A sharp increase in risky sex

Terry Trussler is choosing his words carefully. The research director of Vancouver’s Community Based Research Centre (CBRC) is discussing the results of the 2007 Sex Now Survey Report.

Though Trussler doesn’t want to sound judgmental, he concedes it’s difficult to put anything resembling a positive spin on the latest round of results.

“No one likes to hear bad news,” he notes.

Trussler and the CBRC have been conducting the Sex Now surveys gauging sexual health and trends among gay and bisexual men since 2002. This year’s findings indicate a sharp increase in risky sexual behaviour by Vancouver’s gay under-30 set.

“After a period of relative stability from 2002 to 2006 the proportion of men reporting activities which could transmit HIV has increased from about 25 percent to 37 percent in 2007,” the results show.

Meanwhile, levels of HIV testing — considered crucial for early treatment and stopping the unwitting spread of the virus — have declined.

According to the survey, the proportion of gay men who have never had an HIV test gradually increased from 11 percent to 17 percent, which means fewer gay men are getting tested now than they were in 2002.

“Sex Now 2007 showed that young gay men under 30 were significantly more likely to have engaged in sexual activities with HIV exposure risks than older aged men,” the report states. “This is a reversal of previous years in which younger men were either relatively less at risk (2002) or about the same risk (2004) as older aged men.”

Trussler acknowledges that surveys can sometimes be off — way off — and that this might simply be a wild card. “That’s why you have several companies polling people for election results, for example,” he says.

But these findings are consistent with the findings of other gay communities in larger centres like Sydney, Australia and London, England, he points out. “We’ve been hearing from them about large increases in risk-taking over the last couple of years.”

Experts in the area of AIDS and HIV think the increased risk-taking stems from a myriad of reasons. A larger issue of cultural amnesia around the epidemic appears to be a factor, as is the cavalier attitude young people often adopt when it comes to any kind or risky behaviour — whether it be unsafe sex or driving while drunk.

But Trussler and others point to one of the major revelations in the 2007 Sex Now results: the internet is having a major impact on the ways in which gay men and men who have sex with men (MSM) meet up to have sex.

“The internet is galloping ahead very rapidly,” says Trussler. “Many gay men who are 20 now, their first sexual encounter will have happened through connections made through their computer.”

Michael Kwag, coordinator of the Vancouver youth outreach program Totally Outright, says the influence of the internet on the sexual practices of gay men and MSM is “paradoxical. The internet presents a lot of new opportunities for gay men, but with that comes another set of challenges.

“In the past outreach was, in a sense, more easy when we knew that gay men had traditional cruising grounds: the parks, baths and bars,” Kwag explains. “This survey indicates that 58 percent of gay men under 30 found their most recent partner on the internet. And 83 percent of gay men under 30 indicated that they had an active Facebook profile [as opposed to 32 percent of older men]. People are flocking to the internet, in totally unprecedented numbers.”

Kwag also points out that online gay social sites often present riskier behaviour like barebacking as a simple consumer option — like clicking on an item on Amazon or eBay, rather than a choice with potentially serious health consequences.

Which prompts the obvious question: how are community groups adapting their outreach to respond to this new cyber-challenge?

“There’s no one cure-all,” says Kwag. “We’re obviously going to have to do more outreach online. Right now, there are limited community organizations or health resource programs on Facebook, MySpace or Manhunt. We need to increase visibility there.”

For all the hype around the internet’s opportunities for empowering connections, it can also lead to a sense of isolation for young gay people, or at least disconnection from the gay community and the collective lessons it’s learned around sexual health.

“The shift to the internet for gay socializing has meant that young gay men’s connection to gaydom and the gay community is considerably less than for gay men of just a few years ago,” says Trussler. “A connection to community can often be protective, with men learning safe sex practices from other gay men.”

A certain amount of critical shared knowledge may be getting lost in cyberspace, he suggests. The 2007 Sex Now results seem to back him up: the proportion of men who spend more than 50 percent of their free time with the gay community decreased by 20 percent in the period studied — from 62 to 42 percent.

