In the two decades since HIV/Aids hit the headlines with generous doses of doom, lies and loathing, gay men have been among the most vigilant risk groups to take steps to prevent the disease.

They have lobbied governments, handed out condoms, worked tirelessly to raise funds for hospices and support centres and drummed messages into others in their community about how easily HIV could happen to them.

But 20 years on, many gay men are still testing positive to the virus. East Sussex, Brighton and Hove Health Authority has launched a strategy to try to reduce the number of gay men who contract HIV through unsafe sex.

The Gay Men's HIV Prevention Strategy for Brighton and Hove also aims to help gay men reduce the incidence of other sexually transmitted diseases. It is part of the health authority's broader Sexual Health Strategy.

The HIV strategy was developed during the course of a year in partnership with gay community groups like the Terrence Higgins Trust, individual gay men and Government health providers.

Groups involved estimate there are between 6,000 and 20,000 gay men living in Brighton and Hove. One third of these men has never had an HIV test.

A total of 403 gay men living in Brighton and Hove received medical treatment for HIV during 1998.

Between April 1998 and March 1999, 54 people tested positive to HIV where transmission was thought to be via sex with another man.

The strategy adopts a "you decide" approach, designed to empower men through clear, accessible information to make their own choices.

Direction

Paul Martin, gay men's sexual health adviser with the authority's health promotion department, said: "Obviously, we hope the final outcome will be a reduction in HIV transmissions.

"But it's also about all the various players working for the same cause in the same direction, and communicating with each other to make the best use of resources.

"It's not just about what the health authority is going to do."

Mr Martin explained a key to the strategy was breaking down some of the barriers which might stop men from reaching safe sex information in the first place, such as social isolation, poor self-esteem and limited education.

Research collected will form a "needs map" for East Sussex highlighting areas which are lacking.

An annual report will be published on the internet and through the gay and HIV press. The strategy will be reviewed in 2002.

Mr Martin said: "This is about social support. There are young gay men coming out. They need access to credible information.

"We're moving away from just saying 'use a condom every time'. It's not practical for heterosexual couples. Men might be in a long-term relationship where neither partner is HIV positive. The strategy is about harm minimisation."

He said many men had not taken HIV tests because they simply preferred not to know the answers. What could they do in the absence of a cure, anyway?

And he added gay men, like heterosexual men, were just as prone to enjoying the moment first and worrying about the consequences later. He said: "Human sexuality is a personal and complex area - trying to help people look at their personal sexual activities and what they want to do with their sex lives is difficult.

"People use a whole range of rationalisations for not using condoms from wanting to show someone how much they love them to not wanting to ruin an intimate moment."

Brighton is regarded as one of the best centres for HIV/Aids support and treatment in the UK. Outside London, more people are receiving treatment and care for HIV/Aids in Brighton than anywhere else in the country. During the past 15 years, Brighton's HIV/Aids treatment services have recorded 1,252 cases.

Gil Chimon, joint director of the Terrence Higgins Trust in the South, welcomed the health authority's strategy as a chance to channel people's efforts more closely.

He said: "It's like everybody rowing in the same direction. I think a strategy like this is extremely important. We are very lucky in Brighton and Hove to have a progressive health authority in terms of developing issues around sexual health. We have come a long way.

"The general feedback is once men are through the doors in Brighton and Hove, they get a really good service. But it's helping them know which services are available and where they can go for help in a non-judgemental environment.

"Services need to be flexible. Some people prefer a drop-in centre, some prefer talking to someone one-to-one, some would prefer to talk to a gay man and others want to talk to a clinician."

Campaigners determined to eradicate fearful, homophobic misgivings about the disease agree we have come a long way in our understanding of the condition.

There was a time when the simple act of having an HIV test precluded people from many insurance policies, regardless of whether the test returned a positive reading. And a sufferer's life quality and expectancy has greatly improved with advances in drug technology and medical care.

Mr Martin said: "HIV is still a serious disease. There isn't a cure. Treatments have improved but they're expensive, they don't work for all people all the time and they have side-effects. Economically, it still makes more sense to provide HIV information than it does to treat someone for the course of their life."

Converted for the new archive on 30 June 2000. Some images and formatting may have been lost in the conversion.