Surveys, statistics & fearmongering about gay sex (part 2)

My last post looked at how the Irish Independent presented some recent findings from the first Healthy Ireland Survey regarding condom use among gay and bisexual men in Ireland. The Independent made the alarming claim that “risky sex is widespread among gay men,” but a careful examination showed that while that may or may not be true, it was a misleading interpretation of what was reported in the Summary of Findings from the survey.

In this post I’ll look at some other claims in the article and think about what kinds of information would be helpful for efforts to turn around the rising rates of new HIV diagnoses among gay and bisexual men in Ireland.

Won’t somebody please think of the children?

Given his high profile and the upcoming release of his film, I’m sure the reporters were delighted to get a quote from entertainer Rory O’Neill—better known by his drag moniker, Panti Bliss. According to the caption on the photo of O’Neill at the top of the article, he “expressed his shock at the statistics” but from his comments, I’m not sure what statistics he was actually looking at. He told the Independent:

“I am shocked. I think a younger generation of gay people don’t remember the shock and the fear and people getting sick and dying.”
“They see a pamphlet about safe sex – it’s so removed from their experiences. Young people always think they are invincible, protection is not part of their agenda.”

Suddenly it seems we’re not talking about gay and bisexual men generally, we’re talking about young gay men.

Now, I don’t disagree that there are big differences in how gay and bisexual men relate to HIV today compared to 20 years ago. I’m frankly delighted that young gay and bisexual men won’t suffer through the same traumatic experiences that those of us a few years older did, that they will not be haunted by the memories of friends, lovers, and countless strangers who suffered and died. That’s something to be grateful for, not something to use to berate younger men.

And I quite agree that there’s a problem with the way HIV has disappeared as an issue in the gay community. I don’t pine for “the shock and the fear” of the past, but I do worry that HIV seems removed from gay life, that it’s treated as a concern for some, but not most of us. That’s a mistake and I think it’s a big part of why we’re seeing such dramatic increases in diagnoses. But it’s a problem that affects all of us in the community, not just young men.

In any case, what did the Summary tell us about young gay men specifically? In fact, nothing. When it reported that “54% of men who most recently had intercourse with another man did not use a condom” that included men of all ages. We’re provided with no information about young men specifically.

Well, actually that’s not quite true. The authors of the Independent article don’t mention it, but the Summary notes that:

“Major differences exist across age groups in terms of condom usage with two-thirds (66%) of 17-24 year olds using them compared to 5% of those aged 65 and over. Men aged 17-24 were most likely to have used a condom (69%)”

Again, we lack any kind of breakdown of what the figures for younger gay and bisexual men look like. Although we’ve already seen that gay and bisexual men use condoms more frequently than average, that may or may not also be true for younger gay and bisexual men, the Summary doesn’t tell us. All it says is that overall it’s specifically younger men who seem to be using condoms most frequently!

Ah well, why let a lack of evidence get in the way of a juicy quote?

Is there anything new here?

O’Neill’s comments also imply that this survey reveals something new and different. Are men using condoms less often than 5, 10 or 20 years ago? Have the ways they make decisions about when and with whom to use condoms changed? Knowing the answers might help explain the rising rates of new diagnoses, but the information here sheds little light on questions like these.

Having data that you can directly compare over time lets you see how things are changing. It lets you know where attention should be focused and what kind of impact the efforts you’ve been making are having.

The sporadic surveys of gay and bisexual men in Ireland have used different sets of questions and different methodologies, making it difficult to track trends across time. Even if we knew more precisely what this new condom usage figure actually meant, the disparities among previous surveys means we have nothing to directly compare it to.

This survey will be repeated (for the next two years at least) so we will eventually be able to see if there are changes over time, even if for just a few data points. Right now though we have only a static figure that doesn’t tell us much, certainly nothing about whether it represents a change from the past.

What do we need?

Given all we know about HIV prevention today, I think we should be asking how pertinent and useful the information being collected in this survey really is. Does it help us understand why HIV infections are increasing among gay and bisexual men in Ireland? Does it point to what is needed to turn that around?

There is more useful information to be gleaned from the data in the survey than what’s presented in the Summary and I hope that those with access to the complete data set will make use of it to the fullest extent possible. Too often it seems that we could do more to effectively analyse what information we have. We owe it to ourselves to think seriously about what practical insights we can derive from it, instead of settling for a cursory review of the headline numbers.

With only three relevant pieces of data (gender of most recent partner, relationship status, and condom use) the limitations of the information gathered here are clear. There’s much else that would be useful to know.

It strikes me as a real missed opportunity that the HI survey doesn’t seem to ask any questions like when people last got an HIV test or an STI screening. It doesn’t ask about whether or when people might have been diagnosed with an STI. It doesn’t ask about whether people are aware of their partner’s HIV status. I would hope that the next iteration might expand the set of questions to gather more detailed information. Information that will be of benefit not just to gay and bisexual men but all residents of the island.

An enormous amount of effort went into producing the Healthy Ireland Survey. Face-to-face field interviews with over 7,500 people across the country were conducted over the course of nine months. Interviewers made almost 40,000 visits to over 13,000 addresses, with an average of 2.8 visits per address. Over 6,000 people also participated in an additional physical measurement module. That’s a lot of work, and it suggests that the Department of Health is serious about this project.

Oh, and sexual health?

The sexual health component of the survey consisted of a separate “self-completion questionnaire” with just four questions.

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