WHATEVER…

There is growing concern that young gay men are becoming increasingly complacent about HIV and AIDS and their effects. Is it because of treatment becoming available or could there be deeper issues related to our identity and self-worth at play?

Internationally, researchers have observed that this growing trend has emerged alongside the provision of antiretroviral therapy. It is generally believed that with the emergence of antiretroviral therapy, many people have become less concerned about the risk and severity of HIV and AIDS.

In a recent American study, it was found that complacency was associated with a higher number of sexual partners, an increase in unprotected anal intercourse with an HIV-positive or HIV-unknown-status male partner, and an increase in the likelihood of testing HIV-positive.

So, it would seem that issue of complacency is linked to an increase in risk behaviour. But complacency can also manifest in other subtle ways such as not going for regular HIV and STI screening, not talking about your sexual history with your sexual partner, and not standing up for yourself when pressured to have (unprotected) sex.

While it’s becoming a major concern, is it accurate to say that we have become complacent simply because of the availability of antiretroviral therapy? While this may play a role, it can be argued that a number of other factors also affect gay men becoming seemingly complacent about HIV and AIDS. What follows is a snapshot of some of these possible contributing factors.

DESIRE

Sex is natural and we as human beings have a propensity to want to have sex. For most people, sex is associated with the following immediate benefits:

• Sex is fun and pleasurable;

• Sex is a form of self-expression;

• Sex may reinforce the sexual image we have of ourselves;

• Sex makes us feel good about ourselves; and

• Sex may serve an underlying need for emotional intimacy, physical contact, connection, belonging, and security.

Because of these immediate benefits, many people, including gay men, will consciously or unconsciously overlook any perceived risk or danger especially if not tangible or imminent. Of relevance here is the fight-or-flight response. The fight-or-flight response is a primitive stress response that is activated when faced with real or imagined danger. Once activated, a flood of physiological and emotional activity is turned on and an individual experiences a surge in power, speed and strength in order to handle the danger or pain. Once the threat, danger, or potential pain is no longer perceived to be imminent, the body slowly returns to a stable state.

For most people, this fight-flight response is triggered only in extreme situations where the threat is perceived to be serious and imminent. In the absence of such immediate physical danger people have a built in mechanism to filter out all minor threats experienced on a daily basis without evening knowing it. If this was not the case, we would all be permanently in fight-or-flight mode every time we step out the house or get into a car.

The same idea can be applied to the transmission of HIV. For most people, HIV is not seen as an immediate physical threat as there are usually no apparent signs or symptoms or pain experienced during transmission (during sex). In the absence of a physical threat the stress response is not activated, and people don’t experience an increased need to become vigilant, cautious, and self-protective.

Furthermore, in the absence of any perceived danger, and the associated stress response, people are freed to engage in behavior to obtain the perceived benefits, whether considered risky or not. Public health is full of examples where people continue to engage in risky behaviour because of the perceived benefits in the absence of physical danger. For example, people continue to drink and smoke despite the potential health risks. Here complacency is linked with an unconscious prioritisation of benefits over risks.

DEFENSE

Although most sex is seen as natural and beneficial, some people have deep-seated and longstanding negative beliefs and feelings about sex, including:

• Sex is dirty and bad;

• Sex is shameful;

• Sex is a sin;

• Sex is forbidden.

These beliefs and feelings are generally rooted in culture, tradition and religion. Many people, including gay men, adopt these beliefs and feelings while growing up. Gay men are especially vulnerable, given their continued exposure to heterosexism and homo-negativity in society. As a result, some gay men develop feelings of shame and guilt regarding their sexuality, whether they acknowledge it or not. The resulting spoiled identity (also known as internalised homo-negativity) can manifest in a number of ways:

• Not feeling good about oneself and then using sex (whether risky or not) to feel temporarily better about oneself;

• Not feeling good about oneself and then using alcohol and/or drugs to self-medicate (a link has been established between alcohol and drug use and HIV transmission because of an impairment in overall judgement, a decrease in general inhibitions, an increase in the likelihood of engaging in high risk sexual activities, not using condoms or using condoms incorrectly, an increase in the number of sex partners, participating in orgies where condoms are not used, prolonged sex sessions, ejaculating inside someone, engaging in risky behavior to acquire drugs, and potential loss of consciousness before or during a sexual encounter); and

• Not feeling good about oneself and others, and then developing a fatalistic attitude (e.g., “I don’t care”);

These are only a few ways in which a gay guy might cope with, or act out, his spoiled identity. Here, what is seen as simple complacency on the surface is in fact deep-seated, conscious or unconscious, forces that play a significant role in sexual risk-taking. Psychology is full of examples where people use sex to cope with, or act out, their underlying feelings rather than dealing with the feelings themselves.

MISINFORMATION

There is a lot of information out there on what is considered risky and what is not in terms of HIV transmission. Many of these messages, when actually visible and accessible to the general public, appear to be confusing, contradictory and ambiguous. Amidst such ambiguity, confusion and contradiction, most gay men attempt to evaluate their risk based on their personalised (whether specific or vague, and based on evidence or hearsay) understandings of risk especially when it comes to the following:

• Unprotected anal sex in ongoing relationships, at either two weeks, three months, or a year;

• The relative risk for the insertive partner (top) during anal sex, whether circumcised or uncircumcised, and whether a condom is used or not;

• The relative risk for the receptive partner (bottom) during anal sex, where the top didn’t use a condom but he withdraws before he cums; and

• The relative risk to the guy giving a blow job and the other guy pre-cums or cums in his mouth.

These are only a few examples where gay men need to make up their own minds, often in the heat of the moment, and in the absence of clear and consistent information, about what constitutes relative risk. In many instances, what is regarded as safe is in fact not safe at all. In this way misinformation or erroneous risk perception may be misconstrued as being complacent.

IT’S NEVER TOO LATE

It would indeed seem that gay men are becoming increasingly complacent about the risk and effect of HIV and AIDS. The apparent complacent attitude amongst gay men is not a simple issue but in fact a complex issue that includes a consideration of a range of interlinking factors that cumulatively prevent gay men from taking better care of themselves and each others. If these underlying factors are not addressed then gay men will continue to be, and be perceived as, complacent.

You can do your part by taking responsibility for your thoughts, feelings and behaviours, don’t underestimate your personal risk, get professional support to resolve any underlying beliefs and feelings, recommit yourself to maintaining consistently safe behaviours over time, and let go of the false belief that HIV treatment advances mean that HIV is no longer a serious health threat. You owe it to yourself to be a healthy and happy sexual being. It is never too late.