ssh-chemsex-study-final-main-report

“I am being absolutely open and honest and this may sound cold
and calculated and maybe it’s against all of the health preventions
and marketing materials and so on – but they [STIs other than HIV]
are all manageable.”
by sexual partners meant that many men with diagnosed
HIV were hesitant to explicitly disclose, and this fear
was the reason they relied on implicit cues within their
environment. Some men were cognisant of the fact that
their means of serosorting their sexual partners might not
always be perfect, but were comforted by the knowledge
that their undetectable viral load meant that they would
be unlikely to transmit HIV anyway.
With regards to STIs other than HIV, men’s views and
experiences were varied. A very small number stated
they were unconcerned by any other STIs, now that they
had diagnosed HIV. This was, they felt, the most serious
of all sexual infections and their ability to manage and
control HIV empowered them with the belief they could
do the same with ‘lesser’ STIs.
“ I am being absolutely open and honest and this may
sound cold and calculated and maybe it’s against all of
the health preventions and marketing materials and so
on – but they [STIs other than HIV] are all manageable.
You take the pills, you have an injection. You’re going
to be sick if it’s something like shigella or whatever it is,
but you can come through it.
[Aged
”
33, diagnosed HIV positive]
This view was not common place, however, and most men
both with diagnosed HIV and those believing themselves
to be HIV negative were aware of other STIs and took
at least some steps to avoid them. Most recognised that
STIs were very likely to be transmitted within relatively
small networks of HIV positive men choosing to have UAI
with one another.
“ You don’t know about Hep C and other [STIs]. I mean
I have had two or three STDs in the last 18 months
and that is certainly up on the previous 18 months […]
When you arrange to meet somebody and they may
have already been up and about for 24 hours, you
are already inheriting whatever their last partner or
partners that day may or may not have had.
[Aged 40, diagnosed HIV
”
positive]
Several men had particular concerns relating to Hepatitis
C and would directly question potential sexual partners
to ascertain their infection status and the risk they may
pose if they were to engage in unprotected sex. Others
actively seeking to have UAI with other HIV positive
men made an assessment of the likelihood of potential
sexual partners carrying other STIs based on their profile,
personality or sexual preferences. There was a common
perception that men who engaged in fisting may be
much more likely to have Hepatitis C, and therefore UAI
should be avoided. Men who use crystal meth and those
who inject drugs were also often perceived as more ‘risky’
and therefore more likely to carry STIs other than HIV.
Some HIV positive men sought only to have insertive
UAI, or insisted on partner withdrawal prior to ejaculation
if engaging in receptive UAI, as a means of protecting
themselves from other STIs.
“ If you think logically, yes I’ve had unprotected sex with
other people but it tends to be the usual, “are you on
meds? Are you undetectable? Do you have Hep C?”
and I will avoid anyone that does fisting. As soon as
anyone mentions the word fisting anyway, I block.
[Aged 41, diagnosed HIV positive]
”
Among this group of men we interviewed who frequently
sought UAI, drug use played only a relatively minor role.
Decisions relating to risk management were taken after
consideration of their sexual preferences and in such a
way as to limit the likelihood of onward HIV transmission.
However, as described in chapter 5, chemsex facilitates
longevity of sexual contact, meaning both the capacity
to have sex with a higher number of men and the ability
to have sexual contact with each man for longer. Both
actions increase the likelihood of transmitting sexual
infections.
The Chemsex Study | 6. THE ROLE OF DRUGS IN HIV/STI TRANSMISSION RISK BEHAVIOUR 51