The approach used by Le Vu and colleagues adds substantial value for accurately understanding epidemic trajectories. Importantly, they show a persistent and high incidence of HIV among men who have sex with men (MSM) in France, a situation they describe as “out of control”, whereas HIV incidence has declined in all other major population groups.
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The treatment as prevention strategy aims to reduce community viral load and assumes that this will reduce HIV transmission at the population level. Ecological studies and limited retrospective analyses suggest that treatment might have a preventative role for heterosexuals and people who inject drugs; however, it might be too optimistic to assume that this strategy can be effectively applied to MSM because of higher biological transmission rates and the sexual milieu of MSM. As explained by Le Vu and colleagues, such a milieu includes a high HIV prevalence, together with increased rates of unprotected anal sex with more partners and increased prevalence of sexually transmitted infections. Thus, merely intensifying a treatment as a prevention strategy for MSM without addressing other co-existing issues at the individual or community level is not going to lead to sustained changes to HIV epidemics.
So note what they're saying: there is a high prevalence of gay men who sleep around without using condoms.
The objection about straights also being promiscuous is often raised.
But here's the deal.
Collectively speaking, straights are not nearly as promiscuous as gays.
Why is that?
First it has to do with the procreative aspect of heterosexual sex. If pregnancy can result from your sexual activity, you are far less likely to engage in multiple relationships. There's more at stake than a mere orgasm.
Secondly, it also has to do with the nature of women. Women who are promiscuous eventually end up not being happy. Because sex is the icing on the cake of what they really want: undivided attention and love. And if they don't get that, they won't play ball. It's so hard-wired into women.
But male homosexual encounters don't have those characteristics. Men like sex. If they don't have to worry about babies or living up to female standards of emotional connection, they're going to have a lot of it. More so than if women only are involved.
This is a no brainer to anyone who stops and thinks about it. It's not a so-con thing, it's a common sense thing.
We've thrown condoms at the problem before. And it's not going to solve the problem.
The problem is the nature of male-on-male sexuality itself. It simply refuses to be restrained on a collective scale. Men, especially men unrestrained by a traditional moral code, like to think with their peckers.
The medical authorities will go on to examine the issue of why men take risks, blah blah blah as if the answer is evident in and of itself.
Who thinks of condoms when you're horny? Who likes the feeling of putting that little bit of latex? You want to be carried away by the emotion, no think about "practical" things like HIV transmission. It's the same reason men convince women to have sex even with the risk of pregnancy. At that particular moment in time, they don't care. Also consider the prevalence of alcohol and drug abuse in the gay community. If you're high, are you really concerned about your health?
The real solution to the HIV transmission issue in MSM is abstinence, but no one would dare suggest such a thing. It goes counter to the very nature of the sexual ethos that leads to all this HIV transmission. Of course, it would save lives and prevent countless untold heartache.
But perhaps many men would rather be promiscuous and suffer with HIV than actually eliminate the risk of transmission.
What is really necessary is a change of heart. Not a change of policy. Not a new prevention scheme. It's all window dressing. The men will grow weary of all this practicality and will eventually go back to their old ways. The political correctness is not saving anyone.
