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How committed to condoms are we?

Tue 9 Nov 2010 In: HIV View at Wayback View at NDHA

Reported claims that there is currently an "absence of condom culture" amongst gay and bi men in New Zealand are being hotly disputed by the NZ AIDS Foundation which bears responsibility for promoting safe sex. Dr. David Miller In his just-released Ministry of Health-commissioned HIV Services Review, Dr David Miller says he was told of a perceived "current absence of condom culture" amongst the group hardest hit by the HIV epidemic. He says he was advised of this by clinicians, non-governmental organisations involved in HIV work and by people living with HIV. Despite early interpretations of this comment as relating to only to HIV Positive men Miller has now clarified to that he is referring to men who have sex with men (MSM) in general. But NZAF Executive Director Rachael Le Mesurier says her organisation has hard research which disputes the "absence of condom culture" assertion. She says the Gay Auckland Periodic Sex Survey (GAPPS) and the Gay men’s Online Sex Survey (GOSS ) offer very scientific assessments of condom use by both HIV positive and negative gay men. "We have the data. We do know that the condom culture in New Zealand is one of the best in the world." The GAPPS and GOSS studies, overseen by internationally respected NZAF researchers Tony Hughes and Peter Saxton, are based on Australian studies, which were in turn influenced by American research.The most recent GAPPS, conducted in February 2008, more or less follows the trend of its predecessors when it shows that amongst the responding gay and bi men who were asked about incidences of anal sex in the six months leading up to the survey, 69% report always using a condom with casual partners. 61% said they always used a condom with their "current fuckbuddy." However, the 'I always use a condom' figure drops markedly, to 27%, when respondents were asked about anal sex with the man they term their "current boyfriend." Rachael Le Mesurier GAPPS and GOSS are self-reported surveys and it is of course possible that people telling a researcher, even anonymously, about their sexual and safe sex activities might not tell the whole truth. Some may not be entirely honest about their condom use. Le Mesurier says the bottom-line is that good scientific research technique and analysis addresses that possibility. "It has to and it does, with enormous rigour." There have been four two-yearly GAPPS surveys and a fifth is coming in 2011. GOSS has been running since 2006, meaning there is year-on-year-on-year data which indicates the way people are answering is very, very credible, according to Le Mesurier. "I have absolutely faith that as all scientific quantitative surveys will have, [the researchers] have done everything possible to ensure that it's as reliable as you can get." Additionally, Le Mesurier points out that the HIV Futures survey of HIV Positive people, carried out by a different group of researchers, had very similar results. As did the much earlier Male Call phone-in research project of the mid-1990s. Le Mesurier says a generalised "absence of condom culture" is very different from having a small proportion of positive men who are not using condoms. Skewed feedback? Did Dr Miller receive skewed information? The NZAF boss points out parts of the HIV Services Review are based on opinions from focus groups of HIV positive people. She says you can go to "any club, any bar, any group and sit down with any individuals and get a whole range of opinions on things like condom use." Le Mesurier poses and answers a series of questions: "Are there men not using condoms? Yes," she says. "Were some of those men in Dr Miller's focus group? Quite possibly." "Is that a statistically reliable way to say that we don't have a condom culture in this country? No." What it does say, according to Le Mesurier, is that there are some guys that are not using condoms "and they talked to David Miller about it." Le Mesurier believes the HIV/AIDS NGOs and clinicians agree that there are some men not using condoms. "I have been told that there were even some men not using condoms in the early 1990s . . . and that's when you could have got the virus and actually died! "So, yes, some HIV positive men are not using condoms. [And] that very small percentage is saying so in [Dr. Miller's report]." Warming to this scenario, Le Mesurier elaborates. It is possible, she says, that the members of HIV support groups who had time to come along to the focus groups may not be representative of all people with HIV. "But it is fair to say we, the clinicians and the NGOs are worried about this small portion of positive men who are not using condoms. It is a concern, because you only need a small minority of HIV positive men who are not using condoms, they can individually have a disproportionate impact on the epidemic. So we're not ruling it out." The 2% vocal minority Le Mesurier says a senior Auckland infectious diseases specialist, clinician Mark Thomas, has told her he is worried about HIV positive men not using condoms - and other clinicians may be worried about it too. "I understand he's worried. But if Mark and his colleagues have around 750 cases of HIV positive people on their books in Auckland you couldn't say that all of them who are sexuality active are using condoms. That makes sense, cause you can't get 100 percent condom use... but they don't have to worry at all about the majority of them." As recently as 2007 the landmark HIV Futures study of HIV positive people showed up just two percent of HIV positive men who admitted that they are not not using condoms in casual sex. Le Mesurier suggests that it was they who were in Dr Miller's focus groups. "I'm not discrediting their reality. But  that does not mean their perspective is reflecting every reality." "So if the minority are going to be saying something, what we have to ask is, how do we know what the proportions of it are [amongst the group as a whole]? And we come back to: some of the best science that we have got in this country is on the behavioural surveillance of gay and bisexual men," she says. That is, on GAPPS and GOSS. Strength in numbers Le Mesurier says "condom culture" is very different from a small proportion of positive men who are not using condoms. Returning to the 2008 GAPPS study of almost 1500 men, 31% agreed that condoms are ok as part of sex and a further 66% "strongly agreed."  So by that measure a total of 97% of gay and bi men are cool with condoms. Flip the question and ask about passing on or being infected with HIV and the total is in the same ball park. 17% of respondents disagreed with the proposition that "I would sometimes rather risk HIV transmission than use a condom during anal sex." And 71% strongly disagreed. That's 88% who would rather use a condom than risk HIV transmission. And yet... And yet every week, on average, two more gay or bi New Zealand men are newly diagnosed with HIV. "In most cases the new infections are coming from someone who has previously contracted the virus and sero-converted and is not yet aware of their status, Le Mesurier believes. "However, there may well also be HIV positive men who know they are HIV positive and yet are still having unsafe sex. And that is a challenge for us all." Asked if the NZAF's prevention programmes over the years have somehow failed men who continue to contract HIV, peer support organisation Body Positive's General Manager Bruce Kilmister says he is constantly amazed about how little people know or understand about HIV when they come in for a test. "There are new generations of people who did not experience the “holocaust” of AIDS and feel HIV has no relevance in their lives today. They either are not getting the message or they are getting a wrong message." "How the NZAF counters this growing culture is the challenge," says Kilmister. The AIDS Foundation's message of 'use a condom every time' still has relevancy and statistically still proves to be the safest course of action." The difficulty the NZAF has, according to Kilmister, is "getting that message to the 'core' constituency, especially when some of that core constituency no longer want to hear that message." It's an increasingly tough ask. "I think this is getting harder and harder to do, Kilmister says. "There is a feeling out there that all HIV+ means is having to take a pill. We at Body Positive know the reality as quite different than that." Le Mesurier is upbeat, saying the NZAF's core message, "use a condom and lube every time" is still appropriate and has led to New Zealand having one of the lowest rates of HIV infection in the world. As to the claims reported to Dr Miller, Le Mesurier points out that his review was not a review of condom culture. She says the NZAF welcomes Dr Miller's note that a review of HIV prevention services would be reasonable to consider in the future. Jay Bennie - 9th November 2010

Credit: Jay Bennie

First published: Tuesday, 9th November 2010 - 2:23am

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