Counselling men who have sex with men

The largest group at risk of HIV infection in Victoria, as in most Western countries, is men who have sex with men. Although HIV infection is spread predominantly by sex between men and women in most parts of the world, men who have sex with men will remain the largest at-risk group in Australia.

The term men who have sex with men is used here in preference to the more conventional term homosexual or bisexual men to make the point that not all men who have male sexual partners are willing to describe themselves as homosexual (or gay) or bisexual.

Practitioners need to be aware that many men who define themselves as heterosexual have male sexual partners; in some cases only very rarely, in others frequently. Sometimes these partners will include male prostitutes in Australia or other countries.

Sensitivity to the fear of disclosure that many such men suffer is needed in addressing the issue of HIV testing with them. Many will face painful dilemmas of disclosure to wives or families should their test prove positive. Others will hold fears about careers and other aspects of their lives if their sexual activity or infection status is disclosed. These fears are important to recognise for younger men who may be unsure of their sexuality.

Men who identify themselves as homosexual (or gay) or bisexual will present the practitioner with different challenges. Practitioners who counsel gay or bisexual men need to ensure they do so from a base of adequate knowledge (many gay men are very well informed about AIDS), and not in a manner that may be interpreted as judgemental or censorious.

Practitioners who lack experience with these issues would benefit from specialised HIV-related professional training or contact with AIDS organisations.