When Condoms Aint Enuf...

via TheBody, by Allen Kwabena Frimpong and Michael Terry Everett

"I also want to mention that we are increasingly becoming better at incorporating conversations about 'harm reduction' into the realms of substance use (needle exchanges, safe injection sites, pill testing, etc.), but we often fail to adequately translate this model when speaking of communicating risk reduction in sex (strategic positioning, sero-sorting, viral load suppression, etc.). My question back to the group then is, how do we more effectively communicate to young people the abstract concept of 'harm reduction' for sex within the context of a sex phobic society?"

This was a question posed by Jamie Forrest of Vancouver, Canada in the North America, Western Europe, and Caribbean CrowdOutAIDS Open Forum on Facebook. CrowdOutAIDS is UNAIDS new collaborative online youth-led project.

He posed this question to the group after people were discussing what they considered to be the main reasons for HIV infection among young people.

Reading the responses on Facebook gave us one of those jolted reactions.

The dominant message about sexual health in relation to HIV prevention has been focusing on condom usage. Jamie's question was one that I saw as challenging; given the propaganda that the HIV/AIDS field has been pushing around what it means to have safer sex.

My colleague at the Harm Reduction Coalition, Michael T. Everett, was also raising this same question especially among young men who have sex with men (YMSM) of color given that their rates of infection have been steadily increasing while rates of infection among injection drug users has been on the decline.

The question for us became what (besides the exchange of needles) was accounting for the decrease in transmission of HIV among injection drug users, and how could we use what works in harm reduction messaging and education when it comes to drug use (if anything) for other high-risk populations greatly affected by the epidemic through sexual transmission.

We considered this in light of the following:

1. We cannot exchange condoms like we do syringes.
2. We know people are not using condoms all the time, and the possibilities of HIV and other STI's has not scared enough people into doing so, and so ...
3. If people have been harboring condom use as the dominant end all be all harm reduction response- well then something is terribly wrong with this picture.

The place to begin the conversation around the idea of prevention of at-risk behaviors like having unprotected sex is a great place to start.

We need to engage an intentional conversation concerning the reality that the message of safe-sex, by way of condom usage, may not resonate with people because it is limited and does not allow one to ponder the spectrum of other possible harm reduction practices.

The point is: we want people to still live a healthy life without causing further harm to themselves and others. The spectrum of harm reduction practices includes everything from prevention to helping those who are most affected by the collateral consequences of their at-risk behavior.

The spectrum does not begin or end with condom usage only.


Read the rest

How to Close the LGBT Health Disparities Gap

Negative health outcomes for LGBT people are due to the cumulative and intersecting impact of many different factors, particularly their reduced access to employer-provided health insurance, the social stigma that exists against LGBT people, and a lack of cultural competence in the health care system.

via Center for American Progress, by Jeff Krehely

LGBT health disparities overall

In the past decade lesbian, gay, bisexual, and transgender, or LGBT, people have made rapid progress in winning and securing equal rights. Fifteen states and Washington, D.C. now give same-sex couples at least some of the same rights afforded to heterosexual married couples. Even more states offer nondiscrimination protections based on sexual orientation, gender identity, or both. Polling data show that the general public has increasingly positive views of LGBT people and are becoming more supportive of their civil and political rights. In short, heterosexual Americans are finally recognizing LGBT people as a legitimate social minority that should have equal access to our society’s basic rights, opportunities, and responsibilities.

Despite this progress, however, members of the LGBT population continue to experience worse health outcomes than their heterosexual counterparts. Due to factors like low rates of health insurance coverage, high rates of stress due to systematic harassment and discrimination, and a lack of cultural competency in the health care system, LGBT people are at a higher risk for cancer, mental illnesses, and other diseases, and are more likely to smoke, drink alcohol, use drugs, and engage in other risky behaviors.

People who are both LGBT and members of a racial or ethnic minority will often face the highest level of health disparities. For example, as the National Coalition for LGBT Health notes, a black gay man faces disparities common to the African-American community as well as those suffered by the LGBT community, and a transgender Spanish-speaking woman, regardless of her sexual orientation, must navigate multiple instances of discrimination based on language, ethnicity, and gender. A companion CAP brief, “How to Close the LGBT Health Disparities Gap: Disparities by Race and Ethnicity,” explores these in more detail.

Health surveys cannot continue to treat populations in isolation: Members of the LGBT community who are members of other populations that are recognized as suffering from health disparities must be allowed to identify themselves fully on surveys, including their sexual orientation and gender identity.

Read the rest.

