Words by Ian Howley @ianhowley and Stuart Haggas @getstuart


We surveyed 3,141 gay and bisexual men:

  • 44% of HIV-negative men would not have sex with an openly HIV-positive man.
  • Up to 49% did not know what HIV-undetectable means.
  • 31% did not know what PrEP is.
  • When we explained what PrEP is, 71% of gay men said they would use it.
  • 51% were worried about becoming HIV-positive.

Of the 3,141 men who completed this FS survey, 67% said they were definitely HIV-negative, 17% probably HIV-negative, 6% didn’t know, 1% probably HIV-positive, and 9% definitely HIV-positive.

84% of those with HIV said they have an undetectable viral load.

We asked all those who identified as HIV-negative whether they would have sex with someone who is HIV-positive, and 44% said ‘No’ (30% said ‘Yes’ and 26% didn’t know).

Who are the men who won’t have sex with HIV-positive men? 

  • 71% of 18 year olds and under said no to having sex with an HIV-positive guy. 
  • 59% of 18-24 years olds said no.
  • 43% of 25-44 years olds said no.
  • 29% of 45-54 year olds said no.
  • 24% of 55-64 year olds said no.
  • 47% of 65 and older said no. 

Generally younger gay men are more likely to reject someone for being HIV-positive, although the percentage to over 65’s was also high.  

Of those who wouldn’t have sex with an HIV-positive guy:

  • 79% said that they were ‘definitely HIV-negative’.
  • 15% said that they were ‘Probably HIV-negative’ 
  • 6% did not know their HIV status.
  • 53% of those men were worried about becoming HIV-positive.

We asked: Do you know what HIV-undetectable is? 

  • Yes: 51%
  • No: 23%
  • Not sure: 26%

We explained that HIV-undetectable means that the amount of HIV in the body is so low that it can’t be detected in a standard test and the chance of HIV being passed on during sex is very low. We then asked:

Would it make a difference if they told you they were HIV-undetectable?

9% of those who said “I would never have sex with someone who is HIV-positive” now said it would make a difference if they were undetectable. 

67% still said no.

24% said ‘not sure’. 

So just by explaining what HIV-undetectable means we managed to make a third of men, who previously wouldn’t have sex with a positive man, reconsider their stance. 

Ian Howley, editor for FS said: “Of those men who honestly said they would never have sex with an HIV-positive guy about 10% changed their mind after we explained what HIV-undetectable meant. This goes to show that educating people about the viral load of HIV-positive men can go a long away into combating stigma and rejection.”

We asked Luis Guerra, Public Health England’s National Programme Manager for Sexual Health, Reproductive Health and HIV, for his personal take on these findings. “What surprised me the most is the percentage of people saying ‘don’t know’ because you might think we all had put some thought into that already. However, this is a reflection on the work we still need to do to continue educating people. Clearly stigma and fear continue to play an important role here and, as this survey demonstrates, education can go a long way. I would encourage everyone to base their decisions on accurate information and facts rather than misconceptions and fear.”

“The results paint a complex picture,” agrees GMFA’s Matthew Hodson. “I find it sad that less than a third of the HIV-negative respondents say they would have sex with someone with HIV. This does nothing to encourage honest discussions about HIV status. In the survey we went on to describe what HIV-undetectable means, and it’s interesting to note that from this simple exchange there was a significant shift in attitudes. This illustrates that there is still a need for more information about HIV in the treatment era, and that given the right information we can change not only attitudes but also behaviour.”

THE PrEP QUESTION

PrEP means pre-exposure prophylaxis. You take anti-HIV medication which keeps you from becoming HIV-positive. Trials have shown it  to be extremely effective in stopping gay men from becoming infected with HIV. 

We asked men if they knew what PrEP was:

  • Yes: 58%
  • No: 31%
  • Not sure: 11%

Despite a lot of recent coverage in the news and on gay websites, nearly a third of gay men did not know what PrEP was. Among men who said they would never have sex with an HIV-positive guy the results were:

  • Yes: 43%
  • No: 45%
  • Not sure: 12%

We explained what PrEP is and how it can stop HIV-negative men from becoming HIV-positive, and then asked men if they would use it if it was available on the NHS:

  • Yes: 71%
  • No: 13%
  • Not sure: 16%

Of the men who said they would not have sex with an HIV-positive man the result was basically the same:

  • Yes: 71%
  • No: 14%
  • Not sure: 15%

We also asked why:

Sam, 23 from London said: “Because it would give me peace of mind. Furthermore, if someone was HIV-positive and I had protected sex, things can still go wrong such as a condom split. So PrEP, would be an extra safety measure.”

Logan, 19 from Glasgow said: “Because it would make me a lot less worried and anxious about contracting HIV.”

Callum, 18 from Cardiff told us: “I would take anything that would protect me from catching this virus. I’ve seen how it ruins relationships and opportunities, and PrEP would give me peace of mind and security. It wouldn’t mean that I would sleep around more though.”

Dan, 23 from Manchester said, “I would definitely use PrEP as a young gay man with a higher risk of contracting HIV than the general public. Catching an STI is a constant scare for me and sometimes stops me from wanting to get physical with potential partners.”

Who would be most likely to use PrEP?

  • 92% of 18 years old and younger said they would use PrEP. 
  • 78% of 18-24 years olds said yes.
  • 74% of 25-34 years olds said yes.
  • 65% of 35-44 years old said yes.
  • 58% of 45-54 years old said yes.
  • 62% of 55-64 years olds said yes.
  • 66% of 65 and older said yes.  

Men under the age of 34 would be most likely to use PrEP. 

Of the men who didn’t know what PrEP was before we told them, 69% of them then said they would start using PrEP if it was available. There was no significant difference from those who knew about PrEP already.

What proportion of each relationship category would use PrEP? 

  • 45% are single.
  • 28% of men who in a monogamous relationship.
  • 11% currently dating.
  • 8% in an Open relationship.
  • 8% Married or in a Civil partnership.

Did they use a condom the last time they had sex?

  • 24% - Yes
  • 76% - No

“The emerging evidence supporting PrEP as highly protective against HIV transmission is very strong,” says Luis Guerra. “I think the conversation is now moving away from ‘should we get it?’ and is starting to focus more on ‘how do we get it?’ However, we need to be careful to make sure we are considering how to provide accessibility and availability of PrEP equally for all. We know health inequalities continue to impact HIV transmission and acquisition and crucially, we need to address this.”.

FS editor Ian Howley said: “One major thing this survey has thrown up is the lack of education around viral load and undetectable status. It shows the lack of appropriate sex education leads to sexual rejection and HIV stigma. 

“The other major finding from this survey is the need and want for PrEP. If PrEP were to become available now 71% of gay men would use it. This would not only help to bring down the rate of HIV infections but would help bring peace of mind to many gay men who are fearful of sex with HIV-positive men. We need PrEP now.” 


Useful links

For more info on PrEP visit, www.gmfa.org.uk/prep.

For more info on viral load, HIV and sexual health visit, www.gmfa.org.uk/sex.

Demand PrEP becomes available on the NHS by adding your support to the campaign visit, www.prepaccess.org.uk.


This article is from FS magazine #150


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