All in the timing

Guest column

ACON’s Director of HIV and Sexual Health, Geoff Honnor, responds to last week’s column by Gerry North

Is timing everything or what?  No sooner had Gerry North’s piece, Throwing away the condom – Are we mad?  hit the streets last week than the NSW Ministry of Health released the NSW HIV notifications data for 2012, which had the effect of adding an impressive line-up of metaphorical exclamation marks to the header. In publishing that’s called a serendipitous confluence of events.

Gerry’s is a rhetorical question of course. Gay men would be certifiably insane to throw away the most assured means of preventing HIV transmission available and the good news is we haven’t; at least not according to the Sydney Gay Community Periodic Survey.

The SGCPS (to give it the official acronym) is the UNSW-based Centre for Social Research (Formerly the National Centre for HIV Social Research) survey of HIV/STI-related risk practice in around 3,000 Sydney gay men, conducted every year since 1996. Some of you will recall it as the questionnaire you fill out so you can be in the shade at Fair Day.

In relation to condom use, the February 2013 Survey tells us that of the 1,565 guys who reported having a casual sex partner in the previous six months, 300 (19%) reported no anal intercourse (a fairly consistent figure over the years); 695 (44%) reported always using a condom and 570 guys (36.4%) reported at least one instance of unprotected sex.

In 2009, by comparison, the figures were 252 (16%); 743 (47%); 583 (37%) and that’s enough figures. So while there’s certainly been some slight shifts in trend in the intervening period, ‘wholesale abandonment’ doesn’t exactly leap out at you.

It’s worth pointing out that many of these encounters will be ‘safe’ in that they involve guys whose HIV status is known to each and to each other. For instance, if two poz guys decide not to use condoms, and are aware of the STI transmission risks involved, it’s hardly the end of gay culture as we know it. More than likely they’ll be on treatment and if so their virus is likely to be optimally suppressed or ‘undetectable’ as the terminology du jour would have it. It’s more the optimistic notion of ‘neg/neg  serosorting’ with the hot, asset-packed stranger who recalls his last test kind of when…was it…shit…when…Adele won her first Grammy…? that should have you lunging for the condoms and lube.

Regardless, if we’re not exactly throwing the condoms away, these data certainly suggest that they’re not always in the back pocket and Gerry is absolutely right to point to the dramatically changed nature of the lived HIV experience as fundamental to that shift.

Once diagnosis = death vanished from the equation, everything changed, everywhere and for good. Most guys diagnosed in the last few years will more than likely have a normal lifespan and be able to live life to the full in ways not that much different to the negative guys around them with one crucial exception: for virtually all of us, it’s a wellness utterly reliant on continued access to effective antiretroviral therapy. A few weeks off the meds and viral loads soar and CD4 counts drop. A year or so down the track it’s really bad retro – Maria Callas, candles and Forgettable AIDS Movies revisited. That should be more than enough incentive for you to join us in bringing the whole thing to a long overdue closure.

Test and Treat are kind of the easy bits. Staying Safe is the glue that holds it together. We can’t end HIV without that Staying Safe adhesive and we would be mad to pass up that opportunity.