Data Dump - research of interest to gay men's health advocates

The minions behind LifeLube (your gay, sexy, healthy field guide to gay men's health) read a LOT of literature of interest to our community - and we'd just like to clue you in on some important/interesting articles we have recently checked out - abstracts below. If you are interested in getting the full paper of any one of these - please send an e-mail to lifelube@gmail.com and we will try to hook you up.


Accounts of HIV Seroconversion Among Substance-Using Gay and Bisexual Men   

Childhood Sexual Abuse and the Sociocultural Context of Sexual Risk Among Adult Latino Gay and Bisexual Men 

Factors associated with unprotected anal intercourse between HIV-positive men and regular male partners in a Sydney cohort

HIV Prevalence and Unrecognized HIV Infection Among Men Who Have Sex With Men: Chicago HIV Behavioral Surveillance, 2008 (this links to the full paper)

Social Support Moderates the Relationship Between Gay Community Integration and Sexual Risk Behavior Among Gay Male Couples

Pleasure and Risk

Garrett Prestage gave the following talk at the Australasian Society for HIV Medicine conference held in Brisbane, Australia in September 9 - 11, 2009 as part of a community organization (ACON) panel. Please give it a read. (Thanks to Michael Hurley for putting this on the LifeLube radar.)


For 25 years I’ve noted various attempts to ‘sell’ condoms to gay men as though they could be erotic or fun, usually using bright colours or a sexy pose or some cutesy addition – the latest being a banana. But it’s never worked – it just seemed to because most gay men have practised safe sex throughout the epidemic.

What do they really think about condoms?

Like most straight men, they hate them – they’ll use them because the circumstances require it but if they had some other option they’d go for it.

In PASH (Pleasure and Sexual Health - a survey conducted in Australia) two thirds of men (including 81% of men who did UAIC - unprotected anal intercourse with casual partners) said that if there was no longer any need to worry about HIV it’d be unlikely they’d continue using condoms. Less than a third (29%) of men who did UAIC agreed that condoms can ever be fun or erotic – even among those who ALWAYS used condoms with casual partners only half could agree with the statement. Three quarters – 78% (including almost all – 93% – of the men who did UAIC) said that sex just feels better without condoms. Over half the men who did UAIC said that condoms are a hassle, they slow down the sex & are a nuisance.

Lots of the men in PASH noted that using a condom makes it harder to keep their erection, or makes getting fucked less comfortable, but they also spoke about the sheer pleasure of sex without a condom & how a condom just gets in the way.

So what’s the point? Well, I would argue that gay men appreciate honest and realistic information that enables them to make up their own minds – and they don’t automatically buy what we tell them. Although I know that most organizations have tried to respond to changes in HIV and changes in how gay men think about risk, we basically continue to give them a message that can be reduced down to ‘but really, you should just use a condom’.

In PASH, the majority (59%) think HIV messages are all the same, and that they never say anything new (58%), & three quarters (75%) say that all HIV messages tell you is to use condoms. So do they have any impact: Well, half the men who did UAIC say they see HIV messages but don’t pay much attention. But that doesn’t mean they’re ineffective. Of course condom reinforcement works in a more subliminal way to reinforce a safe sex culture – and we should retain that. And even though large numbers probably ignore much of the content of the messages, they mostly appreciate their value. Despite their general hostility to condoms, almost all men in PASH, whether they used condoms consistently or not, agreed that condoms provided a sense of security either from infection or from the possibility of infecting their partners and so they agreed they were necessary for this reason.

They’re not idiots and they’re not irresponsible. They know how useful condoms are – but that doesn’t mean we ever fooled them into liking them.

However, as I’ve said on previous occasions, at the beginning of this epidemic, when we had to start promoting condoms & safe sex, the common feeling was that once there was a cure, we’d throw one huge orgy to celebrate. And the reality is that some men have quietly begun to celebrate. Not all men: Some men remain locked into a morbid fear of HIV and couldn’t possibly contemplate taking any sort of risk; But others, still just a minority, but undoubtedly growing, are reassessing the situation. They’re not quite ready to throw caution to the wind – they know it isn’t quite over yet – but they feel the risk has decreased enough that they can relax a bit.

In PASH, one third (31%) including a little under half (41%) the men who did UAIC feel that HIV has become controllable, similar to diabetes, & one in six (18%) including a third (32%) of the men who did UAIC say they’re now willing to try some things that they used to think were too much of a risk.

The sorts of things that some men said in PASH about the risk of HIV transmission are the same as what I’ve heard many of us say quietly as well: For example, one PASH respondent said, “I guess I genuinely believe there's a very low chance of passing on my HIV as a bottom, and because I take my own meds so regularly, I believe there is next to no chance of passing on HIV to another partner."



So, my question is how much longer we think we can get away with treating gay men like children and trying to frighten the minority into submission with a boogie-man that even we don’t really believe in any more?

