Tell men who have sex with men the truth

Published: Sunday | July 21, 2013 Comments 0

Kay Bailey, Contributor

US NEWS and World Report of July 3, 2013, reported that if HIV continues to spread at current rates in the United States of America (USA) "half of college-aged gay men will have the infection by the age of 50". This statement is consistent with research presented by Professor Ronald Stall of the University of Pittsburgh in 2008 cited in Infectious Disease News, March 2008:

"Stall and his colleagues conducted a model cohort study to examine the potential lifetime risk of HIV infection among MSM (men having sex with men) in the United States. Using the current estimated HIV incidence rate of 2.39 per cent for this patient population, the researchers created a model cohort of young MSM at age 18 with no HIV infection at baseline and tracked their lifetime risk of contracting HIV.

"By age 20, less than 5 per cent of the model cohort would have contracted HIV. At age 25, this rate increased to 15 per cent; by age 30, it was 25 per cent; by age 40, the rate was 41 per cent.

"Among black MSM in the United States, the rates were even higher. Using the lowest rates of HIV incidence reported for black MSM in the United States, 4 per cent, the model showed that by age 25, 25 per cent of black MSM will be HIV positive. By age 35, the rate was 50 per cent; by age 40, it was 60 per cent".

The US News and World Report article also quoted Jonathan Mermin, the director of the CDC's division of HIV/AIDS Prevention in saying that "Gay and bisexual men remain at the epicenter of the HIV/AIDS epidemic".

The CDC Fact Sheet published in December 2012 noted that:  "MSM represent approximately 4 per cent of the male population but male-to-male sex accounted for more than three-fourths (78 per cent) of new HIV infections among men and nearly two-thirds (63 per cent) of all new infections in 2010".

In the Lancet Special Issue on HIV in Men who have Sex with Men (MSM), July 2012, Summary Points for Policy Makers, Chris Beyrer et al published that HIV epidemics among MSM were expanding in all countries regardless of income levels. They provided the following explanations for this observed phenomenon: "Biological and behavioral factors make the dynamics of the MSM epidemic different than for general populations.

The disproportionate HIV disease burden in MSM is explained largely by the high per-act and per-partner transmission probability of HIV transmission in receptive anal sex. Modeling suggests that if the transmission probably of receptive anal sex was similar to that associated with unprotected vaginal sex, five-year cumulative HIV incidence in MSM would be reduced by 80-90 per cent.

Many MSM practise both insertive and receptive roles in sexual intercourse, which helps HIV spread in this population. Were MSM limited to one role, HIV incidence in this population over five years would be reduced 19-55 per cent in high-prevalence epidemics.

Taking both factors (per act transmission probability and role versatility) into account explains 98 per cent of the difference between HIV epidemics among MSM and heterosexual populations - behavioral differences account for two per cent of the difference."

This information is being provided in response to article of July 7, 2013 by guest columnist Brian Paul Welsh, who accused the Jamaica Coalition for a Healthy Society (JCHS) of lying in advertisements about the status of the HIV epidemics among MSM.

One source of his anger was that JCHS only reported that "98 per cent of the difference in HIV rates between MSM and heterosexuals could be explained by anal receptive activity". Mr Welsh objected because the JCHS did not include the statement that "if unprotected anal intercourse in casual relationships instead happened within long-term main partnerships, HIV prevalence would be reduced by 29-51 per cent". However, this in no way contradicts the information contained in the JCHS advertisement. Both pieces of data were reported by the Lancet and do not hold a contradictory relationship.

Mr Welsh knows quite well that the maintenance of long-term main partnerships among MSM is a big 'IF'. It seems that Mr Welsh is living in the world of 'IF'.

The results of the French and American articles were remarkable because sociopolitical, medical and human-rights advances were expected to solve the HIV problem but they had not done so among MSM. The situation has improved in all other groups, for example, new cases of HIV have decreased in black females in the USA by 21 per cent. The Lancet article proposed possible solutions to the HIV problem in MSM: IF homosexuals became monogamous and did not engage in casual relations, IF poverty were solved, IF better education were provided, IF homosexuals became less dysfunctional - these are all big 'IFs'.

LEAVE LAWS ALONE

The JCHS contends that the intestine is not a sex organ, that the anal erotic practices of MSM are inherently unnatural and disordered and that there is no obligation to change our laws to reflect any right to carry out anal penetration, fisting, felching or farming.

The accusation that "the coalition and its supporters have no interest in preserving the lives of MSM" should be viewed against the fact that on December 1, 2012 the coalition - at its own expense - published full-page ads in both newspapers advocating for "behavioural change to reduce HIV". The dangerous behaviours which the coalition warned against included anal penetration, unprotected sex and multiple partners.

The JCHS advertisement 'Speaking truth is not homophobia', published in May 2013, is an accurate reflection of the state of the HIV epidemics among MSM.

Mr Welsh's use of emotive words like "desperation' and "moral bankruptcy" and his allegation of lying, would have been unnecessary if the statements published by the JCHS could have been shown to be false. It is a great pity that instead of warning MSM of the truth of the dangers of the lifestyle - the HIV/AIDS epidemics - Mr Welsh has instead resorted to slanderous accusations.

We suggest that as a public service, The Gleaner should repeat these advertisements, both as a warning to MSM and as a way of correcting this blatant attack on the integrity of the JCHS and its chairman.

Dr Kay Bailey is consultant paediatrician and director of the Jamaica Coalition for a Healthy Society. Send feedback to jachs2012@gmail.com and columns@gleanerjm.com.

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