High-risk sex lives: HIV on the rise again

Infection rates of the HIV virus are on the rise, particularly in the gay community. But many men are intentionally risking their lives by refusing to wear condoms for sex. Maxine Frith reports

Adam first started having sex with boys when he was 17. Two years ago, at the age of 20, he found out he was HIV positive.

He started having unprotected sex when he moved to London as a student, and freely admits that, despite knowing about Aids and the importance of condoms, he took risks. "I used the internet a lot to get sex and got drawn into trying drugs during sex," he says. "A quick chat and a disclaimer online would ease my mind - are you positive or negative?

"The guy would come round and we'd have fun but then I'd regret it in the morning - I knew in the back of my mind that anybody who is having unsafe sex is either positive or soon will be."

Adam is not alone.

More than 2,300 gay men were diagnosed with HIV in the UK last year - the highest number since records began in 1981. They bring the total number with the virus in the gay community up to 28,000, of whom an estimated 9,000 do not know they are infected.

While rates of HIV among other groups, such heterosexuals and injecting drug users, are stabilising and even declining, an ever-growing number of gay men are contracting the virus.

Figures from the Health Protection Agency (HPA) show that homosexually-acquired HIV rates have risen by 55 per cent in the past five years.

This particular type of infection now accounts for one third of all new diagnoses in Britain.

Overall, less than half of one per cent of people aged 15-44 in the UK is HIV positive.

But among gay men, 5.2 per cent are estimated to be positive (both those aware and unaware of their status) - rising to an alarming 8.4 per cent in London.

So, 25 years after the first cases, what is going on in the community that is still considered to be the behavioural group most at risk of this deadly virus?

The HPA report on the spread of HIV in the UK was entitled "A Complex Picture" - and the profile of gay men with the virus in particular differs from other groups. While the majority of new heterosexual HIV cases are among Africans who have been infected abroad, more than 80 per cent of homosexual diagnoses were acquired in this country and three-quarters of those affected were born in the UK.

Of most concern is that rising numbers of gay men are taking massive risks, indulging in unsafe sex with multiple partners.

The HPA calls it UAI (unprotected anal intercourse) but within the gay community it is called barebacking - and it is a growing culture among gay men.

Some HIV negative men place adverts in gay contact magazines requesting partners who have the virus, claiming the risk adds to the sexual experience. Clubs also cater for "raw" nights - where condoms are banned.

An aggravating factor is the high use of the drug crystal meth in gay clubs. Up to 20 per cent of men in gay clubs have used the drug, which can produce a high similar to crack but lasting for several hours, increasing the chance that users will indulge in risky behaviour.

Research from the US has shown that users of the drug are three times more likely to be infected with HIV than those who don't. Adam agrees. He says: "Why did I have unsafe sex? It felt good, I was high, I wanted guys to sleep with me. I understood the safe sex message more than most and sometimes I did use condoms, but it wasn't every time."

The Terrence Higgins Trust is the oldest HIV/Aids lobby group in Britain and was named after one of the first people in the UK to die of the disease.

Oliver Wright, who works at the charity, said: "There are a number of issues connected with this rise in cases. Some gay men are well aware about the risks they are taking, yet still do it.

"What we are coming up against are very deep-seated problems at a psychological and cultural level. A lot of gay men have a degree of self-hatred, fuelled by homophobia and bullying that still occurs in schools and the workplace.

"For the older generation, they may have been made to feel guilty about their sexuality by their family, particularly if they have a Catholic or other religious background - and that can feed in to hating themselves and taking risks because they don't believe they deserve any different.

"Gay men are much more prone to mental health problems, suicidal thoughts than the community at large and that in itself can mean people will indulge in risky behaviour."

Mr Wright added: "Risky behaviour for some gay men is also part of the cultural identity of the gay community - seeing sex as just being sex rather than about love and relationships.

"It is different from the way women perhaps think about sex.

"Men may identify being gay with having casual sex with multiple partners, and even if they are in a relationship, they will still seek "exciting" sex elsewhere.

"That is the problem - giving someone a poster about HIV is not enough; we have got to address very complex issues that go to the heart of how gay men feel about themselves and how society treats them."

It is not just older men who are taking risks. A new generation of young gay men is emerging that does not remember the falling gravestones and voice-of-doom advertising campaigns of the early 1980s and has not seen partners or friends die of Aids because antiretroviral (ARV) treatments now mean that an infected person can live - and look healthy - for years.

Deaths from Aids reached in a peak in 1996, when there were 1,469 victims - now there are fewer than 500 a year.

Due to increased acceptance of homosexuality, teenagers and men are coming out and becoming sexually active at an earlier age - but are still ignoring the dangers of unsafe sex.

The website Puffta was set up seven years ago and is aimed at young gay men. It conducts an annual survey of more than 800 gay men aged 13 to 21 - and the results show a worrying trend.

Last year's survey found that 35 per cent of respondents had had bareback sex in the past three months and a similar proportion do not know whether they are HIV positive or not. Figures out next week from the 2006 survey are expected to show a rise in both the proportion having unprotected sex and those who do not know their HIV status.

Simon Johnson, the 25-year-old editor of the site, said: "There is a really big problem around young men who may be walking around with HIV, having unprotected, casual sex and not knowing that they are infectious or could be infecting other people.

"The virus is now spreading to a very young age group who don't have information about HIV and safe sex.

"They don't talk about it and they don't get tested because it isn't a big issue for them."

Younger men are not just a risk to themselves, Mr Johnson warned. "An older man who is having regular testing and knows he is negative may go with an 18-year-old guy, thinking that he is young and, therefore clean, but it may be that younger guy who poses the biggest threat."

Another concern is that men who are infected and are on treatment know that their "viral load" - their infectivity - is reduced by the drugs they are taking and may be taking risks, believing that a partner has a diminished chance of contracting HIV.

But they may still pass on the virus. And in addition, by having unsafe sex they could contract an additional sexually-transmitted infection such as gonorrhoea that could compromise the effectivemess of their treatment.

Treatment has transformed HIV from a death sentence to a chronic disease but ARV drugs have only been about for the past decade or so and the virus is constantly developing resistance to them.

A vaccine is still a long way off, and condoms remain the most effective form of prevention.

Both Mr Johnson and Mr Wright agree that education is the key - and that schools are currently failing to provide enough support and information for young gay men.

The latest Government information campaign about sexually-transmitted infections, aimed at teenagers, focuses solely on heterosexual couples and does not even mention HIV or Aids.

Mr Johnson said: "I don't remember the scary adverts and maybe something like that is needed as a wake-up call to young gay men so they get the message."

Sadly, that message is too late for Adam.