What is therefore needed is an analysis of Bailey’s data. Why are persons in homosexual relations prone to be in illegal lottery scams? Is it because they are faced with discrimination at the workplace and cannot get or retain a legitimate job? Or are they suffering disproportionately because of the economic hardships? Is it that their lifestyle requires big bucks?

Additionally, some persons who appear to be sporting a homosexual lifestyle have been noticed to shop in groups. Is it that they are proud of the lifestyle and want to flaunt it, or are they afraid of violence and feel safe in a group? It seems to me that there needs to be more research done on persons within this community.

Not surprisingly, Jamaica’s lonely gay rights group, J-FLAG, was concerened that this would give homophobes one more reason to beat the shit out of gay men. Much more surprisingly, Jamaica’s top cop was also upset by the statement; although Bailey refused to retract it, his boss apologised on behalf of the Jamaican police.

It happens that J-FLAG has roped Miss Jamaica and her gay brother into a new campaign that aims to start chipping away at homophobia:

I’m in two minds about it. On the downside, the phrase “unconditional love” implies loving someone despite some hideous deformity in their character. I love my brother even though he’s… (sharp intake of breath, try not to hold your nose)…gay. On the more positive side, it does make sense to try and start from where the target audience is, and it’s clear that most of the target audience in Jamaica are very far from being ok with gay brothers. So far, indeed, that the national TV station has refused to carry the ad.

I’m interested that Rev Dick felt the need to point out that Jamaican political satirist Owen Blakka Ellis, who has had the gall to say that being gay isn’t so bad, was a “returnee from Canada”. Obviously he’d be pro-gay, then, Canada being a paradise for over-entitled whiny gays, seems to be the implication. It’s true that Canada’s at the other end of the gay stigma spectrum from Jamaica.

I have been accused (with some justitification) of being impatient with people who pull the stigma card when they have things so relatively easy. But this beautifully written, nuanced essay about young gay men in Canada from Michael Harris reminded me that “relatively easy” does not mean “easy”. The tornado that was AIDS has been more or less dissipated by treatment in Canada, but the wreckage it left has indeed shaped the landscape for another generation. Read it, please (pdf here).

The screen shot above shows a small corner of Filth Fair, a new, quite clever word game app commissioned by the somewhat staid scientists at The Wellcome Trust to go with their new Dirt season. On the left, the app before the Apple censors rejected it. On the right, the revised version. Even then, it has a 17 age rating; though the censors don’t have to give reasons for their decisions it appears that they remain upset about the use, hidden within the painting/puzzle of the words sex and pornography.

I remind you that these censors sit in a country which allows pregnant girls to marry at 14 in some states. To see a fig leaf on your phone, though, you have to be 17.

The Apple censors didn’t apparently, think there should be any age restrictions on homophobia. A recent app from Exodus International that seeks to cure people from the affliction of being gay was released with no age restrictions. Needless to say, there was quite a bit of protest. I’m glad to say that sense beat the censors, and the anti-gay app has been removed.

If you’re in London, I’d urge you to visit the Dirt exhibition. Perhaps because of my own dirty mind, I got roped in to writing a chapter for the book of Dirt, that goes with the exhibition. There’s quite a lot of fun stuff in it, quite apart from the sex and drugs bits.

The song was banned by the Canadian Broadcast Standards Council after a solitary Eljibiti radio listener whined that it bruised their fragile soul.

Every reader my age knows the “MTV” song virtually by heart — boneheaded delivery men being grumpy about the absurd amounts of money made by boneheaded musicians with more mullets than talent. The offending lyrics include the following:

“See the little faggot with the earring and the makeup
Yeah buddy that’s his own hair
That little faggot got his own jet airplane
That little faggot he’s a millionaire”

Our Sensitive Soul found this “extremely offensive” and labeled it “discriminatory”. Since the complainant says they are a member of the Eljibiti Community, I’m assuming they consider it to be offensive to gays rather than to rock stars. But that confuses me. A pop classic which won the Grammy for record of the year in 1986 portrays homophobia as a sentiment expressed by bigoted and resentful boneheads. One person in Newfoundland, who apparently has not mastered the skill of switching off the radio, considers the association of homophobia with stupidity to be offensive. And six adults of sound mind meeting on behalf of the Canadian Broadcast Standards Council spent I’m not sure how much time coming up with a 5000+ word decision that boils down to this: “The song contained a word that referred to sexual orientation in a derogatory way.”

Give me strength.

