Each month in Boyz the team from NAM aidsmap report the latest news on HIV and sexual health. Keep up to date and read more on their website at aidsmap.com.
Activists and health organisations from across Europe recently met in Paris to discuss how best to help men having problems with chemsex. The starting point for their discussions was to better understand what men are looking for in chemsex.
One French man told the forum why he continues to use drugs in sexual situations. He said there are multiple reasons, many of them shared by other people.
“Firstly, the idea of pleasure is essential,” he said.
“There is also the fear of not being able to do without, as well as the fear of not being up to the mark.
“The disinhibition allows me to forget for a moment my body that I find hard to accept, and particularly the way other people look at me and their hurtful comments.
“And the loneliness experienced by many gay men is definitely a factor that encourages this behaviour.”
Other speakers agreed that most men’s involvement with chemsex begins by seeking pleasure, even if it does not always remain carefree. Jan Großer, a psychiatrist from Berlin, said that as well as the intrinsic reward of sexual (physical) pleasure, sex can also have rewards in terms of bonding, belonging and identity. For example, sex can give us status, whether as half of a couple or as part of a group that sees itself as sexually adventurous.
Sometimes, sex or drugs (or the two together) can help us avoid feeling some pain or distress, he said. Pleasure may result from successful defence against feelings of shame, anxiety, ambivalence or loneliness.
“If your defence is successful, you may not even be aware that you are going through these conflicts and you may not even feel these feelings,” Großer said.
Adam Schultz, a chemsex activist from London, said that support services need to focus on each person’s specific issues. “It’s never about sex and it’s never about the chems: it’s about the person who is trying to escape,” he said.
Read more at aidsmap.com/node/32173
PrEP is changing the way gay and bi men have sex
The HIV prevention medication PrEP is leading to significant changes in gay and bisexual men’s sexuality, two new studies show. These changes go beyond the simple fact of having a new and effective way of avoiding HIV infection.
Firstly, PrEP users tend to be less anxious during sex. Ever since the beginning of the HIV epidemic in the 1980s, fear of HIV has led many gay and bisexual men to be worried during sex, often getting in the way of pleasure, intimacy and satisfaction. Some men feel this even in situations where HIV transmission is not possible – like sex without a condom with an HIV-positive partner who has an undetectable viral load.
Phillip Keen of the University of New South Wales ran a large survey of gay and bisexual men living in Australia. They were asked whether they agreed or disagreed with statements like “When I’m having sex HIV tends to come to mind” or “After having sex I sometimes get concerned that I might have done something risky”.
He found that, on average, men who were using PrEP were less anxious than men who did not take PrEP. This fits with other studies which have interviewed PrEP users. Many have said that PrEP allows them to relax and enjoy the sex they want to have. For some, it takes feelings of guilt or shame out of sexual situations.
The second study is about how often HIV-negative men have HIV-positive men as sexual partners. Over the years, lots of studies have shown that men who don’t have HIV tend to choose partners who are also HIV negative. At the same time, men living with HIV have more partners who are also HIV positive than would be expected if everyone ignored HIV status when pairing up.
Men have often done this out of concern about the spread of HIV. It can work for HIV-positive men – they can be sure they aren’t putting anyone else at risk of HIV, regardless of viral load or condoms.
But for men who don’t have HIV, choosing other partners who they think are also HIV negative is not a good way to stay safe. It’s just not that reliable. HIV-negative men’s status is only certain up to the last time they took an HIV test. The man you are hooking up with may honestly believe that he doesn’t have HIV, but the situation could have changed since he last tested.
While many men living with HIV have experienced rejection or had unkind reactions from HIV-negative men, it may be that PrEP – as well as increased understanding that ‘undetectable = untransmittable’ – is breaking down the divide between positive and negative men.
A Canadian study has found that HIV-negative men who used PrEP were nearly twice as likely to have HIV-positive partners as other negative men. Among PrEP users, 17% of their partners had HIV, compared to 9% of the partners of non-PrEP users.
The survey also found that men using PrEP were more likely to have sex with other PrEP users than you’d expect by chance alone. The researchers call this ‘PrEP matching’.