Sure, HIV is still quantitatively different to other STIs and we all think we should avoid getting infected or infecting anyone else – but it’s now no longer an absolute. It’s a question of how much do I want to avoid it.

People tell me I should eat more healthily. Probably I should if all I cared about was getting all my health indicators into perfect alignment. But, really, if my health is generally pretty good and I have other things in place that make me think the risk of anything really bad happening is probably fairly low, why should I sacrifice eating things that give me so much pleasure? It’s pretty unlikely.

In life we all judge relative risks and pleasures, and pleasure always wins unless the risk is judged to be relatively great.

Until the mid-90s, the risks posed by HIV appeared very great indeed, especially to gay men, and so, of course, they mostly sacrificed their pleasure, at least to a significant extent. But nowadays an increasing number of gay men – still a minority, but definitely increasing – are coming to a different conclusion. They’re not abandoning all caution – they mostly still practice some sort of risk-minimisation. But condoms are no longer an automatic part of that.

I’m going to quote something from Elizabeth Pisani’s writing in the Guardian a couple of days ago to put this in context. She’s talking about the tension between trying to promote HIV-prevention at the same time as let people know that if they get HIV they’ll still be able to live a normal life. I’m selectively quoting from a fairly long article.

She says: “If there’s absolutely nothing wrong with having AIDS then why should be bother with HIV prevention messages? … AIDS industry dinosaurs like myself know that AIDS really is something bad. What we’re not so good at admitting is that it is practically non-existent in rich countries… Treatment readily available means you can have HIV without getting AIDS for decades, maybe forever. And the treatment is free for patients (LifeLube note - not in the USA), if not for the taxpayers… HIV is no longer a mass murderer in rich countries. It’s an inconvenient disease that will have you taking pills for the rest of your life, cost taxpayers lots of money and make big pharma rich… ‘HIV increases your tax bills. Protect yourself!’ Not really a line that’ll get you reaching for the condoms is it?”

And, really, plenty of gay men know this is the reality. They still try to reduce risk, but it isn’t a life-or-death priority any more.

What is a big part of gay men’s decision making though is the question of trust. How well they know someone, how well they can trust the situation they’re in, how much they can trust their sexual networks. And key to this is knowing someone’s HIV status.

Most men when asked will recite what we’ve all been taught is the correct line: In PASH 93% agreed that you can never really be sure of someone’s HIV status – but two thirds (66%) also believed that there are some men whose HIV status they could be sure of, plus three quarters (72%) felt that knowing someone’s HIV status is a way to reduce HIV risk. And when they were asked about the casual partner that they’d last engaged in UAI (unprotected anal intercourse) with, nearly half said they were very confident that they knew his HIV status.

So, all these serosorting campaigns that are based on telling men that they can’t really be sure of knowing someone’s HIV status are probably fairly meaningless. Yes, gay men nod approvingly to this statement, but for many the statement is only meaningful in the abstract. And then it simply doesn’t apply to this particular guy, because I know him, or I trust him, or I trust this situation.

We don’t provide him with any tools to minimise his risk in these situations – other than to imply that he’s a fool for trusting anyone. And we mostly justify this because the Seroconversion Study is full of stories where this trust was misplaced – but of course it is. These are the stories of the men who were unlucky enough for it to go wrong.

But when we look at data from our other research what we see is that many others are doing the same thing and not seroconverting: A substantial proportion of men are engaging in UAIC with partners they believe they know, and mostly with partners they believe they can trust. And the HIM data (Health in Men study in Sydney) tell us that while these sorts of decisions may be riskier than using condoms, they’re significantly more protective than when they have UAI with men whose HIV status they don’t know.

Nonetheless, we know from the Seroconversion Study that often this trust can go awry. This statement from a PASH respondent tells us a lot about why it can go awry: “He asked me if I was neg. If he'd been positive I would have assumed he wouldn’t have cared."

So, he’s placing his trust in the situation. His logic was that a pos man wouldn’t have bothered asking if he was neg & then proceed to have UAI with him. His implication about the irresponsibility of pos men is clearly misplaced but his assumption that this guy was neg based on the interaction was probably a reasonable one but even so a pos man might have used that information to decide whether he should be top or bottom.

When we look at the Seroconversion Study data, the lesson we need to learn from them is not that we need to get gay men to behave like they did a decade ago and return to absolutely consistent universal condom use with casual partners. Not because it’s not a worthy ambition to get gay men to take up condom use in the same way again – but it’s simply not reality. It won’t happen.



The lesson from the Seroconversion Study is that we need to provide gay men with some practical tools so they can make informed decisions about the safest circumstances for them to discard the condoms, and so they start to reflect on what’s really going on for them when they feel they can trust the situation they’re in.