The decision makes for amusing reading, dredging as it does through the history of similar complaints. It seems that even more sensitive souls have in the past been upset by songs and skits about cigarettes (fags, to a good British sometime smoker such as myself). Of course the way Canada is going, it’s not impossible that cigarettes will soon be outlawed, with all evidence of their existence digitally excised from old Humphrey Bogart films.

In fairness, I should note that the overwhelming majority of Canadians of all sexual hues commenting on the Globe and Mail’s report of the ban think it is just plain silly. But I think I’ll try be more careful about my “hookers, fags and junkies” shorthand when I next visit Canada, just in case. I wonder if any radio listeners in Newfoundland are offended by any of these words: Big. Girl’s. Blouse.

The Canadian ruling is the more complex, because it has given us the right decision for the wrong reasons. A judge has said the nation’s blood transfusion service can refuse gifts of blood from men who have had sex with other men. The right reason for this decision is that it is a cost-effective way of reducing the likelihood that sexually transmitted viruses, in particular HIV, make it in to the blood supply. The reason given (which I think sets a bad precedent) is that the blood transfusion service is not bound by legislation intended to reduce discrimination against people who choose anything other than vanilla sex, because it is not a government agency.

Of course that’s nonsense. You shouldn’t be allowed to discriminate against people on the basis of who they choose to have sex with in the private sector, in NGOs, in schools or anywhere else, unless they are choosing to have sex with someone who doesn’t or can’t consent. But I don’t believe that asking gay men not to give blood is discriminatory. None of us has a right to put out body fluids into a pool from which the public will draw, and the judge, Catherine Aitken, agreed, saying: “Put simply, blood donation is a gift. A gift is freely offered, but also must be freely received, or freely declined….There is no requirement under the law for CBS, or any other blood provider, to accept the gift of blood from anyone.”

I do agree that the exclusion criteria are a little draconian. “A man who has had sex with another man even once since 1977 is not allowed to donate blood in Canada or the United States,” says the blood service. In terms of HIV, what we’re most worried about are brand new infections — people who have lots of virus in their blood but haven’t yet got enough antibodies to HIV to show up on the screening tests that blood banks use. Those are the ones more likely to lead to the “tainted blood scandals” (blerch) that got the voters so exercised about blood safety in the first place. Blood donated by people who’ve been infected for longer will get picked up in the normal screening process so it’s not quite such a drama if they give blood. In most countries, it make it more expensive for the taxpayers who foot the bill, because blood is pooled into batches for testing, and any reactive test, including false positives, mean the whole batch gets thrown out. (Canada tests individual units so that’s less of a problem).

Activists whine say that refusing to accept blood from gay men tars them with the brush of “AIDS victim” and reinforces stigma. “Not everyone who is gay has AIDS”, declared Kyle Freeman when he brought the case against the blood service that precipitated the ruling. Well of course not. Not everyone who is gay has HIV, either. But in Canada, a gay man is around 20 times more likely to be infected than a heterosexual (pdf) (51% of HIV infections are concentrated in the roughly 4% of sexually active adults who are gay men). If gay guys think that fact is stigmatising, they might want to reinvigorate HIV prevention efforts in their community. Screening men who have sex with men out of the pool of blood donors is not discrimination, it is common sense. (As an aside, I find it interesting that no-one seems to be whining complaining about the rights of drug injectors being violated because the blood service won’t accept their blood. Surely their rights are being violated in exactly the same way, even though they are actually less likely to be infected with HIV than gay men in some Canadian cities).

Meanwhile, across the border, American courts continue to chip away at the great edifice of true discrimination against people who choose their sex partners according to their own taste, rather than that of the Sex Police in groups like the Traditional Values Coalition. Hot on the heels of a ruling that repealed a ban on gay marriage in California, another California judge, Virginia Philips, has ruled that the “don’t ask, don’t tell” rule that makes it impossible for openly gay people to serve in the military is unconstitutional. This is very good news indeed; let’s hope the mid-term elections don’t scare the administration and the Senate into prolonging the agony for gay men and women who want to invest their lives waging war on behalf of the citizens of the US.

Thanks to Sarah Chown for nudging me to write about this.

So gay guys go on having unprotected sex after they are diagnosed with HIV, a new descriptive study of gay poz guys at a clinic in Boston tells us. Nothing new there, although it’s sobering to be reminded that one in two of the men who know they have HIV choose to bareback with someone who may be negative.

