Trust has become a significant factor in the increased risk of HIV infection among homosexual men, according to the national HIV Seroconversion Study. The study is a joint project of The National Centre in HIV Epidemiology and Clinical Research (UNSW) and the Australian Research Centre in Sex, Health and Society (La Trobe University).

The study found that while most of those newly infected accepted they had engaged in high risk sex – such as unprotected receptive anal intercourse – they were largely unaware that their partner was HIV positive.

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However some still knowingly engaged in high risk sex with partners they knew to be infected but were unaware of their viral load.

Among the 175 seroconverts who responded to the survey, many described their risky behaviour as having occurred during ‘intensive sex partying’ where they became ‘swept up in the moment’ despite being well informed of the risks and trying to avoid infection.

‘Sexual desire is undoubtedly a major explanation for what occurs in these instances, but even so, there is an increasing trend that individuals are more likely to act on these immediate desires than was the case in the past,’ the report said.

‘Another issue that appears to emerge from these data is that of familiarity and trust. Very often the men in this study described the person they believed had infected them as someone they already knew and whom they believed they could trust.

‘However, regardless of whether this was their regular partner, a friend or someone else, it was often the case that they had actually only known this person for a relatively short time.’

It also found that ‘increasingly, men in serodiscordant relationships are also agreeing to and actually discarding condoms within their relationships’.

As a consequence the study recommended the ‘revision of the study’s protocols to enable a greater focus on the contexts and motivations for risk behaviour and an exploration of the beliefs and attitudes concerning HIV and risk among individuals recently diagnosed with HIV infection’ and ‘revision of the study protocols to explore issues of trust in more detail’.

It also recommended that for policy and program development there needed to be ‘provision of more detailed information about the specific circumstances in which the risk of infection through oral sex might be increased; continued prioritisation of work with highly sexually active gay men; renewed emphasis on gay men’s relationships, particularly relatively short-term sexual relationships; consider the implications of issues of trust and what resources might be provided to enable individuals to make decisions about risk behaviour that might assist them to distinguish when under what circumstances this trust can be considered reliable’.

Australian Federation of AIDS Organisation WA President Graham Brown said it was important to remember that the majority of gay men were having safe sex and the examples cited were not a sample of all gay men in Australia.

‘However, it is about the complexity of sex and emotion within an ongoing epidemic – it is not simply complacency to HIV. Simply more “knowledge” will not change solve this,’ Dr Brown said.

‘The challenge for health promotion is not to force a separation between risk and emotion or we can end up with health promotion that ignores the reality of sex as an intense human experience that is, and always should be, much more than a health risk assessment.

‘I think we also need to reflect on reducing the stigma associated with disclosing HIV status – which we know reduces people’s willingness to text for HIV – and not assuming knowledge or disclosure of HIV status.

‘I think the challenge before us includes “why do many gay men assume that everyone knows their HIV status?” If people assume or expect others to disclose their HIV status in a casual context, “why do they assume this?” and “what are they doing to show they can be trusted with that information?”’

‘An increase in HIV and STI testing is a key part of the solution.’
WA AIDS Council spokesman Mark Reid said anecdotal information and HIV periodicals showed that WA men were having more unprotected sex.

‘After 25 years of safe sex messages is becoming harder to sell [condoms] as men constantly tell us that they just want to have sex without them,’ he said.

‘There is also some complacency that with low numbers of men with HIV in Perth that people will not come into contact with someone with HIV, but there are still men in Perth who have not tested and so do not know their HIV status.

‘We need to keep reminding men that not everyone is being truthful and honest with them when they are negotiating UAI.’

The study is still seeking to incorporate more men from Western Australia and South Australia since a majority of respondents have been from the eastern states.

It is also looking at ways of incorporating heterosexual men and women recently infected with HIV.

For those who wish to participate, visit the study website at www.hivss.net

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