Doctors are concerned that gay men with HIV are abandoning safe sex practices, and may unwittingly be spreading previously rare sexually transmitted infections such as syphilis.
Instead of adopting the safe sex practices that turned around the AIDS epidemic of the 1980s, men are arranging only to have sex with people who share their HIV status – a practice known as “serosorting” – which they believe eliminates the need for condoms.
But clinicians are concerned that some people may not be aware they are HIV positive when they negotiate such encounters, and it may be the reason some sexually transmitted infections are returning in record numbers.
The Kirby Institute for Infection and Immunity in Society at the University of NSW reported this week that syphilis had hit its highest level in recorded history.
David Wilson, head of the surveillance and evaluation program for public health at the institute, said researchers had observed an increase in serosorting.
“If they negotiate that they’re both HIV positive, they don’t use condoms with each other,” Associate Professor Wilson said.
“We’ve got much more syphilis in that group and they’ve spread to other groups.
“I know of massage parlours and bath houses in Sydney where there are back rooms that the community knows, if they’re HIV positive, that’s where they go.”
There was a 9 per cent decline in condom use among gay men having casual anal intercourse between 2004 and 2013 according to research released this week by the by UNSW’s Centre for Social Research in Health.
The Annual Report of Trends in Behaviour 2014 found the decline in condom use among gay men was one of the key drivers in HIV transmission.
There was also an increase in the proportion of HIV positive men with casual partners reporting unprotected sex, from 51 per cent in 2004 to 67 per cent in 2013.
The centre’s director, John de Wit, said as HIV treatment had improved, so had the number of infections increased.
“Most people will not die of HIV so it’s become less of a health threat in people’s minds, which results in – intentionally or unintentionally – people taking more risks.”
But Sydney Sexual Health Centre director Anna McNulty said people were still worried about acquiring HIV.
“Men are taking significant steps to protect themselves, but that’s moved beyond just condoms,” she said. “Sometimes people make assessments that probably assume someone’s HIV positive when they’re not.”
The NSW government launched a campaign in February to end HIV by 2020, but the prospect seems more remote than it has been since the nadir of new infections in 1999.
There has been a 9 per cent increase in HIV diagnoses over the past 10 years.
“The problem is that we’re not even nearing an end,” Associate Professor Wilson said.
“In fact we’re seeing an increase. We don’t have a cure and there’s no vaccine in sight.”
A study involving 10 sexual health clinics with patients on the Australian HIV Observational Database found that chlamydia infections among HIV positive men who had sex with men nearly doubled between 2004 and 2011, and gonorrhoea infections also increased.
The research, published in the journal Sexual Health last week, speculated that serosorting is pushing up the rate of sexually transmitted diseases.
“It is quite possible that these behavioural strategies are effective at reducing HIV transmission risk but have no effect on STI transmission,” the study said.
A staff member at the Darlinghurst sex club Signal said it would be discriminatory to reserve rooms for men who were HIV positive.
“We don’t really know if they’re practising safe sex or not, or anyone’s HIV status,” the staff member said.
“We promote safe sex. What people do is up to them.”