When is that trust rational and when is it misplaced?

Mostly, gay men still want to protect themselves and their partners from HIV, but not at the expense of enjoying themselves. It’s not our job to decide for them that there’s only one way they should behave, or that virtually no degree of risk is acceptable. Our job is to provide them with the tools to enable them to put into practice their perfectly reasonable decisions about relative risk and pleasure.

After 25 years I think we can trust them to get it right.

Men Who Bareback Should Be Made Partners in Health Promotion, Not Banished

Nice post on Trevor Hoppe's blog by Tony Valenzuela. Don't forget to come hear Tony speak at Risky Business on August 17th!



The tone of the online debate has been, well, impolite following the announcement by International Mr. Leather to ban the promotion and distribution of bareback porn at the weekend event's leather marketplace.

"Fascists. No wonder they like uniforms," wrote a man identified as Liam Cole reacting to the ban on Treasure Island Media's blog "You're just a bunch of sick people who need help," countered an anonymous poster on the same blog.

On August 17th at 6 pm at the Center on Halsted in Chicago, I will be sitting on a panel called "Risky Business? Reclaiming Pleasure," to discuss what effect bareback porn has on men's desires, fantasies and behaviors. The forum is not about IML's ban but will throw a wider net on the discussion of porn, sex without condoms and desire.

As a guest on Trevor's blog, I'd like to focus here on the IML ban that, once again, brought into focus the raw feelings that surface when gay men talk about raw sex. I should state my opinion up front: I disagree with IML's decision, don't believe it will affect behavior, and fear it will further marginalize a group of high risk men who need to be brought under the tent of community wellness, not banished.

"I never thought I'd see the day that IML is used as a vehicle for censorship," said one anonymous source at the Chicago Free Press website. "I don't like being treated like a child at an adult event." Disputing this charge was Colin at Gay Men's Social Crisis blog (GMSC) who said, "I have a hard time with this [censorship] argument. I find bareback porn in direct conflict with health education, even if it does present what can and should be recognized as a fantasy scenario."

Maybe the better question isn't whether or not IML's new policy is censorship - it is by definition - but whether censoring bareback porn from the IML marketplace, however offensively this may strike some of us, is worth the presumed outcome of "social responsibility" and health?

Read the rest at Trevor Hoppe's blog.

High-risk HPV infection raises HIV risk at least fourfold: HPV vaccine study suggested

Infection with one or more of the cancer-causing subtypes of the human papilloma virus (HPV) multiplied the risk of acquiring HIV among young men in by 4.5-fold in a randomised controlled study of circumcision in South Africa.

Bertran Auvert, the principal investigator of the ANRS1265 circumcision trial in Orange Farm, South Africa, hinted that he was proposing a trial of one of the HPV vaccines as a method of reducing HIV infection.

The substudy of HPV infection collected swabs for DNA analysis from 1683 men and tested them for the presence of 13 of the high-risk, cancer-causing subtypes of HPV and 24 of the low-risk wart-forming ones. HPV samples were collected when the study terminated, 21 months after participants were circumcised.

Observed HPV prevalence was related to the risk of seroconversion during the study and the researchers also related it for the purposes of multivariate analysis to the participants’ age, education level, number of sexual partners, condom use, and whether they had TB or other sexually transmitted infections including herpes, gonorrhoea and chlamydia.

Read the rest at AIDSMAP.

RSVP for LifeLube Podcast Forum Risky Business Now Up!

Please join LifeLube, Project CRYSP, and Feast of Fun for this special gay men’s health forum in conjunction with the 2009 National LGBTI Health Summit:

Risky Business?
Bareback Porn and the Reclaiming of Pleasure

How does porn – and bareback porn – affect our sexual desires and practices?

Are videos depicting edgy sex a HOT but safe way to get off for viewers or does condomless porn signal a dangerous normalizing of risk?

Come for a raw discussion about the kind of sex, intimacy, fantasies and pleasure we crave, and how we can get there.

RSVP Here!

Moderated by Fausto Fernos and Marc Felion of the Feast of Fun Podcast

Featured panelists include writer and gay men’s health activist Tony Valenzuela, Dr. Braden Berkey of the Center on Halsted, and Mufasa Ali, founder of ONYX, a leathermen’s group for men of color.

Monday, August 17, 2009
Center on Halsted
3656 North Halsted
Hoover Leppen Theatre

Doors open 6:00 p.m. for light nibbles and schmoozing
Program begins 7:00 p.m.

Space is limited for this free event.
Please click to RSVP. You must RSVP, thanks!

