Social Work with People Practicing Same-Sex ... - ILGA Europe

Round table on LGBT issues, MOH
of Ukraine, 2008
1 Royce R, Sena A, Cates W, Cohen MS
(1997) Sexual transmission of HIV.
New England Journal of Medicine,
336(15):1702-8.
2 Koblin BA et al. Risk factors for HIV
infection among men who have sex
with men. AIDS 2006;20(5):731-9.
3 McFarlane M, Bull SS, Rietmeijer
CA. The Internet as a newly
emerging risk environment for
sexually transmitted diseases. JAMA
2000;284(4):443-6. Rietmeijer
CA et al. Risks and benefits of
the internet for populations
at risk for sexually transmitted
infections (STIs): results of an
STI clinic survey. Sex Transm Dis
2003;30(1):15-9. Bolding G et al.
Gay men who look for sex on the
Internet: is there more HIV/STI risk
with online partners? AIDS 2005;
19(9):961-8.
4 Comparative analysis of 12 studies
to evaluate the prevalence of
smoking among the lesbians, gays
and bisexuals in the United States
was performed within the period
from 1987 to 2000. The smoking
rate among young LGBT varied from
38% to 59%, and among adults —
from 28% to 50%. Ukrainian
smoking indicators constituted
28% — 35% for young people and
28% for adults (Ryan H., Wortley
P.M. et al. Smoking among lesbians,
gays, and bisexuals: a review of the
literature. Am J Prev Med. 2001
Aug;21(2):142-9)
12
Behavioural Factors
Specific sexual practices in the repertoire of MSM increase the infection risk: they
include an unprotected receptive anal sex, unprotected insertive anal sex and oral sex.
Not all sexual contacts between an HIV infected person and non-infected partner result
in HIV infection. The probability of infection in case of unprotected anal sex (without
condom use and with ejaculation in the rectum) is estimated to be the following:
� 0.03%-0.1% for all contacts, in which an uninfected partner plays an active
role (penis is inserted in the partner's rectum), while an infected partner plays
a passive (receptive) role (range: from 1 case per 3,333 to 1 case per 1,000
contacts).
� 0.1%-3% for all contacts, in which an infected partner plays an active role, while
an uninfected partner plays a passive (receptive) role (range: from 1 case per
1,000 to 1 case per 33 contacts) 1 .
Some behavioural practices also increase the risk of infection, for instance, having sex
with multiple partners, inconsistent condom use for anal and oral sex, lack of knowledge
about HIV and STIs, negative or negligent attitude to safer sex. High levels of alcohol
and drug use contribute to the lower level of self-control and responsible decisionmaking.
There is a link between depression and higher sexual risks, such as unprotected anal sex,
alcohol and drug use, inconsistent condom use and sex with multiple partners 2 .
A link has been described, particularly for young MSM, between sexual violence in
childhood and higher sexual risks, such as unprotected anal sex, alcohol and drug use
and selling sex for money or drugs.
A quick development and spread of Internet contributed to the fact that thanks to
the appearance of special meeting sites and chat-rooms, traditional places frequented
by MSM (bars, clubs, saunas) are becoming more impersonal and virtual and do not
require much time to get acquainted with other people and get information about
potential partner. In spite of the fact that a person can be HIV infected, MSM prefer not
to provide this information in the personal questionnaires. Acquaintance through the
Internet with “sexual“ implication increases the chance to contact with a HIV infected
partner 3 .
Social and Cultural Factors
Stigma and discrimination, homophobia, racism, xenophobia and depression increase
the risk of drug use, the frequency of unprotected receptive/insertive anal sex, the
number of partners and inconsistent condom use.
Stigma associated with homosexual sex prevents many MSM from recognizing their
sexual identity (homo- or bisexual): “I will not get infected because I do not belong
to a risk group, I am a heterosexual and HIV prevention programmes for homo- and
bisexual people are not related to me”.
Since the middle of the 1990-s, when thanks to the appearance of highly active
antiretroviral therapy, HIV infection was shifted to the category of chronic diseases,
the so-called HIV optimism has started to spread in the MSM communities. Confidence
in the accessibility and efficiency of the modern antiretroviral therapy, as well as the
social tiredness of the constant, standard calls for safer sex practices contributed to the
growth of risky sexual behaviour (e.g., unprotected anal sex). Nevertheless, according
to the UNAIDS, due to various reasons only one in 20 MSM in the world has an access to
HIV prevention and treatment services.
Use of Psychotropic Substances by LGBT
Alcohol use, tobacco smoking and use of both legal and illicit psychotropic substances
are widespread among LGBT people around the world, which is confirmed by numerous
research data 4 . The reasons for such behaviour will be discussed later, but first of all it
should be noted that LGBT community is very attractive for transnational corporations