The most important finding from the Boston study is that the more recently diagnosed a guy is, the more likely he is to be exposing other people. We can’t tell from the paper if that’s something new. It may be that there’s a blast of screwing around soon after diagnosis, possibly as a reaction to it, then a calming down. The post-diagnosis binge is one of the possible explanations given by NAM’s ever-sensible Gus Cairns, posting over at rectal microbicide site IRMA.

The thing that most determines whether a poz guy will pass on HIV during unprotected sex is his viral load. We know that’s likely to be highest for the few months after he first gets infected. So if we do get better at detecting HIV early and we don’t do anything about bringing viraemia down instantly, the “post-diagnosis sex binge”, if real, would be a worry we’d have to add to the known dangers of the “slutty phase” that affects undiagnosed men as well.

Gus gives us another potential explanation:

3. The historical explanation. It can’t be about young gay men not having experienced AIDS, because it was recent diagnosis that was the risk factor, not age. But it could be about prevention fatigue that affects all ages, and lack of relevant, effective and up to date messages. The result would be that the recently diagnosed have higher risk behaviours (and have caught HIV) because they haven’t internalised prevention messages in the way that the longer-term diagnosed seem to. Does risk behaviour decline over time in the longer-term diagnosed for one reason or another (more ease of disclosure, self-education, awareness of criminalisation, catching one too many STIs, etc) or will men diagnosed today continue to be higher-risk than men diagnosed years ago?

If it’s a binge thing, behaviour will get safer over time. If it’s an “I’ve zoned out HIV messages” thing, it won’t. But there might be something else going on: The “HIV isn’t so painless after all” thing.

One of the reasons that HIV prevention messages are failing is that much of the public health world still treats HIV as though it’s AIDS, as though it is self-evident why you would want to prevent it. But now that AIDS has virtually disappeared, what’s the big deal about HIV? Why bother to protect yourself, or to avoid passing it on?

Guys who were diagnosed longer ago are more likely to have realised that HIV (like diabetes and arthritis) is actually more than a one-pill-a-day shrug-off. The ups and downs of treatment — having to call off a date because you’ve blown up like a tomato, worried that your boss will see you popping pills, having to cancel a day’s skiing because you’ve got to go for your viral load monitoring, — it can be a real pain. A pain that, on reflection, you might go out of your way to avoid passing on. That may be one reason why people who were diagnosed longer ago are less likely to expose their partners to HIV.

But treatment is improving all the time; as prevalence goes on rising and the ick factor falls, HIV becomes less and less of a pain. It seems likely to me, then, that barebacking will continue to rise. That makes people in public health crazy, of course. We have to think about resistance, a reappearance of AIDS, costs to the health system. But frankly, the guys who think HIV is no big deal at the individual level are not entirely wrong these days, at least in rich, socially tolerant countries with good health systems.

Ken Mayer and his colleagues in Boston end their paper by saying that we need “Innovative programmes that facilitate education and skills building around safer sex when MSM are relatively recently diagnosed”. But frankly, we’re never going to figure out how we should prevent HIV in a post-AIDS world if we can’t make a convincing case to the individuals most at risk that we should prevent HIV.

For more nerdy observations on the Mayer and co. paper, read more.
As far as I can tell, the paper looks at syphilis, gonorrhea and chlamydia in HIV-positive gay men who come to a gay-friendly clinic for health care. It seems that guys are deemed to have had an STI if they test positive in a baseline study screening or if their clinic records say they had any one of those infections in their urethra, rectum or throat in the year before the start of the study or. But the arse or mouth appear to come only from clinic records. If that’s correct, then pharyngeal and rectal infections may be substantially underestimated. Rectal STIs include infectiousness in Bottoms, which is worrisome for negative guys practicing “strategic positioning” — only ever being the Top when they’re barebacking with a guy who is poz and who’s status they don’t know.

The study does have some measures of viral load at baseline; guys with detectable viral load (>75 copies/ml) were 68% more likely than guys with undetectable viral load to have barebacked with someone who might be negative. Since viral load is THE key in transmission, that’s not good. The effect disappears, though, if you sling it in to a model with a lot of things that are related to viral load, including meds and years since diagnosis. But it would be hard to wave too many flags about that anyway — viral load is apparently measured only at baseline, while the unprotected sex we don’t want to see in conjunction with it can be up to six months previously, and STIs (which also lead to spikes in viral load) up to a year previously. As though that’s not enough confusion about time periods, drug use is measured up to three months previously.