Gay men diagnosed during primary infection substantially reduce their risk behaviour

via Aidsmap, by Roger Pebody

Gay and bisexual men who are diagnosed with HIV in the first few weeks after infection make significant changes to their sexual behaviour, write British researchers in the August issue of HIV Medicine.

While risky behaviour was common before diagnosis, three-quarters of men surveyed posed no risk of onward transmission during the three months after their test result. The authors argue that this demonstrates the value of early diagnosis.

Moreover, they argue that more intensive risk-reduction counselling should be targeted towards men in primary infection, especially the minority who are most likely to continue with risk behaviours.

They suggest that even short-lived changes in behaviour will have a significant impact on onward transmission. Primary HIV infection is the period just after infection, during which HIV viral load and infectivity are exceptionally high.

Read the rest.

IML MAKES HISTORY

Today the International Mr. Leather (IML) group out of Chicago made history by stopping the sale of bareback porn at their event.

IML has been around for over 30 years starting out as a little gimmick by bar owner Chuck Renslow as a way to get more people into his bar. It blossomed into a successful annual event which has become (so I've heard over the years) one of the biggest conventions in the city of Chicago.

Anyway, the interesting part of this is that the leather community was very Safer Sex oriented at the start of the AIDS epidemic (and I don't call that 'language of fear', I know that's what we called it then because I was around .. just coming out but I was around) but by the late 90s because of The Cocktail and hardon-inducing drugs (Viagra!) not to mention the popularization and virtual decriminalization (at least from a social point of view) of crystal meth (which allows guys to fuck all night long), Safer Sex went out the window and barebacking became the new fetish.

Check out Will Clark World for the rest and stay tuned for LifeLube's upcoming August podcast forum Risky Business, discussing bareback porn and intimacy in the gay community.

Peter, I keep having men that are undetectable tell me that unprotected sex with them is ok. What makes them think that?

[Peter Pointers is here 4 YOU, as a service to LifeLube readers - whatever question you may have regarding sexual health, physical health, mental/emotional and spiritual health - ask him. He will find the answers you are looking 4. Below is a recent Q&A you may be interested to read.]

Question: I keep having men that are undetectable tell me that unprotected sex with them is ok.....What statistics are out there that make them think that????? I have always took the opposite stanz with these folks....but it has been thrown at me so many times by different men....that I am assuming they are getting some sort of stats somewhere making them think that.....

Answer: This is such a great question and, frankly, one that I wonder why I don't hear more often. I know that information about unprotected sex with undetectable men is out there... and there is a lot of back and forth about what the most accurate information is.

So, I'm not sure how much you want to read about this, but there are a number of studies that have recently come out that have to do with your question. Here is a link to several articles about them on LifeLube.

But the short of it is: In January of 2009, researchers in Switzerland published an article saying that "an HIV-infected person on antiretroviral therapy (ART) with completely supressed viraemia (effective ART) is not sexually infectious, i.e. cannot transmit HIV through sexual contact." Importantly, some important additional factors must be present, also: that the viral load must have been undetectable for over 6 months, the person must be completely adherent to ART, and both partners must be free of other STDs.

Since that statement, a number of other studies have come out challenging the Swiss statement.

1. Some argue that while viral level may be undetectable in blood, it may be found in higher amounts in semen.
2. Others stress the STDs issue, expressing concern that many men may not know they have an infection (such as rectal herpes with or without symptoms or HPV, the virus that causes genital and anal warts).
3. Furthermore, criticism came from the fact that the studies that the Swiss researchers looked at were done only on heterosexual couples from sub-Saharan Africa – not on men who have sex with men.

It is true that if someone is on HAART and has a non-detectable viral load, it will DECREASE the chances of HIV infection, but it will not eliminate any chance. And, in a real life situation, it is very difficult (if not impossible) to know if the person you are deciding to have sex with has been undetectable for a full 6 months, or if they have never missed a dose of their meds. It is even a challenge to be sure if they have had a recent STD test that was either negative or that they had gotten treatment after. In other words, we're still not sure. The U.S. government has not signed onto the Swiss statement in any way.

We still advocate that if you know someone is HIV positive and you are not, then it's best to use condoms correctly and consistently. It still remains the best way we have to prevent HIV transmission.

If you are not going to use condoms, try to use other safer sex strategies like using lots of lube to reduce tearing and friction, make sure you and your partner have been tested for STDs and treated for any that may have been there, and try not to have your partner cum inside of your ass or mouth.

Let me know if there is more information that you would like to have on this topic! I'd be happy to pass it along.


