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What’s going on in gay men’s lives when they become HIV positive?

New study finds many gay men are dealing with stress, depression, self-esteem issues or other stress factors when they choose to have risky sex

What’s going on in gay men’s lives when they become HIV positive?
© Wernerimages | Dreamstime
Why do gay men engage in risky sexual behavior?

A British study has taken a look at what is going on in gay men’s lives when they become infected with HIV.

More specifically, researchers interviewed men who had become HIV positive and asked them about the reasons they might have become positive: Did they knowingly have unsafe sex. If so, what where the factors behind the decision to engage in risky behavior?

The study was carried out be researchers at University College London. It involved interviews with 21 men in London and Brighton who had been diagnosed in the previous 12 months. The results have been published in BMJ Open.

Some men were able to point to an individual factor that prompted them becoming HIV positive (e.g. drug use or addiction).

However, it was more common for risky behavior to be influenced by a combination of factors. These could be split intro three categories.

1. Personal stressors

These are issues prompting low self-esteem or psychological distress, such as: a relationship break-up; childhood trauma; being raised in a homophobic environment; midlife crisis; drug use; mental health problems; loss of friends or death or relatives; etc.

‘My father was…an alcoholic and he used to beat my mother and me…That may have had some impact on how destructive one is, and the fact I never had any unconditional love is something that I have struggled with in adulthood,’ said one participant.

Another man, now in his 50s, said he’d had something of a midlife crisis in his 40s when he found himself dealing with low self-worth and unfulfilled ambitions: ‘I mean it probably was the perfect storm you know, they [drugs] got me at a time … mid-forties when I wasn’t that secure, there were a few issues, I was looking for fun … it was an escape and it seemed at the time that it was … enjoyable.’

2. Social environment

Participating in chemsex scenarios (taking drugs and having sex), or social media factors, such as hook-up apps. Guys said apps make it easier to meet up with other men, which sometimes led to risky sexual encounters.

One man in his 20s commented, ‘The introduction of gay apps just makes the sex so much more promiscuous…I think people get a rush from it. I probably did at the time.

‘These apps…just make it so much more convenient. They had these code words for “come round to ours and do this”…”have this drug” … “chill-outs” … It all escalates.’

3. Community beliefs and peer influence

Particularly beliefs and opinions about HIV now being a manageable condition, or peer pressure to have risky sex as other guys appear to be doing it.

One man in his 20s said, ‘Everyone knows somebody positive now and knows that they’re fit and healthy and they take a few pills a day … That’s a huge factor in why so few people use protection anymore … because it has become a treatable illness … I think it changed everyone’s risk calculations, because even if the worst did happen, it was no longer the worst.’

In addition to this, the relative availability to men of anti-retroviral therapy, PEP, recreational drugs and HIV testing also play a factor.

‘Complex web of factors’

The researchers conclude: ‘Recently acquired HIV infection among MSM reflects a complex web of factors operating at different levels. These findings point to the need for multi-level interventions to reduce the risk of HIV acquisition among high-risk MSM in the UK and similar settings.’

The study recommends health and support services better identify HIV negative men in need of more support. It suggests outreach work to eliminate social isolation, linking gay men up with peers in more social settings.

It also recommends greater access to PrEP and awareness-raising on the consequences of becoming HIV positive.

‘Homophobia … underpins the idea that gay men are irresponsible’

Commenting on the findings, Matthew Hodson, Executive Director of NAM aidsmap said, ‘All too often discussion of HIV within the gay communities is reduced to gay men being somehow “irresponsible.” The reality is that gay men’s lives are complex and the reasons that gay men may engage in sex that carries a risk of acquiring HIV are complex too.

‘The homophobia which underpins the idea that gay men are irresponsible, in itself, seems to have played a role in many men not finding themselves able to avoid HIV infection.’

National Gay Men’s HIV/AIDS Awareness Day

In the UK in 2015 an estimated 101,200 people are living with HIV. This is the last year for which there are figures. There were 6,095 HIV diagnoses in the UK that year, of which 54% were men who have sex with men.

Two-fifths of people diagnosed with HIV were diagnosed at a stage after which they should have started treatment. There were 594 HIV-related deaths that year.

In the US, today is National Gay Men’s HIV/AIDS Awareness Day. Approximately 1.2million people are living with HIV in the US, of which more than half are gay or bisexual men. The Center for Disease Control has marked today by issuing a range of advice, including information on where to find people can find their nearest HIV test center.

What are the factors that led to you engaging in risky behavior? Share your own stories below.


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