Just to be clear, the thing that the Boston gay community (and/or the public health authorities) need to be most worried about in terms of ongoing spread of HIV among guys in care, are, in this order:

• Poz guys with detectable viral load being the top in bareback sex with guys they don’t know are poz

• Poz guys with urethral STIs being the top in bareback sex with guys they don’t know are poz

Drug use: ah yes. I was surprised by two things. The first is that “binge drinking” (defined as five or more drinks in one day any time over the last three months — oh dear, oh dear) is so low — at 19%. The other is that crystal meth use is so high — 23% worship at the shrine of Tina. If there is one mistress that makes you behave worse than most, it is surely Tina.
On the other type of drug, there’s a bit of a surprise too while 66.1% of the nearly 400 guys in this study are on ARVs, only 54.4% had an undetectable viral load. That means that over 11% of these men are on meds and don’t have an undetectable viral load in a single baseline measure. Pause for thought for those who’s prevention strategy relies on thinking “Oh well, if he’s poz he’s probably on meds so he’s not infectious”.

One more deeply curious finding. Men who had any unprotected anal sex with someone that they didn’t know was HIV-infected over the last six months were over four times more likely to have had an STI in the last 12 months (odds ratio 4.42, 95% CI 1.88 – 10.36). But when they looked separately at insertive and receptive anal sex, they found lower chances of infection for both. In receptive anal sex, which you might expect to be associated with greater risk of STIs generally, guys were under four times as likely to have had as STI as those who never took it up the butt without a condom, and despite the fact that it’s by definition a subset of the previous measure, the confidence interval is narrower (OR 3.86, 95% CI 1.78 to 8.28). In insertive anal sex, which you’d expect to be perhaps less likely to associated with STIs, it was lower still: guys were just over twice as likely OR 2.11, 95% CI 1.04 to 4.30). I’m on a flight right now without my trusty stats textbooks, but in my mind, those you can’t have smaller sub-sets of the same measure giving you tighter confidence intervals.

Maybe they are not sub-sets. The “risk behaviour” measure is unprotected anal sex with anyone who is not known to the poz guy to be infected with HIV. In the results section of the paper, the other two measures are described as “unprotected serodiscordant insertive anal sex” and “unprotected serodiscordant receptive anal sex”. In other words, it’s possible that it excludes the “don’t know his status” partners, although the truth of it is that the only status you every really know for any length of time is poz. As the paper says in its introduction, poz guys have higher rates of all these infections, especially syphilis, so if there were a way of restricting the analysis to those who only had truly negative partners, you’d perhaps get those lower rates. But you’d still likely have wider confidence intervals.
In my day job, I teach a course in scientific writing; it includes a fair bit of paper critique work. If I were to add this paper to the course, what else would you expect students to pick out?

The IAS conference on HIV Pathogenesis, Treatment and Prevention in Cape Town, South Africa produced its usual crop of second rate abstracts on issues currently fashionable in the HIV industry — gender, health systems strengthening, scaling up — along with the inevitable calls for more cash. The IAS also runs the biennial international AIDS conferences — giant circuses full of amusing but expensive set-pieces: protesting sex workers, singing orphans, earnest celebs. There’s so little science at those conferences that a lot of researchers have abandoned them in favour of low-key, high-science meetings such as CROI. It seems IAS is trying to claw its way back on to the scientific platform with the pathogenisis sub-conferences. Perhaps we’ll see more good sense from the organisation now that it is coming under the spell of the inimitable Robin Gorna.

Among the conference’s silliness was a study of the protective effect of circumcision in anal sex between men in Soweto. It’s hard to tell much from an abstract and this came from a good research team so perhaps I’m being unfair. This cross-sectional study (picked up by IRMA) reports results for men who only ever act as tops in anal sex with other men. Not one iota surprisingly, the results are exactly the same as for men who only ever act as tops in vaginal sex with women (i.e. all men who have vaginal sex): uncircumcised men are four times more likely to be infected with HIV.

What does that tell us? Almost nothing of any use in HIV prevention programming. Over 13% of the guys in the study had HIV. In the very high prevalence settings of Southern Africa, guys (and boys and infants) should be getting snipped regardless of their eventual sexuality. We don’t need more clinical trials of exclusively insertive MSM to prove that, especially since 80% of these blokes are also shagging women. But the South African study doesn’t mean gay guys in other parts of the world will necessarily be protected by circumcision. In this study, three quarters of respondents said they were only ever tops. (If you believe them, spare a thought for the remaining quarter; they must be getting poked painfully frequently just to make the numbers add up.) If you don’t believe them it may well be because that degree of role separation is unusual in many gay communities. Indeed one of the reasons HIV spread so rapidly among gay men is that the very people who are most likely to get infected (because they’re taking it up an orifice not designed for the purpose) are also most likely to infect others (because they give as good as they get). Heteros don’t have that flexibility, and that slows transmission down.

