HIV positive men neglect safe sex, report says

DESPITE increasing sexual encounters between gay HIV positive and HIV negative men, leading to higher infection rates, prevention strategies are neglecting those diagnosed positive.

A new report, launched yesterday, entitled "Men who have sex with men: HIV prevention among those who are HIV positive" has called for health strategies which include the needs of HIV positive men.

"They are no less likely to engage in high risk sexual practices than men who are HIV negative," the report warns. It says preventative strategies should ensure all men who have sex with men (MSM), and not only those who are HIV negative, "have the skills to negotiate safer sex."

The report, commissioned by GLEN the Gay and Lesbian Equality Network has called for an inclusive system of HIV prevention where:

Primary prevention includes activities with both infected and uninfected people to reduce initial or new HIV infections.

Secondary Prevention relates to activities to maintain the wellbeing of people with HIV and to delay disease progression.

Tertiary prevention relates to activities to minimise the ill-health of people with HIV who have impaired immune systems, particularly those who have any symptomatic HIV related illness or who have developed AIDS.

The report warns that gay and bisexual men "feel they cannot reveal their HIV status due to fear of discrimination."

"Anecdotal evidence from HIV positive people suggests that Ireland is less accepting, even on the gay scene, than other countries, most notably parts of the UK and US," the report says.

It also warns that HIV positive people in Ireland face significant prejudice in employment and that this affects self-esteem and ability to negotiate safer sex.

"Studies show that gay men who are unemployed or who have lower educational qualifications are at greater risk for HIV. Therefore HIV prevention needs to take account of a range of social processes that influence the factors leading to HIV exposure," it says.

It says further research on the needs of MSM who are HIV positive is needed "and should be commissioned by the Health Service Executive."

Although HIV is less common in Ireland than in many parts of the world, diagnoses of new infections are increasing annually. The 2000 figure of 72 cases was an 80% increase on the figure for 1999, with figures rising to 73 new cases in 2001 and 75 new cases in 2003, the highest figure yet recorded in Ireland for this group.

According to the Health Protection Surveillance Centre this increase is "likely to reflect an increase in risky behaviour in this group."

Research, both internationally and in Ireland, indicates that some MSM who are HIV positive do engage in unprotected anal intercourse, which is a particularly risky practice for the transmission of HIV. A significant proportion of this activity was with people of unknown HIV status.

Ciarán McKinney, director of Gay HIV Strategies (a GLEN initiative and authors of the report) warned: "Too many people seem to think that it is the sole responsibility of the positive person to prevent HIV transmission and it's just not that simple."