The blog of Monty Moncrieff
London Friend Chief Executive
22nd November 2013: HIV Testing Week
Today marks the start of HIV Testing Week. Do you know your status?
We’ve come a long way with HIV since the panic of the 1980s when so many of our community died before their time but gay, bisexual and other men who have sex with men (MSM) still face a disproportionately high risk. We’ve made huge advances in treatment, with post-risk PEP treatment further reducing the likelihood of becoming infected. Life expectancy for somebody on HIV medication is virtually the same as for those who are HIV negative. It’s impressive, but still the numbers of new infections are rising, with latest figures showing a record number of new diagnoses for gay and bisexual men.
HIV testing Week aims to inform those most at risk of the benefits of regular testing and how timely treatment for those who test positive can play a vital role in reducing the risk of passing the virus on. One in five MSM living with HIV don’t know they’re positive, and late diagnosis increases the potential for those with a high viral load to pass HIV on to others. It’s estimated that 8 out of every 10 new HIV infections is from men who are undiagnosed. You can see why testing is so important.
The latest figures for 2012 show that in London we saw a further 14% increase year on year in the number of new diagnoses in MSM. We saw 3250 new MSM diagnoses during the year – 51% of all new cases in the UK - with 1600 of these in London. What happened to the simple message of safer sex? What’s driving the rise in new infections?
At London Friend, through our Antidote service, the greatest risk factor we see is the use of so-called club drugs. It’s well documented that some gay men have long enjoyed the use of pills and potions to dance – and shag – the weekend away, but over the past few years we’ve seen a huge change in what’s being used – and how. Where once the weekend would start with some drinks and some dancing, and maybe ending up in bed if you got lucky, a more common tale we hear now is to cut straight to the chase using websites and smartphone apps to find others up for some chemsex ‘party & play’. At many such sex parties we hear that bare-backing – with several partners – can be the (expected) norm.
We’ve seen a shift away from the ecstasy generation towards newer drugs on the block. Crystal, G and mephedrone seemed to come almost out of nowhere to rapidly become the unholy trinity of substances most men we support now seek help about. More and more of them have swapped the pill for the pipe, and even more alarmingly, for the syringe ‘slamming’ their drugs (injecting) following the pattern of others they party & play with. The harms are different too: more men come to us emotionally frazzled from days of over-stimulation, or dependent on topping up with G every couple of hours. Say what you like, but things ain’t what they used to be...
It’s tempting to just blame the drugs, but that would be a little simplistic. It’s difficult to pinpoint the link as the cause for the spike in new infections, although talking to the men who come to us for support we get a few clues. Over half of those who have been diagnosed HIV positive tell us they believe they became so whilst using. They tell us that whilst using they lost many of their inhibitions, had sex with more partners, and thought less about using condoms. Over half of those who already know they’re positive tell us they find it difficult to adhere to their meds when they use drugs, risking that all-important viral load count being higher than they might have thought.
Of course, drugs don’t ‘make’ you have unsafe sex: they may indeed lower your inhibitions but you still make your own choices. Here we have some more complex issues at play. Although we’ve seen advances in treatment, stigma about HIV can still be acutely felt. Some men tell us they opt to bareback because they’ve reached ‘rejection fatigue’. Discussing your HIV positive status sometimes means having to deal with a negative reaction: seeking out bareback sex can feel like shorthand to avoid having to go through this time and again.
There are other underlying issues too; last night at an event discussing the chemsex phenomenon hosted by the Royal Vauxhall Tavern members of a panel discussed drug use. Several speakers were themselves in recovery, having successfully managed to move on from problematic drug using. They spoke passionately about the factors that had led them to use and some themes came through strongly: people craved a sense of belonging, of identity, of feeling they had a place somewhere on the often alienating gay scene. People spoke of wanting intimacy, stability, fulfilling friendships and relationships but finding only the offer of casual sex fuelled by chems and the loneliness of a come-down before the weekend came around again.
It felt like the things we really all want were being falsely withheld on the scene through a notion that you had to present a different image of yourself to belong. An image that pretended more confidence, more indifference, and driven only by the desire to party hard. Living up to that lifestyle was impossible, but nobody seemed to acknowledge that nobody really wanted to have to. A Catch 22 that was driving behaviour that actually nobody really enjoyed that much. If only we could find a way to embrace that and start seeking what we really all seem to want – a friendlier, happier, less pressured party scene where we take some time to care about ourselves and our currently disjointed community.
Supporting changing need
With changing risk we’ve had to adapt the way we deliver our services, and adapt techniques to a changing environment. Our work to help men avoid relapse might include helping them manage the ‘trigger’ of being offered drugs whilst using a dating app, for example, or to manage the message of really wanting a long term relationship but responding only to the offer of no strings fun. We work with men to understand the risks they’re taking, to remember to take their meds, and to be aware of their limits and boundaries. We’ve changed our locations too, moving into sexual health settings where we can speak to men long before they might end up in a drugs project, helping them to identify potential risk and make healthier, informed and responsible choices.
We’ve been passing on our experiences too, providing training to drug workers and sexual health staff to enable them to be more attuned to the joint sexual and substance risk. We’re helping them to better identify risk and to become more comfortable asking about drug use and sexual practice and letting the men they support know they can talk openly and frankly without the stigma of sex and drugs being a barrier to receiving excellent and appropriate healthcare. We’re working too with commissioners and policy makers to help them understand the issues we deal with and to plan and deliver services which meet the prevention and treatment needs of MSM.
Taking action, taking responsibility
Reducing the spread of HIV relies on us all accepting our own responsibility, and with testing to know our own status and act to reduce the risks to ourselves and others. Will you join me and London Friend in pledging to test and in supporting your friends and partners to do so too?
Gay, bisexual and other MSM can test at one of our clinics in partnership with NHS sexual health services. We’re with the Mortimer Market Centre every Monday morning (9-12) and at Code Clinic at 56 Dean Street every Tuesday (5-7). Trans people can test with our specialist service cliniQ every Wednesday at 56 Dean Street (5-7). Alternatively you can find out where to test locally in the UK here. For support around drug and/or alcohol use come to one of these clinics, or to our Antidote drop-ins – Monday morning in Kings Cross (11-1) or Thursday evening in Soho (6-8.30). We also work in partnership with the Club Drug Clinic.
Public Health England recommend that MSM test for HIV every 12 months, more regularly if you’re having sex with multiple, new or casual partners.
London Friend is a local delivery partner with the national HIV Prevention England campaign. During HIV Testing Week we’ll be promoting the campaign throughout our services, our partnership clinics and through outreach.