Be Well,
Peter Pointers
Friend Peter on Facebook

Gay men sexually abused in childhood more likely to have risky sex, get HIV

via Aidsmap, by Michael Carter

An experience of sexual abuse in childhood or adolescence is associated with an increased risk of gay men becoming HIV-positive in adult life, American researchers report in the July 1^st edition of the Journal of Acquired Immune Deficiency Syndromes. The research also showed that men with a history of sexual abuse in early life had higher levels of depression and problematic drug and alcohol use, as well as being less receptive to HIV prevention interventions.

“This is the first study…to demonstrate a predictive relationship between a history of childhood sexual abuse among HIV-uninfected men who have sex with men,” comment the investigators.

Earlier research has shown that gay and other men who have sex with men are more likely to report a history of childhood sexual abuse than heterosexual men. Other studies have also shown that a history of childhood sexual abuse is associated with sexual risk-taking by adult gay men. There are also data demonstrating a relationship between the experience of sexual abuse as a child and depression and other mental health problems in adult life, as well as poor social skills and drug and alcohol use.

Studies have also demonstrated that that gay men with a history of abuse have higher rates of HIV and other sexually transmitted infections. But this research has been limited in its generalisability by its cross-sectional design.

Read the rest.

Let's all start sucking around

via Fridae, by Jan Wijngaarden

Fridae’s Men’s Sexual Health columnist Jan Wijngaarden wonders why oral sex has not been as widely recommended as a 'safer option' given that it has been found to be of much lower risk compared to anal sex.

A while ago, a friend of mine, who is around 55 years old and from Europe, sadly looked back on his life during a birthday dinner. He said that none of his (gay) friends from when he was in his twenties and thirties was alive to celebrate his birthday with him. They had all died - most of them, by far, died of AIDS.

I was intrigued. Why did he survive? Was he immune, or what? Or was he the only one who used condoms? When we were alone, after the dinner was finished, I decided to ask him.

He said: "Condoms? Nobody used them at that time. It was true; I had syphilis, gonorrhea and chlamydia several times, but those could be treated easily. That was not it, for sure."

So, what then? He answered: "It is the fact that I HATE anal sex which must have saved my life!"

It is an interesting conclusion, with a lot of truth in it. Anal intercourse is the sexual behaviour which is - by far - most likely to transmit HIV among gay men (and - much less well known - maybe among some heterosexuals, too).

Read the rest.

Similar rises in gay men’s HIV diagnoses seen in Western Europe, North America and Australia since 2000

via Aidsmap, by Roger Pebody

A comparative analysis of HIV diagnoses in gay men in eight industrialised countries has found that while they decreased between 1996 and 2000, diagnoses went up by 3% a year from 2000 to 2005, researchers report in the June 2009 issue of the Annals of Epidemiology.

The researchers used national surveillance data compiled by public health bodies in the UK, the Netherlands, France, Germany, Spain (Catalonia only), Australia, the United States (25 states only) and Canada. These countries were chosen as a convenience sample of concentrated epidemics where the surveillance systems were broadly comparable (although not identical) and did not change too much during the period studied.

Read the rest.

RESEARCH: The Non-sexual Needs of Men that Motivate them to Engage in High-Risk Sexual Practices with Other Men

"If I'm in chat and I put that I am looking for my knight in shining armor, they tell me to fuck off, haha. So it's best to say I'm looking for sex and then see what happens. I know that normally guys use the Internet to find sex, first you get them into bed, and then you find out their name. What I ask for and what I offer is sex, then if I like the person, maybe something else will happen, whether it be friendship or even better a stable relationship, but as the situation is, the only way is to go for sex first and see what happens."

by Percy Fernández-Dávila

Abstract: Currently there is a growing trend toward high-risk sexual practices with casual partners in the group of men who have sex with men (MSM) in many industrialized countries. This study offers some understanding of why a group of men had unprotected anal intercourse (UAI). A grounded approach was used to analyze 20 interviews with MSM from Barcelona between 18 and 40 years of age who had at least one episode of UAI in the past three months. The results reveal that many respondents had UAI practices with casual sexual partners because they were in search of experiences that were not directly related to sexual relations: reaffirmation of a sense of personal worth and of their own physical attractiveness, offset shortcomings and feelings of emotional loneliness, the search for connection and intimacy, being in love, conversion of the risk intopleasure for the forbidden and a desire to rebel against established rules. In these cases, concernsabout sexual and health care seemed to overwhelm and were not taken into account when havingUAI. It is important that HIV prevention programs include in their messages the power of these motivations that lead to practices of UAI.

Read the whole paper here.

To risk is human

Buckle Up Your Seatbelt and Behave

Do we take more risks when we feel safe? Fifty years after we began using the three-point seatbelt, there's a new answer

Smithsonian magazine, by William Ecenbarger

Excerpt:

The concept is that humans have an inborn tolerance for risk—meaning that as safety features are added to vehicles and roads, drivers feel less vulnerable and tend to take more chances. The feeling of greater security tempts us to be more reckless. Behavioral scientists call it "risk compensation."

