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Monday, Jul 07, 2008
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Number of sex partners isn't main cause of HIV rate among Gay men |
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| Number of sex partners isn't main cause of HIV rate among Gay men | ||
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UW researchers say Gay, straight men share similar rates of unprotected sex
by Robert Raketty - SGN Staff Writer A team of researchers at the University of Washington in Seattle have concluded that the number of sexual partners among Gay men may have little do with their rates of HIV infection. According to Public Health - Seattle & King County, 6,188 residents of the county are living with HIV or AIDS and 370 new HIV infections are reported each year. Men who have sex with men, intravenous drug users and foreign-born Blacks make up 86 percent of the King County residents who are HIV positive. An analysis of two large population-based surveys found that Gay men and heterosexuals share a similar rate of sex with unprotected partners. "People should not assume that the big difference in HIV and STD rates between Gay men and heterosexuals in the U.S. implies that Gay men as a whole have a lot more risky behavior," Steven Goodreau, an assistant professor of anthropology, told the Seattle Gay News. Goodreau and a colleague, Dr. Matthew R. Golden, analyzed data from the two surveys to estimate how many sex partners people-both Gay and straight-have had and what number of Gay men are anal tops, bottoms or versatile. "...[E]ven when you mix things up-when Gay men's number of sex partners matched heterosexuals', and vice versa-Gay men in the US have a large HIV epidemic, and heterosexuals don't," added Goodreau. Goodreau and Golden found that straight men and women would have to have an average of almost five unprotected sexual partners every year-almost three times the rate of the average Gay male-to experience an epidemic of HIV infection as widespread as that of Gay men. "It's a combination of the greater risk of anal sex over vaginal, the fact that Gay men can be 'role versatile' for the sex acts that spread HIV while heterosexuals can't," Goodreau explained. "And it is true that a small number of Gay men do have unprotected sex with lots of other men-it's not the whole story, but it is still a piece of it, and we shouldn't lose sight of it." To end the HIV epidemic among Gay men, Goodreau suggests the rate of unprotected sex among Gay men would need to be significantly lower than those seen among straight men. To get the full story on their findings, the SGN spoke with Goodreau about their research, which has been published in the Sept. 12, 2007, online edition of Sexually Transmitted Infections. Seattle Gay News: Who proposed the research and why was it done? Steven Goodreau: My colleague Matt Golden from the King County STD Control Program and I came up with the idea for the project together. Matt had a clear sense from years of taking men's sexual histories that most Gay men have unprotected anal sex with no one or, at most, one man in a given year. And likewise, most heterosexual men have unprotected vaginal sex with either zero or one woman per year. Individual sexual behavior is not all that different for the majority of Gay and straight men, at least for the behaviors that carry the most risk of HIV transmission. Meanwhile, I was working on a study of Gay men in Peru, looking at the issue of what we call "role segregation." In Latin America, it is more common than in the U.S. for a man to always be the top or always be the bottom during sex with other men. It turns out that this has a huge impact on HIV transmission. The virus goes much more easily from top to bottom than vice versa. If men always play one role, then the virus needs to go through the "bottleneck" of bottom-to-top in order to move through the population. But if men are versatile, then the virus can move more "efficiently" through the population-a guy can be infected quite easily by being a bottom, and then turn around and be a top with the next guy, and so on. While working on this, it occurred to me that this is a major difference between Gay men and heterosexuals-Gay men can be versatile, and heterosexuals can't, again with regard to the sexual acts that carry the most risk. And of course, anal sex carries a higher risk of transmission than vaginal sex in the first place. So, we wondered how much these two things together-anal vs. vaginal transmission rates, combined with role versatility among Gay men but not heteresexuals-explained the vast differences in HIV rates in the U.S. these days. SGN: How did you conduct the research? SG: We used data from two published studies-one on Gay men specifically, and one on the U.S. adult population generally. And we then programmed a computer simulation package that simulated the spread of the virus through each population based on their sexual behavior and the probability of transmission associated with each kind of sex-insertive and receptive, anal and vaginal. We then mixed things up, and conducted a simulation in which Gay men had the rates of sexual contact that heterosexuals report, and heterosexuals had the rates of sexual contact that Gay men report. SGN: What are the major findings of your research? SG: We have a couple of major findings. One is that even when you mix things up-when Gay men's number of sex partners matched heterosexuals', and vice versa-Gay men in the US have a large HIV epidemic, and heterosexuals don't. As a whole, Gay men have done a lot to change their behavior over the last few decades and put themselves at less risk. People should not assume that the big difference in HIV and STD rates between Gay men and heterosexuals in the U.S. implies that Gay men as a whole have a lot more risky behavior. Another finding was that for Gay men who do only occasionally have unprotected sex-with one man a year, say-their risk of getting HIV was very much dependent on what the Gay men who had lots of partners were doing. This was much more true for Gay men than for heterosexuals. So, the idea that we're all in this together-that Gay men's behavior ends up affecting lots of other people in the community, is true in a very real sense. SGN: How have the findings been received by your colleagues and/or the public? SG: The paper hasn't appeared in print yet, just online, but I've already gotten a bunch of requests from other researchers. So it's clear there's some interest in it. SGN: Are you surprised that your research has been so widely reported? SG: I am, yes. It's not common for a paper that's all about mathematical modeling-that doesn't have any new data in it, just new analysis-to get much attention. I'm very happy with it. SGN: Why do you think Gay men are getting infected with HIV at greater rates than heterosexual men? SG: Most of this is in my previous responses already. It's a combination of the greater risk of anal sex over vaginal, the fact that Gay men can be "role versatile" for the sex acts that spread HIV while heterosexuals can't. And it is true that a small number of Gay men do have unprotected sex with lots of other men-it's not the whole story, but it is still a piece of it, and we shouldn't lose sight of it. |
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