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In this issue

Gus Cairns
Published: 01 April 2009

A hope and a warning. That’s what we have in this issue. The warning is about hepatitis C (see The New Epidemic). It’s now becoming unpleasantly clear that the transmission of this chronic and potentially lethal infection between gay men is not an occasional event that only happens between people into esoteric sex practices. On the contrary; there’s every sign that we may be at the tipping point where an epidemic that’s been slowly gaining pace starts to affect the gay community at large.

More dangerously still, for a variety of reasons that are still unclear, it might turn out to be almost exclusively restricted to gay men who already have HIV. The implications both for sexual health and for stigma among a group who already have enough problems (see Sex, sleep and self-esteem) are worth thinking about very seriously. Studies are already finding that positive gay men who contract hepatitis C are feeling further stigmatised, even by fellow positive gay men.1

The biggest challenge the hepatitis C epidemic throws at us is how to refresh prevention messages. One hundred per cent condom use amongst gay men in the UK has declined slowly but steadily, according to the annual Gay Men’s Sex Surveys, since 1997. It’s now the exception rather than the rule; just over half of the men surveyed the last time the survey asked (in 2005)2 hadn’t always used a condom in the last year, and just under two-thirds of those with HIV. And yet this is the only HIV reduction strategy we have (apart from circumcision) the efficacy of which has been proven in scientific studies, again and again.

Many people would rather not use condoms if they didn’t have to and this problem has led to a global search for HIV prevention methods that might add to the quality of sex, or at least not intrude on it. One method that offers hope of an alternative could suddenly find itself in fashion sooner than you might think, if a couple of studies produce positive results, is pre-exposure prophylaxis (PrEP) – taking anti-HIV drugs to prevent HIV.

As Keith Alcorn points out in A jagged little pill, the real dilemmas associated with PrEP will only start if we get those results. Who will use it and, more crucially, who will decide who gets it? And, if the net result is that already-wobbly condom use declines further, will the net result on HIV be neutral or even negative?

And just as crucially – given what we started with – will we just replace bad health due to HIV with bad health due to other STIs like hepatitis C? Using PrEP, our interviewee Paul found, didn’t prevent him catching something else.

References

1. Owen G. An ‘elephant in the room’? Stigma and hepatitis transmission among HIV-positive ‘serosorting’ gay men. Culture, Health and Sexuality 10: 601 – 610, 2008.

2. See www.sigmaresearch.org.uk/files/report2007c.pdf

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.