As Trussler writes in his report summary, “These findings suggest dramatic shifts are reshaping the social and sexual norms of gay culture.”

Vancouver Coastal Health (VCH) says it’s keenly aware of the shifts in infection rates, and is working to respond to the changes.

“We are indeed aware of the high HIV infection rates in some cities internationally among MSM,” says Anna Marie D’Angelo, public affairs officer for VCH.

“We agree that HIV services in Vancouver require additional focus and support to meet the problems the HIV epidemic presents us with today… There are gaps in services, for sure, and we’re working to correct that.”

D’Angelo points to VCH’s strategic plan, unveiled last July, which acknowledged that men who have sex with men account for a majority of new infections — and directed greater resources be focused on prevention within this demographic.

Vancouver AIDS activist Phillip Banks argues that gay men have specific needs in terms of HIV-related counselling and prevention strategies and, as such, need a more gay-focused approach to their health.

“Whatever we’re doing right now is failing gay men,” he says bluntly.

“We need better prevention for them, we need an infrastructure that will keep them negative. The attention given to gay men in Vancouver on this issue has been negligible over the past decades. We need stronger advocacy and leadership.

“Montreal has Sero-Zero, which is a group that works very specifically to educate gay men about transmission,” notes Banks. “We need an organization that specifically addresses gay men.”

Kwag points to VickVancouver.com, Gayway’s recently launched online animated series, as a good example of attempts to reach young gay men via the internet. The series, which is updated weekly, shows young Vick moving to Vancouver to explore his gay identity.

But Kwag and Trussler both argue that what’s needed is more resources.

Trussler points out that the Sex Now surveys have had to make do with scant amounts of money — even though such surveys are direly needed to indicate what segments of the gay population are most at risk and need the most attention.

Kwag says Totally Outright — which “aims to create a corps of well-informed, sex savvy young men who can communicate with a wide range of other players toward building a society in which gay health is assured” — could also use more resources.

“Our Totally Outright program serves 15 to 20 participants a year. Past participants are really enthusiastic after completing it, agreeing it should be much more widespread. There isn’t enough sex education for gay men,” he says. “They invariably don’t get it in the school system.”

Trussler says anecdotal evidence confirms the cost of skipping gay-specific sex education in schools: “Some young gay men who have become HIV-positive have said that they wish they’d had better education and instruction so they could have avoided this.”

Banks adds that homophobia is at least partially to blame for the spike in risky sex as well.

The Sex Now survey found that men under 30 were three times more likely to be exposed to homophobic slurs and anti-gay violence.

“I think rising rates of HIV infection are driven by homophobia and heterosexism,” says Banks. “HIV is as much a social issue as a medical one. Homophobia can’t be ignored. Sex education in schools is often devoid of any discussion of homophobia — when there is even any sex education.”

Tim McCaskell, a long-time AIDS and gay activist based in Toronto, says he’s not shocked by the latest round of Sex Now survey results.

“Many now see AIDS as simply another STD. Not one that can be cured, but one that is treatable. When the epidemic first hit, people were freaked out about it because they knew someone who was sick or dying. Now it’s much less visible, because of the treatments.

“Many of the young who are infected will get treatment, which will effectively keep them invisible. The risk, in a sense, won’t exist for many young people.”

Trussler says further anecdotal evidence suggests a serious case of epidemic amnesia has set in.

“One person contacted us who had contracted HIV a number of years ago. He was on medication, but then went off it for about six years. Then he got sick again. He was inquiring with us about medication and for advice, and he told us that he’d literally forgotten he had HIV.”

Trussler says he is now eager to see the results of another survey that will be conducted in Vancouver this summer. This survey will not only present gay men and MSM participants with an extensive questionnaire, but will test their blood for HIV as well.

“This will give us a very clear picture of whether our data can be backed up. Does what we found represent what’s actually happening in the community?” Trussler asks.

“I don’t want to raise undue alarm but if it does, it’s very concerning. It ties in with the trends in other cities, and means the resurgence of the epidemic in the Western world.”

Where do you draw the line?

What’s unsafe sex to you?