"Condom use is still generally high among an Auckland sample of men-who-have-sex-with-men (MSM), but the continuing proportion of men who have sometimes not used a condom for anal sex is enough to propel the HIV epidemic, rather than stop it," say researchers in the 2004 GAPSS (Gay Auckland Periodic Sex Survey). The full results from the 2004 GAPSS will be released today (Tuesday 14 December) at a launch in Ponsonby. This study provides follow-up information from the inaugural 2002 GAPSS study and enables changes over time to be identified. GAPSS investigator Peter Saxton says the survey highlights a number of issues for MSM, which, in addition to the continuing proportion of men sometimes not using condoms for anal sex, also includes: An increase in non-condom use among young men with regular partners; high levels of risk taking among men who have negative attitudes toward condoms; an increase in men using the internet to find sexual partners; and an increased likelihood of unsafe sex the more sexual partners a man has. The GAPSS study recruits participants from the Big Gay Out fair day, gay bars and gay saunas/sex-on-site venues in Auckland over a one-week period. Participants each fill out an anonymous questionnaire and return it to a sealed box. In 2004, 1220 MSM participated, a 50% increase from the 812 who took part in 2002. “The findings for condom use were awaited with particular interest,” Saxton says. “Among men who had any casual sex in the six months prior to survey, 24.2% reported any unprotected anal sex compared to 22.7% in 2002, a slight increase over time. Among men who had sex with a regular sex partner, 50.4% reported any unprotected anal sex compared to 52.0% in 2002, a slight drop.” Saxton says this represents a generally high level of condom use, but the proportion of men who sometimes had not used a condom during anal sex was enough to propel the HIV epidemic rather than stop it. This is particularly true since the number of men living with HIV in New Zealand is increasing each year. Of some concern were the results reported by younger respondents (those aged 15-24). Whereas in 2002 this group reported the lowest rate of non-condom use with their regular partners (37.3%), in 2004 this had risen to 61.7% and was the highest of any age group. Younger respondents were also more likely to agree with the statements “new HIV treatments are simple and have few side effects” (23.2%), “a man who knows he has HIV would tell me he was positive before we had sex” (30.5%), and “if a man I was going to have sex with told me he was HIV positive I would not want to have sex with him” (75.1%). The most significant association found in the 2004 study was the high levels of risk-taking among respondents who reported negative attitudes to condoms. Respondents who disagreed that “condoms are OK for sex”, who agreed that “I don't like condoms because they reduce sensitivity”, or agreed that “I would rather risk HIV transmission than use a condom for anal sex” were much more likely to report unprotected anal sex not only with regular partners but also during casual sex. “This finding demonstrates the importance of improving men's access to a range of condoms that are a suitable fit, and that are freely available the time they need to use them such as on a date or at a gay bar or venue,” Saxton says. “It's also vital for men to know how to use condoms in ways that minimally interfere with their enjoyment of sex, and to eroticise their use in ways that still incorporate intimacy, turn-on, and desire.” A clear pattern also emerged between the number of recent sexual partners and unsafe sex: Men who had higher number of male partners in the previous six months were more likely to report at least one incident of unprotected anal sex with a casual partner. Tony Hughes, NZAF Research Director suggests: “Although an underlying NZAF message has always been that it doesn't matter how much sex you have, it's how safe it is that counts, clearly the more often men change sexual partners the more likely it is that they will be encouraged by someone, or some situation, into dropping their guard and not using condoms for anal sex. The important response, of course, is to get straight back into using condoms, and then identify what it was that made them break their safe sex routine in the first place.” Interestingly, while the study showed a large increase in the proportion of men who had sex with someone they met via the internet (from 25.1% of the total sample in 2002 to 42.0% in 2004), internet hook-ups were not associated with greater amounts of non-condom use, dispelling speculation that web dating sites are wholly responsible for the increase in HIV diagnoses witnessed recently. Rates of HIV testing were similar to 2002, with 72.5% of all respondents having tested for HIV at least once in their lifetime and 25.9% having tested in the six months prior to survey. As Saxton suggests: "Men who haven't used a condom during anal sex ought to consider testing for HIV. That way any undiagnosed HIV infections can be detected, treatment options can be developed and future sexual partners can be protected." GAPSS investigator Dr Nigel Dickson notes that the rate of lifetime HIV testing among Pacific respondents (56.5%) was lower than for other groups, and that Pacific MSM could be encouraged to test if they have had any unsafe encounters. Other GAPSS 2004 results will be highlighted in the New Year and the full report can be accessed at www.nzaf.org.nz. There will be a public launch and discussion of the findings at St Columba Centre, 40 Vermont St, Ponsonby at 6-7pm on Tuesday 14th December with refreshments provided. The GAPSS project is a collaboration between the Research, Analysis and Information Unit at the New Zealand AIDS Foundation, Auckland and the AIDS Epidemiology Group, University of Otago Medical School, Dunedin. New Zealand AIDS Foundation - 14th December 2004
Credit: New Zealand AIDS Foundation
First published: Tuesday, 14th December 2004 - 12:00pm