Marriage (Same Sex Couples)

Memorandum submitted by National Aids Trust (NAT) (MB 84)


1. NAT is the UK's leading charity dedicated to transforming society's response to HIV. We provide fresh thinking, expertise and practical resources. We champion the rights of people living with HIV and campaign for change.

2. NAT supports the bill to introduce civil marriage for same sex couples and the proposal to enable civil partners to convert their partnership to a marriage.

3. Evidence shows reductions in partner change will reduce sexually transmitted infections, including HIV. We believe introducing same sex marriage will encourage safer sexual behaviour among gay men as a result of fewer partner changes. It will also promote equality regardless of sexual orientation. This in turn will have a positive impact on the physical and mental well being for all gay people.

The importance of Same Sex Civil Marriage for safer sexual behaviour

4. Current evidence shows that reductions in partner change is critically important for reducing sexually transmitted infections (STIs) and HIV amongst all sexually active people. [1] A reduction in partner numbers and influencing partnership patterns is therefore a key intervention to promote good sexual health in general and HIV prevention in particular.

5. Influencing partnership patterns NAT believes is particularly significant for gay men as STI and HIV prevalence has been rising within this group [2] . The Gay Men's Sex Survey (GMSS) shows that almost 21% of those with 30 more partners in the last year were HIV positive compared with 6.6% of those with between two and four partners in the last year. For more detailed information please see NAT's (2010) report 'Partnership patterns and HIV prevention amongst men who have sex with men (MSM). [3] '

6. Whilst marriage is not the only valuable form of relationship for gay men - and individuals will make their own choices - we believe opening civil marriage to same sex couples will give gay men access to an institution that encourages, celebrates and supports stable, long term sexual relationships. This can only encourage consideration by gay men of options for their sex life which reduce HIV risk.

The importance of Same Sex Civil Marriage for Equality

7. Many gay men and women continue to suffer from inequality and as a result, internalised low self esteem. Disbarring same sex couples from marriage sends out a clear message that same sex relationships are not equal or worthy of the same institutions as opposite sex couples. Whilst civil partnerships were a very welcome introduction of equal legal rights and an important step forward, the retention of a 'cordon sanitaire' around marriage, excluding same sex couples, continues to communicate to the LGBT community an unmistakable message that same sex relationships are inferior. Introducing marriage for all couples regardless of their sexuality promotes a society where everybody is treated fairly with equal respect, dignity and worth. Equal rights for all will in turn encourage higher self esteem and psychological well being amongst all gay people.

8. Promoting higher self esteem for gay men and women is particularly important as it is shown to have an impact on self care and the decisions people make to preserve and promote their personal health. Poor mental health and low self esteem can result in greater risk behaviour such as high risk sexual activity or injecting drugs. [4] Recent research by Stonewall [5] and others including the Department of Health [6] show for example that lesbian and gay men have higher levels of substance abuse and mental health concerns, due in considerable part to ongoing stigma and discrimination. Recent evidence suggests combating institutional discrimination through opening civil marriage to gay and lesbian people can significantly influence their patterns of health. [7]

9. NAT believes, same sex marriage is a key step towards ending stigma and discrimination towards gay people by encouraging current and future generations to treat everyone equally, no matter what their sexual orientation. The passing of this legislation will be a milestone in celebrating gay people, gay communities and gay sexuality. It also crucially helps to promote social, physical and mental health for all people in the UK.

10. The Same Sex Couples Bill as it stands makes it possible for a person to annul their marriage if a partner conceals a sexually transimitted disease, including HIV [8] . The same provision exits for opposite sex couples so it is of course one current element of 'full equality'. Whilst NAT would always encourage disclosure, the evidence collected shows the difficulties of doing so in an environment where HIV is stigmatised. [9] More generally, having an STI as one of the very few grounds on which a marriage is voidable seems to be now an odd and outdated perspective. NAT recommends a review of this provision as soon as practicable for both same sex and opposite sex couples.

February 2013

[1] See The Lancet (2008) ‘HIV Prevention' and NAT (2010) ' Partnership patterns and HIV prevention amongst men who have sex with men' Available online at .


[2] The latest HPA statistics show more gay men are living with HIV than ever before. In 2011 as estimated 40,100 men who have sex with men (MSM) had HIV in the UK . Gay men are also disproportionately affected by sexual ill health. For example, in 2007 gay men accounted for 30% of all men diagnosed with gonorrhoea, 40% of syphilis, 98% of LGV and 97% of hepatitis C. Please see Sigma Research (2009) 4.1.3: 'Testing targets: Findings from the UK Gay Men’s Sex Survey 2007 .


[3] NAT (2010) ' Partnership patterns and HIV prevention amongst men who have sex with men .' Available online at

[4] See NAT's (2012) work on HIV and people who inject drugs at:

[5] Stonewall (2011) Gay and Bi-sexual Men's Health . Available online at : . Please also see National Institute for Mental Health In England (2007) ' Mental disorders, suicide and deliberate self harm in lesbian, gay and bisexual peopl e . ' Available online at:

[6] DH (2007) Mental health issues within lesbian, gay and bisexual (BGB) communities . Available online at :

[7] Hatzenbuehler M , McLaughlin K , Keyes K and Hasin D (2010) 'The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study' Am J Public Health , Mark,100 (3): 452-9.

[7] Riggle , E, Rostosky , S and Horne, S (2009) 'Marriage amendments and lesbian, gay, and bisexual individuals in the 2006 election' Sexuality Research & Social Policy , Vol 6(1): 80-89

[8] This is in reference to ' Annulment of marriage, schedule 4, part 3 subsections (1), (2), (3) of the same sex marriage bill. This invokes (and amends) section 12 of the Matrimonial Causes Act 1973 which in section 12, subsection (e) says a voidable ground is: ' that at the time of the marriage the respondent was suffering from venereal disease in a communicable form .'


[9] Please see NAT (2010) 'HIV: Public Knowledge and Attitudes.' Available online at:


Prepared 6th March 2013