More than half of the men having sex with men in BC aren't using condoms consistently, despite the rising rate of new HIV infections among them, a new study finds.

The findings are part of the results of the Community-Based Research Centre's second Sex Now survey.

The 2004 study of 2,605 BC men shows a need to "rethink, reorganize and reinvest" in HIV/AIDS prevention activities, reads the report prepared by Drs Terry Trussler, Rick Marchand and Mark Gilbert.

"It is a disturbing reality that a comprehensive approach to gay men's HIV prevention has yet to take shape in British Columbia," they note.

Phillip Banks, director of HIV prevention for AIDS Vancouver, says the very fact so many men participated in the survey indicates a willingness in the community to find solutions.

But, he adds, the Sex Now results suggest many men feel HIV risks don't apply to them and aren't affected by their sexual behaviours.

That reasoning is false, says Banks.

"If 52 percent of men are out there having casual sex with multiple partners on a regular basis and not using condoms when they engage in anal sex-that doesn't bode well for managing HIV in the gay community or for the futures of many peoples' lives," he says.

Men have to realize that there is a connectedness in the community and that is how the virus spreads, he continues. "You've screwed somebody that's screwed somebody that you know. We're all connected to everybody. That's how HIV survives. It's because of the networks."

A critical finding of the previous Sex Now survey, conducted in 2002, was that at least 70 percent of gay men expected their sex partners to disclose their HIV status. However, one third of respondents in 2002 expressed difficulty in talking about sexual safety with partners, putting the onus for safety on HIV-positive men.

The latest report is more blunt.

"Some gay men continue to have unprotected sex in casual situations without exchanging information about HIV status," it reads.

Pressure from partners seems to be a significant factor in situations where condoms are not used for anal sex. Forty-two percent of those who had high-risk sex felt pressured into it, respondents said.

"Pressure for sex without condoms was felt throughout the region, although somewhat more common among urban men than rural," reads the report.

That finding shocks Banks.

"I wasn't prepared to see that," he says, noting that it highlights the need for men to discuss their sexual wants and HIV status. That dialogue seems to have vanished with the ongoing stigma associated with the disease, he adds.

More needs to be done to educate younger men about HIV as they come into the community, he continues. Men who were active in the '80s and '90s may have gotten the message, but younger guys may not be getting it.

Among the other findings in the report: casual sex is the norm for 65 percent of the gay population and anal sex is the norm for 82 percent of those having casual sex.

Men who reported having casual sex without condoms are 2.7 times more likely to have a large number of partners than those who reported safer sex only. And men who reported casual sex without condoms are 2.6 times more likely to be crystal meth users.

At least 95 percent of gay men feel sexual health promotion activities are needed and important.

"It would be both helpful and progressive to hold an annual summit of all those invested in gay men's health to consider the currently known ground and prevention challenges and to plan effective strategy," the report concludes.

But the question remains: what happened to prevention?

The study attributes the decline of prevention to a variety of factors:

* The widely misinterpreted decline of infections in the late 1990s wrongly implied that HIV was a diminishing threat;

* The consequent decline in public funding and change in values of government, public health services and social service agencies diminished attention to gay men's prevention;

* The narrowly focused strategies on high-risk, individual behaviour failed to look at broader, longer-term interests;

* And cultural shifts in response to anti-retroviral medications led to an increase in unprotected casual sex.

This last factor echoes the findings of another recent study, led by Trevor Hart, a clinical psychologist and professor at York University.

Hart found that HIV-positive men who believe drug treatments make it more difficult to transmit the virus are six times more likely to engage in unprotected anal sex with a casual partner.

It's the first Canadian study of gay and bisexual men to draw a clear link between beliefs about HIV/AIDS medication and risky sexual activity. Researchers analyzed the relationship between beliefs about highly active antiretroviral therapy, a drug cocktail in use since 1996, and sexual behaviour.

"It was really the transmissibility belief," Hart told Capital Xtra's Toronto sister paper Xtra. "If you believed that it is harder to get or to give HIV because of the medication, you are much more likely to have engaged in unprotected sex."

Currently, one in six gay men are HIV-positive in Vancouver, while one in nine gay men are positive province-wide, according to the Sex Now report. "No other Canadian population is affected to this extent," it notes.

"By 2004, the proportion of new infections attributed to gay men increased from 25 to 40 percent of all positive tests in the region," it adds.