For practical purposes what we’d like to know from the Soweto data is: does circumcision protect men who have anal sex against HIV regardless of whether they are a top, a bottom, or “versatile”?

More silliness from Canada on needle exchange, but some good news from the States on that front, too. Of which more after I’ve unpacked more boxes. In the meantime, this comment on trafficking hysteria from another member of the Silliness Police over at Preipheries.

The day before the UK release of Bruno, Sasha Baron Cohen’s swish along the catwalks of homophobia, the UK’s House of Lords voted to allow Brits to criticize homosexuality. Gay groups are painting this as a victory for homophobia. Christian groups say it is a victory for free speech. I say, on balance, that it is a victory for common sense.

The debate focused mostly on the difference between criticism and incitement to hatred. Is it wrong to teach schoolkids that it’s OK to thump anyone who they think is a sissy? Yes, just as it is wrong to encourage violence against anyone with the “wrong” skin colour. But should people face prosecution for open debate about the pros and cons of gay marriage, nuclear families with same-sex parents and the like? Surely not. We may not like people who are crtical of the things we hold most dear, but our society is built on their right to criticise our views, and ours to criticise theirs.

For my part, I would be more than happy to criticise (possibly even thump!) the self-righteous prig who told The Moral Maze that she didn’t think that gay people ought to be allowed to work as gardeners in Christian schools. (Replay of programme available until 18/07/09) I kept willing one of the panelists to ask her what she thinks Christ would have done (or indeed did do) if any of that tight little band of apostles was gay. I find her views pretty offensive, but I don’t think she should be locked up for expressing them.

If we want treatment to work as effective prevention, we need to do more to indentify cases soon after infection. That means doctors knowing their patients may be at risk for HIV, which in many countries means knowing if their patients are gay. I’ve written before about doctors’ squeamishness about sexual history-taking, and I think gay men, drug injectors and sex workers might want to let on to their doctors that they are gay. But reading this excellent post from Ickaprick, I can see why people don’t want to, at least in Canada.

The most interesting thing for me about the post (read it, do) is the stereo-type swapping. You want freedom of religion, so that you can deny me freedom of choice over my sexuality. Make anyone out there think about the voting patterns behind Prop 8?

The US is one of nearly 60 countries which stamped its feet in opposition to France’s declaration (made in the United Nations general assembly) that homophobia is a bad thing. The New York Times reports that 66 nations supported France as it called for homosexuality to be decriminalised around the world — some 80 countries still forbid people with similar genitals from having sex with one another.

Needless to say the Vatican and the Organization of the Islamic Conference, well known bastions of tolerance and human kindness, were at the forefront of the bigotry. They said allowing people who love one another to have sex “threatened to undermine the international framework of human rights by trying to normalize pedophilia”. Merry Christmas to you, too.

And it wasn’t until much later that I learned that the other great barrier to equality had been shored up, for now. Three states have supported a ban on gay marriage and a fourth has entrenched its prejudice. Nowhere is this more disappointing than in California, which began to allow people so joyously to marry in June. Needless to say the support for Proposition 8, which reversed the ability of people who love one another to marry even if they happen to have similar genitals, is now bringing people out on the streets of San Francisco in protest. Needless to say, Sarah Palin’s mates at the Traditional Values Coalition are gloating over their victory. Their new book, “The Agenda: The homosexual plan to change America”, yours for just $19.99, is a textbook on how to play dirty in political campaigning.

It makes me cross, of course. But I can’t help agreeing with Andrew Sullivan that this is not a fatal blow to the right of people to be treated equally regardless of which adults they choose to have sex with. As he points out, when California last voted on this in 2008, 61 percent of people who cared enough to tick a box were opposed to gay marriage. This time it was just 52 percent. (There are some interesting graphics on the LA Times website.) Voters appear to become more in favour of gay marriage with every generation so as the dinosaurs age out of the voting pool and more younger voters replace them, the margin will almost certainly be reversed.

In fact, the ban on same-sex marriage in California would probably have been ditched on Tuesday if it weren’t for Obama. I find it somewhat ironic that the very voters who were tearing down one set of prejudices were busy shoring up another. Black voters, who turned out in unprecedented numbers to put a black family in the White House, voted heavily against gay marriage.