Read the entire article.

New on the LL site - Interesting Paper on Family Rejection

Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults, PEDIATRICS, January 2009.

Caitlin Ryan, PhD, ACSW, David Huebner, PhD, MPH, Rafael M. Diaz, PhD, Jorge Sanchez, BA Cesar E. Chavez Institute, San Francisco State University, San Francisco, California; Department of Psychology, University of Utah, Salt Lake City, Utah

ABSTRACT

OBJECTIVE
We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults.

METHODS
On the basis of previously collected in-depth interviews,we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys.

RESULTS
Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence.

CONCLUSIONS
This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.

Read the whole paper.

Conference highlights the forces encouraging risk behaviour in gay men

via Aidsmap, by Roger Pebody and Michael Carter

The forces encouraging sexual risk behaviour are large and widespread, but the forces for precautionary behaviour are meagre and narrowly focussed, argued Ford Hickson of Sigma Research at the CHAPS conference of gay men’s health promoters in Brighton last week. Rather than describe HIV prevention in the UK as failing, he suggested it would be more accurate to say that it is inadequate.

Other sessions at the conference included one of the first qualitative studies of the experiences of gay men co-infected with hepatitis C and HIV, and an examination of how HIV-positive men have adjusted their behaviour in the light of prosecutions of HIV transmission.

In the plenary, Ford Hickson outlined the forces encouraging risk behaviour:

• The power of sexual pleasure. "If you do not understand sexual risk," he commented, "it is probably because you don’t appreciate sexual desire".

• The rapid expansion of the gay scene into "a large business sector supplying services for sexual contact and locations to have sex".

• The continued denigration of homosexuality in society, and the associated emotional isolation and low mood of many gay men.

• Men’s self-medication with alcohol and drugs, which is problematic in a culture which excuses risk-taking while under the influence.

• The widespread belief that ‘real sex’ is anal sex.

• The commodification and fetishisation of barebacking as a transgressive behaviour. "Gay sub-culture has long legitimised the eroticisation of unacceptable thoughts," Hickson suggested, and barebacking porn is one manifestation of this.

• Individualistic cultural norms that reject notions of responsibility. "The idea that you would sacrifice something yourself in order to protect or care for someone else seems, at the moment, to be deeply alien to gay culture and HIV prevention approaches," he said.

• Optimistic biases in our thinking: telling ourselves that risks are smaller than they really are.

Read the rest.

Sexy new HIV prevention campaign for South African gays

Cape Town, via PlusNews

Dance music pumps from large speakers while a half dozen shirtless young men serve drinks at a bar bathed in pink light. It is the last weekend of Gay Pride in Cape Town, South Africa, and men of all ages have come to a "fetish party" to launch a safe-sex campaign, "Play Nice", targeting men who have sex with men (MSM).

Whether bound in black leather straps or attired in khakis and collared shirts, everyone here is bombarded by projected images of gay men, many nude, carrying messages about HIV, safe sex and treatment; posters with more messages liberally adorn the walls.

The campaign is run by Health4Men, a programme of the Perinatal HIV Research Unit (PHRU) of the Johannesburg-based Witwatersrand University aimed at men in underserved populations, including MSM and unemployed young men, and is the first large-scale campaign specifically geared to get HIV-related messaging to the MSM community.

The MSM community has historically had a very low profile in the HIV/AIDS conversation in Africa, despite having an HIV prevalence rate two to three times higher than the heterosexual population.

Glenn De Swardt, co-director of Health4Men and a leading expert on gay issues in South Africa, said the project could not have come at a better time. "Even though they have the information, they're not practicing safe sex consistently - we know it and they know it - so we're tying to make safe sex messaging sexier."

Using the internet, mobile phone technology, traditional media and direct campaigns, Play Nice hopes to reach various groups of MSM in novel, pro-sex ways that will appeal to them.

Read the rest.

Increase in serodiscordant casual sex among Sydney gay men at a time when HIV diagnoses have not increased

via Aidsmap

Between 2003 and 2006, there was an increase in the numbers of HIV-negative gay men in Sydney who reported having unprotected anal intercourse with casual HIV-positive partners, report researchers in the online edition of AIDS and Behavior. However the researchers do not believe that these men form "a core group of high risk men".

Iryna Zablotska and her colleagues from the University of New South Wales analysed data from two cohort studies among Sydney gay and bisexual men: the Positive Health cohort of 760 HIV-positive men, and the Health in Men cohort of 1427 HIV-negative men. Both studies asked identical questions about sexual behaviour in annual surveys from 2003 to 2006, including questions on sex with partners of a different HIV status (rather than, as in some other studies, sex which could have been with a partner of a different HIV status).

