Is he likely to be HIV-positive?

In most cases, when gay men have sex with someone new they will not know the HIV status of their partner. Research suggests that one in seven gay men on the London gay scene has HIV.1 Up to a quarter of these men have not been diagnosed and so probably do not know that they are HIV-positive.2

Even if we knew exactly what percentage of gay men are living with HIV it would not tell you what the actual chance is of you having sex with someone of a different HIV status. We do know that there are HIV-positive men in every part of the UK and that there are HIV-positive men of every age and nationality. Estimates suggest there are 35,050 gay men with HIV in the UK.2

Because of advances in treatment, it is becoming rare that someone shows visible signs of HIV infection, such as facial wasting or the skin cancer Kaposi's sarcoma. The majority of men in the UK living with HIV will probably not have any visible symptoms and so you will not be able to tell by looking at them. It's easy to think that only a certain 'type' of gay man is likely to have HIV but this is not true. There are men on the extreme sex circuit who are HIV-negative, just as there are HIV-positive young guys dancing to Kylie at Ku Bar on a Saturday night.

It is unrealistic to expect someone to tell you their HIV status. According to research, about three quarters of gay men expect HIV-positive men to disclose their status before sex.3 But in fact about a third of men living with HIV never disclose their HIV status to casual sexual partners. Just under half of HIV-positive men sometimes tell the men they have sex with that they are positive, and about one in five always disclose their HIV status.4

This doesn't mean that HIV-positive men are deliberately misleading their partners – just that many of them decide not to tell. This could be for a variety of reasons, such as an expectation that there will be no risk of HIV transmission in the sex, a belief that both men are positive because neither has mentioned condoms, or a fear of rejection.

So long as HIV is associated with stigma and fear, telling someone you're positive is likely to lead to rejection – and who wants to be rejected?

The fear of rejection is not unfounded. Research has shown that just over half of HIV-negative men would not want to have sex with a positive man.5 With so much rejection it's not surprising that many HIV-positive men decide to keep quiet about their HIV status, especially if they're not expecting to have unsafe sex, or if they're in a situation where it's hard to talk.

Most gay men, whether they are HIV-positive or HIV-negative, have safer sex most of the time. Because they expect that the sex will be safe, many HIV-positive men won't disclose their status because they don't think it's relevant. At other times and in other places, for example saunas and backrooms where conversation isn't expected, it's difficult for a positive man to find a way to talk about his status, even if he wants to. In these situations it's also unlikely that an HIV-negative man will reveal his status, even if he's about to have unprotected sex with a stranger.

Many HIV-negative men tend to think that if someone is willing to have unprotected sex with them, they will also be HIV-negative. And many HIV-positive men believe that if someone is willing to have unprotected sex with them, it's because they are also HIV-positive. This is how HIV is often transmitted. If someone you're going to have sex with doesn't mention HIV, it doesn't necessarily mean that he has the same HIV status as you. It just means he's chosen not to talk about it.

Another reason why a positive man may not reveal his HIV status is that he may not know that he is HIV-positive. It is estimated that just over a quarter of HIV-positive gay men in the UK have not been tested since they were infected, and many of these men will believe that they are still HIV-negative.2

If everyone only had sex with people who had the same HIV status then there would be no increase in the number of people living with HIV. Sero-sorting is the name given to the practice of selecting partners with the same HIV status (i.e. HIV-positive men only sleep with other HIV-positive men, HIV-negative men only sleep with other HIV-negative men). Some HIV-positive men use online dating sites, such as Gaydar, to find other HIV-positive men for condomless sex, because they feel more able to disclose online (although many positive men still won't choose to give out that information about themselves).6

If you're HIV-negative and only have sex with other HIV-negative men then you won't catch HIV from sex, although you still risk catching other STIs. However it's very difficult to be sure that the men you have sex with really are HIV-negative.

Guys are more likely to fuck without condoms if they think someone has the same HIV status as them. But research has shown that around 40% of HIV-negative men who say they 'know' their partner's HIV status are in fact guessing.7

If you are sexually active and have taken even small risks in the past, the only way to be sure of your status is to have an HIV test. It's not sensible to have unprotected sex with someone you've just met on the basis that they say they're HIV-negative. If they're willing to take that risk with you, they're probably willing to take that risk with other people too, and it's possible that they're HIV-positive but don't know it.

The fact that there have been prosecutions for transmission of HIV does not mean that HIV-negative men can assume that they are not at risk. There will always be positive men who are unable to disclose their HIV status, because there are men with HIV who have not had an HIV test and so do not know that they have HIV. Even if all positive men were aware of their HIV status, it's likely that many men, for a variety of reasons, would choose not to disclose their status before sex.

References:

1 University College London (UCL), Health Protection Agency (HPA). Gay men's sexual health survey 2009 in 36 gay venues.

2 Health Protection Agency (HPA). HIV in the United Kingdom: 2010 report. Health Protection Agency, November 2010.

3 Weatherburn P, Hickson F, Reid D, Jessup K, Hammond G. Multiple chances: findings from the United Kingdom Gay Men's Sex Survey 2006. Sigma Research, 2008.

4 Hickson F, Weatherburn P, Reid D, Jessup K, Hammond G. Testing targets: findings from the United Kingdom Gay Men's Sex Survey 2007. Sigma Research, 2009.

5 Hickson F, Bourne A, Weatherburn P, Reid D, Jessup K, Hammond G. Tactical dangers: findings from the United Kingdom Gay Men's Sex Survey 2008. Sigma Research, 2010.

6 Velter A, Bouyssou-Michel A, Arnaud A, Semaille C. Do men who have sex with men use serosorting with casual partners in France? Results of a nationwide survey (ANRS-EN17-Presse Gay 2004). Eurosurveillance, 2009;14(47):pii=19416.

7 Zablotska Manos I, Prestage G, Rawstorne P, Imrie J, Grulich A, Kaldor J, Kippax, S. Practice of serosorting: will it minimise HIV transmission risk? 8th international AIDS Impact conference, Marseille, July 2007; abstract 282.