It was 8 am when 18-year-old Ben got the call from the clinic telling him he had to come in and see them immediately. He had been out partying all night and hadn’t slept, but he instantly knew what he was going to hear. “I’m not quite sure where I contracted HIV,” he tells me. “I do have some idea, but I can’t be sure. I’ve contacted everyone I slept with, and they all say they’re negative, so someone is lying.”
Ben is one of an increasing number of young gay men who have contracted HIV, and the figures are alarming. The US Centres for Disease Control and Prevention recorded that new HIV diagnoses among gay and bisexual men between the ages of 13 and 24 increased by 132.5% between 2001 and 2011. Similar increases have been reported in the UK and across Western Europe. More young gay and bisexual men are contracting HIV than any other group, but why?
“One of the problems,” says Ben, “is that there’s the perception that you’re invincible. I don’t remember HIV being in the media when I was growing up. Gay people my age think of HIV as an old man’s disease, something from the 1980s.”
Ben’s points are valid. The new generation of gay and bisexual men do not recall the devastation caused by AIDS or the ferocious battles against the Reagan administration in the US when the epidemic was at its height. HIV can now be treated effectively with much more advanced drugs than the toxic cocktails that were first used to fight the virus in the 80s and 90s. As soon as Ben was diagnosed, he started on Atripla, one of the most widely used drugs to treat the virus, but nothing prepared him for the side effects.
“At first I thought I was one of the lucky ones. All I had were a few dizzy spells and a bit of nausea, so when I started getting depressed, I was surprised. Only when I lashed out at my brother did they tell me that it was probably because of the Atripla.”
Other young men I’ve spoken to have had similar experiences. The common perception is that HIV can be treated by taking a pill, in much the same way as you would deal with any other sexual infection, but the side effects of the drugs are less reported.
Then there are the men who contract HIV during middle age. John was diagnosed at 46 and was put on Atripla quickly because his CD4 count didn’t creep up. While he didn’t suffer from the psychological side effects that Ben experienced, Atripla caused liver problems.
Does he think the safe sex message has been diluted? “Yes, I’m living proof of that. I went from not having bareback sex with anyone else but my partner, to having bareback sex with all sorts of people.” Why was this? “Everyone says it: bareback sex just feels more satisfying.” He pauses and steels himself to go on. “This is a very uncomfortable part of the conversation… you know it’s something you shouldn’t be doing, but there’s this thrill to it. A lot of the people I have sex with now are HIV-positive.”
The normalization of condomless sex has come about, in part, Ben believes, by the proliferation of bareback porn. Porn is now freely available on the internet and bareback videos - once in the minority - now dominate. Log on to any gay porn site and the page will be filled with videos depicting 'breeding' and 'raw sex'. “Young men watch these and think that this is how they should be having sex, and if they aren’t doing it this way, then they're doing it incorrectly,” muses Ben.
Ben is also critical of the sex education that he received at school. “I asked about anal sex during sex education classes and all they said was 'we wouldn’t recommend it.'” In the place of adequate education about safer gay sex, he believes that young gay men are increasingly learning about sex themselves - largely through watching porn. He also believes that the widespread use of chem sex in the major cities is having an impact on HIV rates, with men taking more sexual risks when they’re high.
PrEP (pre-exposure prophylaxis) - the use of prescription drugs by people who do not have HIV, as a strategy for HIV prevention - has been called a game changer in the ongoing fight against HIV. In the US, the only drug currently recommended by any health organization for PrEP is Truvada.
There has been much controversy about Truvada, with people claiming that it encourages irresponsible sexual behavior among gay men. Proponents of the drug, however, argue that it's a vital new weapon in reducing the increasing rates of HIV infection. The World Health Organisation states that it should be used in conjunction with existing strategies, such as condom use and regular testing.
Given that it's clear that condom use alone is no longer working in tackling the spread of the virus, other methods should be welcomed and more options are opening up in the US for men who have sex with men to gain access to Truvada, even if they do not have medical insurance. Men like 46-year-old John believe that condom fatigue is a real issue: “gay men are fed up with having to use condoms. They have had to do so for decades now, and many feel a condom gets in the way of intimacy.” But the use of PrEP alone does not protect against other sexual infections, such as Gonorrhoea and Chlamydia.
In the UK these infections are spiraling among young gay and bisexual men, to the extent that Health Protection England (an executive agency of the UK’s ministry of health) have warned that in five years' time there may not be an effective treatment for Gonorrhoea. Then there is the issue of HIV-positive men picking up co-infections, such as hepatitis B and C. This can mean that the choice of HIV medication they can take can be limited. 18-year-old Ben has first-hand experience of other sexual infections.
“Shortly after I was diagnosed with HIV I had unprotected sex with another positive guy. I was lonely,” he tells me. “Two days later I contracted Chlamydia and Gonorrhoea and went back to the clinic and just balled my eyes out.” Ben isn't sure where the solution to reducing the increase in HIV rates among men in his age group lies, but his experiences have changed his attitude towards sex and relationships.
“I’ve realized that I’m mortal, fragile and vulnerable. I’ve started to look at things and people more empathetically and treat sex as something more meaningful. Sadly, many other gay men of my generation are totally unaware of the risks.”
Names have been changed in this article.
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