Among the HIV-negative men, whilst the number having sex with casual partners decreased from survey to survey, there were small but statistically significant increases in the numbers having serodiscordant sex. Those having sex with casual partners they believed to be HIV positive rose from 11% to 13%, and the number specifically having unprotected anal intercourse with those men increased from 3% to 4%.

The number of HIV-positive men reporting serodiscordant casual partners did rise, but there was no statistically significant rise in unprotected anal intercourse with them.

The study examined a number of behaviours that have been previously found to be associated with sexual risk-taking, and confirmed that serodiscordant unprotected anal intercourse with casual partners was more common among men with higher numbers of sexual partners, men who met partners online or in sex clubs, Viagra users, those who injected drugs, men who used 'party' drugs regularly and those having ‘esoteric’ sexual practices (fisting, sex toys, water sports, bondage etc).

However the researchers note that men who had risky sex did not do so consistently. Over 85% of the men who reported having serodiscordant unprotected anal intercourse only reported it at one of their annual interviews, and they typically reported that behaviour with just one or two partners in the previous six months.

Read the rest on Aidsmap.

Marathon Man Richard Cordova Spills for LifeLube

Our intentions shape the world around us

Tell LifeLube a little about yourself Richard.
I’m Richard Cordova and a native Chicagoan. I am a health educator who counsels callers on the IL State HIV/STD hotline [1-800-243-2437]. In addition I am a Spin instructor and running coach with the National AIDS Marathon training program.

What is different about your life now as opposed to a few years or months ago?
I suppose the biggest difference is that a few years ago I was a strung out crystal meth addict with no hope for a future.

What or who motivated you to make a change in your life?
The motivation to change my life came from the realization that as an HIV-positive individual and if I wanted to live a long and healthy life I was going to have to make some serious changes. This included getting sober, regular exercise, and healthy eating habits.

What is one key issue for you that needs addressing in terms of gay men's health?
Risk reduction is one area where I think gay men really need to have a better understanding of their own behaviors. A lot of guys out there seem to be willing to engage in risky behaviors simply because they are “the top” or because their partner says “they’re negative” and behaviors like that are going to lead to a lot more gay HIV positive men in the future.

How do you educate, motivate and inspire others who might be going through a similar situation?
One of the main ways I intend to help change the behaviors and thought processes of the local community is by being an HIV tester. When people come in for HIV tests we will do a risk assessment and together come up with different steps they can take to practice safer activities.

What are some of the assets in our community that we overlook?
I think that we overlook the younger generation in our community. Younger people have a passion and energy that, if harnessed, can help create new and exciting change in the community and the world around us.

On that note, and often working with younger people, what is your opinion on the high rate of new infections among young gay men? Is this a contradiction to your previous statement?
No I don't find that these numbers are a contradiction to this idea. What I'm curious to know is that if we break down that age group into demographics by ethnicity/race what would those numbers tell us? Perhaps they would tell us where to focus our prevention efforts. As far as the younger community being a source of advocacy for change I think that the “abstinence only” policies which have been in our schools have left young adults unprepared for the realities of being sexual beings able to make wise and healthy choices for themselves when it comes to their sexual health. I think the fact that 30% of all new HIV diagnosis are coming from the 13-25 age group bracket is even more reason why young people need to stand up for themselves and for their peers and demand that people listen to the facts surrounding HIV transmission and ways to reduce your risk.

Do you consider yourself a spiritual person and, if so, in what respects?
I consider myself a spiritual person in the sense that we are all connected. What you put out there comes back to you three-fold and most importantly our intentions shape the world around us.

How do you keep yourself motivated?
I’ve learned to always be looking towards another goal no matter how big or small. It’s okay to change your mind about things along the way to reorient yourself towards another goal.

What makes you happy?
Helping others, working out, a job well done, one-on-one time with a good friend... these are just a few of the things that make me happy.

In overcoming your addiction, or dealing with HIV, or finding a healthy and balanced lifestyle, what role did finding "meaning" in your life play?
I suppose in my case I wrapped it all into one. When I stopped doing crystal meth I started training for my first marathon through the National AIDS Marathon training program. I ran not only for myself, to prove to myself that I could, but also for the other HIV+ people out there who needed the services that I was raising money for: services such as housing, needle exchange, food & nutrition services, child care, and many more that are vital to people living with HIV.

In a few words, can you offer a bit of advice for someone who may be struggling with a similar issue?
Follow your bliss… If your happy doing drugs then do them but if your not then ask yourself why, why, why and then make your transition.