This fact sheet was published in November 2000 by the Canadian AIDS Society as part of an information package for World AIDS Day 2000.

Fact Sheet: HIV/AIDS and Gay Men

Key Issues:

• New drugs used to treat HIV/AIDS are not a cure.
• Creating a more tolerent society allows people to make healthier life choices.
• HIV/AIDS continues to be a threat to the gay community.
• Younger gay men have not experienced the loss of loved-ones to AIDS to the same extent as older gay men. Therefore prevention messages must take this into account.

Since the early 1980s, AIDS has had a direct impact on gay men. Men who have sex with men account for nearly 80% of all AIDS cases reported in Canada and 40.9% of the cases reported in 1999 affected that same population [1]. Nearly 20% of gay men living in urban centres are HIV positive. It is reasonable to claim that HIV still constitutes a real threat to the gay community.

In Canada, prejudice and discrimination against gay men persists. Despite the progress in recent years in the social recognition of gay men, society still treats homosexuality as something "unnatural". Many gay men react to this by denying or concealing their sexual orientation. As a result, they keep their distance from the gay community and do not have access to the support that it provides. They are not exposed to the safer sex messages that the gay community has promoted since the onset of the epidemic. Difficulty in accepting one's sexual orientation has a profound impact on one's psyche, well-being, self-esteem and quality of life in general. It causes considerable isolation and psychological distress. Moreover, many studies have demonstrated that low self-esteem, fear of rejection, isolation and mental health problems are linked with unsafe practices among gay men.

The main risk for HIV infection among gay men (and other men who have sex with men) is unprotected anal intercourse with an HIV-positive partner. Many gay men have changed their behaviour to avoid unprotected anal intercourse with casual partners or with those whose HIV status is unknown to them. This change in sexual behaviour is undoubtedly an important factor in explaining the significant decrease in new HIV infections among gay men. Between 1997 and 1999, 47.8% of new positive test results affected men who have sex with men, whereas prior to 1995, this proportion stood at 81% [2].

But recent research suggests that the decrease in new HIV infections should not be considered a permanent gain. A recent study of gay men (the Omega cohort) in Montréal found that 13% of those under the age of 30 and 12% of those over the age of 30 had unprotected anal intercourse with at least one casual partner in the previous six months [3]. A study in Vancouver focusing on gay men aged 18 to 30 revealed that 32% of the subjects had unprotected anal intercourse with at least one casual partner in the previous 12 months [4].

Trends in the incidence of HIV among gay men are being closely monitored by professionals involved in intervention and by many epidemiologists. It is feared that a slackening of safer sex practices among this population could occur, coupled with a second wave of HIV infections. It has been suggested that young gay men take greater sexual risks because they have not witnessed the ravages of AIDS to the same degree as their older counterparts, because they have not lost friends and lovers to this disease and because they believe that choosing a sexual partner as young as themselves provides protection against HIV infection. It has also been suggested that a level of nonchalance about HIV has set in among gay men since the development of new drugs that treat HIV/AIDS (combination therapies). A recent study has shown that the level of risk a gay man is prepared to take in his sexual practices corresponds to his belief that new anti-HIV drugs are a cure [5]. Research conducted over the past 15 years with gay men has made it possible to link several psycho-social factors with risky sexual behaviours. They include: age, level of education and level of income.

Certain social conditions, including discrimination, intensify the vulnerability of individuals to HIV infection. Belonging to a marginalized group reduces an individual's capacity to protect himself against HIV infection. Societal prejudice against gay men continues to be linked with a worrisome number of suicides among gay teenagers. Much work remains to be done to create better conditions where gay and bisexual persons are better able to adopt and maintain lower-risk sexual behaviours. Effective approaches to prevention among gay men have been implemented in countries where homosexuality is accepted [6]. For this reason, it is important to support institutional or community-based interventions that enable gay men to develop skills for coping with their stigmatized sexual orientation. Particular attention should be paid to young people, as well as to those gay men for whom ethnicity and sexual orientation can be a twofold stigma.

With respect to HIV specifically, it is necessary to continue to disseminate accurate information on the ways HIV is transmitted and how best to protect against infection. It must be emphasized that new anti-HIV drugs have serious side effects, and that they are too new to conclude that they will be the definitive treatment or a cure for HIV/AIDS.

There are precautions that men who have sex with men can take to reduce the risk of HIV infection. They include using a new condom with each sexual encounter and using sterile needles and other injection drug equipment if they are injection drug users. For more information on how to prevent HIV infection, please contact the Canadian AIDS Society at 1-800-499-1986 or visit our web-site at <www.cdnaids.ca>.

1. Health Canada, HIV and AIDS in Canada: Surveillance Report to December 31, 1999. Division of HIV/AIDS Surveillance, Bureau of HIV/AIDS, STD and TB, LCDC, Health Canada, 2000.
[back to text]

2. Idem.
[back to text]

3. Dufour, Annie et al. (2000). Correlates of risky behaviours among young and older men having sexual relations with men in Montreal, Quebec, Canada. Journal of acquired immuno-deficiency syndrome 23: 272-278.
[back to text]

4. Craib KJ et al. (2000). Comparison of sexual behaviours, unprotected sex and substance abuse between two independent cohorts of gay and bisexual men. AIDS, 14(3): 303-11.
[back to text]

5. Misovich, Stephen J and Fisher, Jeffrey D (1999) Belief in a cure for HIV infection associated with greater HIV risk behaviour among HIV positive men who have sex with men The Canadian Journal of Human Sexuality, vol 8, no.4: 241-248.
[back to text]

6. Morrison, Ken and Vassal, Anne (1997) Les hommes gais, le sida et la science, in Le Sida, aspects psychosociaux, culturels et 'thiques, under the direction of Joseph J. L'vy and Henri Cohen, ed. of Méridien, pp.144-170.
[back to text]

For more information, contact:

Bonnie Devlin
Vanguard Project Coordinator
608 - 1081 Burrard Street
Vancouver, BC, Canada, V6Z 1Y6
Tel: (604)806-8306
Fax: (604)806-9044