In March 2008 OUT released the Prism Project needs assessments reports which found that both gay men and lesbians indulge in risky casual sex encounters and thus expose themselves to Sexually Transmitted Infections (STIs), including HIV. They concluded that some sort of intervention is needed to address the situation.
OUT LGBT Well-being is a progressive non-profit organisation in Pretoria. PRISM is the PRevention Initiative for Sexual Minorities, funded by the Dutch Ministry of Foreign Affairs and the Schoror Foundation, in collaboration with several LGBT organisations in Southern Africa.
What is significant is that these findings result from rigorous scientific research. This newspaper has been calling for this type of intervention for years, because even a casual observer can reach the same conclusion by visiting numerous venues where unsafe sex practices take place. To try and raise awareness, we have run some of our own safe sex advertisements, and many articles on HIV-related subjects. We have tried to motivate the Health Department to institute gay-themed safe sex messages in bars and the gay media, and we have tried to get sponsorship from companies which make condoms and lube for similar campaigns, but with minimal success. An example of minimal success is that the Gauteng Health Department placed safe sex ads in ONE issue of Exit (but refused to have their logos or name associated with it). And we have sporadically had adverts from pharmaceutical companies, for instance for our annual World Aids Day issues, or when we brought out a special issue for the World Aids Conference in Durban in 2000.
The PRISM reports form part of a broader programme which over 4 years aims to upscale HIV/Aids prevention programmes targeting LGBT people. This is a very welcome development. OUT identified gay men who engage in sexual risk-taking during casual encounters as its first target group, and 36 gay white men in Pretoria were included in the needs assessment. A separate report was done on the lesbian research which found similar causal factors, but admitted that the risk for lesbians contracting a potentially lethal STI (namely HIV) were much lower.
The research questions explored biographical data and background information, perceptions on health issues facing gay men, as well as respondent’s own experiences of risk behaviours. The health problems identified were Sexually Transmitted Infections (STIs), including HIV and the risky practices that contribute to their transmission.
Preliminary factors leading to risk taking behaviour were found to be: Substance use, escapism, inability to delay gratification, impulsivity, poor self image, thrill seeking, destructive tendencies towards the self, fear of intimacy, defiance of the heterosexual model and poor insight, amongst others. Considerable attention has been placed on establishing a hierarchy of risk associated with STI and HIV transmission which ranges from minimal risk (abstinence) to highest risk (unprotected anal intercourse with internal ejaculation).
Some areas of the report make compelling reading:
“For many gay men, in the 21st century, there is no longer the same, strong sense of community norm about having safer sex as there was during the height of the AIDS epidemic. In 1995, in the United States, gay men openly showed their defiance by saying that they were tired of using condoms and would no longer use them. The term bare-backing was first used in 1997.
“A recent development among Western gay men is that of the internet and its use in accessing and meeting sexual partners with relative ease. Research conducted by OUT found that 97% of respondents used the internet (amongst other reasons) to chat with other men (OUT, 2005). The internet has become the new gay bar. It cuts through the uncomfortable small talk present in face-to-face encounters and alleviates social anxieties (e.g., being rejected). Younger gay men, especially, grew up with the internet as a way to meet partners for sex. For many of them the AIDS crisis is a distant reality, and they appear less serious about HIV/AIDS than their older gay counterparts (Shernoff, 2006).
“Another development is the dramatic increase and prominence of substance use within the gay sub-culture. The places and venues where gay men meet have a strong sexual undertone (if not overtly sexualised, such as a sex club) and substance use is largely accepted … as part of the gay lifestyle.
“In the West, gay community norms have shifted from sexual safety (mid 1980’s and early 1990’s) towards ‘free sex’, reminiscent of the early gay liberation. Unlike the West, white gay men in South Africa did not develop experiences of sexual safety norms, due to a largely lacking gay movement, poor community norms, political transformation, and the heterosexualisation of the HIV/AIDS epidemic. But things are changing. At present, there is a stronger, more visible gay movement and greater attention is being paid to their HIV/AIDS experiences. However, an international development around ‘free sex’ complicates the development of sexual safety community norms.
OUT’s report concludes as follows: “It became clear that HIV and STIs are seen as serious health problems confronting gay men. Without a strong sense of community, they appear apathetic and disinterested in taking responsibility for their own sexual health and well-being. Casual sex seems to be occurring in a context where anal sex is a preference, where motivating and de-motivating factors are mediated by the type of venue, the time of day, the codes given and the substances used, where there is no regular testing and no one knows their recent status, where there is no condom use in steady relationships and inconsistent condom use in casual encounters, where there is no negotiated safety in steady relationships and casual encounters, and where monogamy is claimed but not carried out and secrecy surrounds the most recent casual encounter. It is clear that this situates these men as being at a high risk of contracting and transmitting and STI or HIV.”
The report realizes that there is a need for a holistic approach that intervenes on multiple levels to deal with the developing problem. In this situation, it is not exactly rewarding to be able to say we’ve been saying that for years.