Shaun de Waal Body Language One hates to sound like Bill Clinton, but what exactly is meant by “having sex”? The “Shock survey on gay sex” story in last week’s Mail & Guardian rather blurred the issue an issue which one suspects remains fuzzy in the minds of many heterosexuals, not just those who are still shocked by the idea that gay men have sex at all. What does it mean to “have sex”? Heterosexuals are inclined to think of full vaginal/anal penetration as “having sex”, and the rest as foreplay. If two men fondle each other in a dark corner of a club, without either reaching orgasm, have they actually had sex? Mutual masturbation may be unprotected sex, but is it unsafe? Is oral sex sex or just playing around? It’s always hard to get one’s head around statistics, but these, as presented, seemed especially confusing and possibly misleading when read with an uninformed, lazy or prejudiced eye. For a start, the survey represents only men who frequent venues in Cape Town where it is possible to have sex with other men or to pick someone up. Apart from the fact that this does not represent gay men all round South Africa, Cape Town being such a “gay mecca”, it does not represent gay men in general. It may show a small percentage, even within the age-groups cited only 185 men were interviewed for the survey. Many gay men find such casual sexual activities distasteful and avoid them like the plague. To speak of “gay sex” as one undifferentiated lump is both insulting and inaccurate. The survey itself, commissioned by the Triangle Project, is clear about the fact that it is “a first attempt to gain a ‘snapshot picture’ of this activity” to inform “immediate strategic planning of HIV-prevention initiatives” and to “provide a baseline for future, similar surveys”. It includes more detail than was included in the article, obviously, and is clearly of vital importance. But the story does not enable the statistics, as given, to illuminate each other. More than half the men interviewed had sex with up to 10 partners in the past year; on the other hand, 71% had, as the survey itself puts it, “some form of anal intercourse in the last year”. Was that with one partner out of 10? Two? Three? And 25% of those did it unprotected: does that make-one fifth of the men interviewed? How do these figures overlap? We have little idea of frequency from the story, though the study itself isolates “at least 23 occasions when men had had unprotected [receptive anal intercourse] that involved potential risk of HIV-transmission”. How shocked should we be? Going beyond the specific remit of the survey, we can ask important questions of both fact and perception, raising issues that need to be investigated more fully (as the survey acknowledges). The results as reported seem to presume a black-and-white difference between safe and unsafe sex. But this is a grey area. For a start, there is no safe sex only some forms of sex that are safer than others. It’s all relative, a continuum, with the degree of risk contingent upon a huge variety of factors, including the viral load borne by an HIV-positive man at the time of sexual activity. We need more information and the issues raised by the survey need to be opened out, explored further and carefully debated, rather than being presented as simply shocking. The point by the Triangle Project that gay men are statistically under-represented in state HIV surveys because they don’t attend antenatal clinics, and that there may thus be a “hidden epidemic” of gay HIV/Aids is valid. But these findings must be placed in context. It seems to be the consensus that in South Africa white (62% of those surveyed) gay men are not a high-risk group it is black women who are most at risk. If the survey’s finding that 7,7% of the men believed they were HIV-positive is reflected in clinical reality, that figure is still lower than the national average for HIV positivity. How about comparing these statistics to some numbers showing sexual behaviour in the society as a whole? What percentage of heterosexual men have had unsafe sex in the past year? And with how many partners? Without the capacity to place the gay survey statistics in a broader context, it is hard to tell whether the “shock” results are truly worrying or merely the hyperbole of headline writers insensitive to nuance and the fine grain of fact.
The finding that younger gay men are more likely to take sexual risks is sobering; they need urgently to be targeted for education. But then so does the population at large, and, for many, this kind of piece will confuse as much as it clarifies.