) where he predicts a "conducive environment" or something from the large number of infected and "energetic" men kept alive indefinitely by the drug treatments. > And according to official figures, HIV infections have continued to > increase year after year here in the UK, despite the huge take up of > condom usage and anal sex abstinence. Are you comparing apples and oranges? From what I've heard, the UK is experiencing a huge increase in positive HIV tests among African immigrants. Many were infected in Africa and many arrive in the UK free of the disease but were infected by members of the immigrant community, and the disease begins to percolate out of that community and into the mainstream community by a steady stream of young white people who are fascinated by big black nigger dick. But this tells us nothing about the infection rate among white Britons. Oh, and the NHS treats undocumented African immigrants at taxpayer expense, and there is a debate on whether the UK government should actually pay to advertise in African countries for HIV-infected Africans to come to the UK for free treatment. I think the argument is that HIV/AIDS treatment in Africa is so substandard, that it constitutes the sort of human rights abuse that is grounds for political asylum. The debate is rather one-sided, with opponents accused of racism and thus subject to arrest under hate speech laws. > One alternative theory is that gay men in the 1970s overloaded their > immune systems with drugs and a range of reoccurring STIs/STDs. That was a popular theory, along with the theory that the CIA had invented the virus and deliberately spread it among homosexual men and blacks to exterminate them: Ronald Reagan had used a time machine to transport the HIV virus back to Jimmy Carter's 1976 and infect a gay flight attendant and brainwash him to be sexually promiscuous so he would infect gay men across North America so that symptoms would appear in late 1981 so Reagan could be blamed for it. |
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