Sexual health and use of condoms among local and international sex workers in Sydney.

OBJECTIVES: To compare indicators of sexual health and predictors of condom use for commercial sex among local and international female sex workers first attending an STD clinic. SETTING: A public STD clinic in Sydney, Australia. SUBJECTS: All sex workers first attending between June 1991 and May 1993. METHODS: Cross-sectional analysis of demographic, behavioural and morbidity data from proforma medical records. RESULTS: 91 local sex workers and 123 international sex workers (predominantly from Thailand, Malaysia and China) first presented during the study period. There were significantly higher prevalences of chlamydia (0 v. 15%, p = 0.0002), gonorrhoea (0 v. 14%, p = 0.0006), syphilis (0 v. 10%, p = 0.006) and clinical genital herpes (0 v. 5%, p = 0.04) among international sex workers. The only case of HIV infection was in an international sex worker. Inconsistent condom use for commercial sex was significantly more common among international sex workers (RR = 4.5; 95% CI 3.1-6.5). On multivariate analysis, inconsistent condom use in international sex workers was associated with a recent history of prostitution outside Australia (p = 0.04), while inconsistent condom usage among local sex workers was associated with increasing age (p = 0.003). CONCLUSIONS: These data illustrate the efficacy of condoms and the success of targeted education programmes in local sex workers in Sydney. By contrast, international sex workers continued to be at high risk of STDs. The international sex industry in Sydney requires enhanced culture-specific interventions. Immigration laws as they affect sex workers should also be reviewed.     

Understanding male sexual behaviour in planning HIV prevention programmes: lessons from Laos, a low prevalence country

METHODS: Focus group discussions were conducted with a range of young men in Vientiane, Laos; interviews were conducted with male sex workers. A questionnaire survey was conducted with a purposive sample of 800 young men. RESULTS: Most young men initiate sex at an early age and have multiple sex partners. Married men are more likely to pay for sex and most sex for money is negotiated in non-brothel settings. Despite high reported condom use for last intercourse with a casual partner, decisions on condom use are subjective. Many men have extramarital sex when their partner is pregnant and post partum. 18.5% of men report having had sex with another man; most of these men also report having sex with women. Moreover, more men report having had anal sex with a woman than with a man. CONCLUSIONS: Although not a probability sample survey, this study of a broad range of young men in Vientiane reveals sexual behaviours that could lead to accelerated HIV transmission. Education should emphasise the need to use condoms in all sexual encounters outside the primary relationship. This needs special emphasis when the partner is pregnant or post partum. Advice on safe sex with other men needs to be integrated into all sexual health education for young men.     

HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia

OBJECTIVES: To establish the prevalence of HIV, syphilis, and sexual risk behaviour among three groups of men who have sex with men in Jakarta, Indonesia, and to investigate sexual links between these men and broader heterosexual populations. METHODS: Anonymous, cross sectional surveys among community recruited transgender and male sex workers and self recognised men who have sex with men (MSM) were undertaken in mid-2002 in Jakarta, Indonesia. Places where transgender and male sex workers sell sex and where men go to meet non-commercial male sex partners were mapped. Probability samples were selected for the sex worker populations, while a mixed probability and convenience sample was drawn for self recognised MSM. Blood was drawn for HIV and syphilis serology and community interviewers administered a standardised questionnaire. RESULTS: HIV prevalence was 22% among transgender sex workers, 3.6% among male sex workers, and 2.5% among self recognised MSM, and syphilis prevalence was 19.3%, 2.0% and 1.1% respectively. 59.3% of transgender sex workers and 64.8% of male sex workers reported recent unprotected anal intercourse with clients, and 53.1% of other MSM reported unprotected anal sex with male partners. Some 54.4% of male sex workers and 18.3% of other MSM reported female partners in the preceding year. CONCLUSION: HIV has reached substantial levels among transgender sex workers, and is not negligible in other MSM groups. Risk behaviour is high in all subpopulations, and bisexual behaviour is common, meaning the threat of a wider epidemic is substantial. Prevention programmes targeting male-male sex are needed to reduce this threat.     

HIV, sexually transmitted infections, and risk behaviours in male commercial sex workers in Sydney

OBJECTIVES: To assess prevalence of HIV and sexually transmitted infections (STIs), risk behaviours, and demographics in male commercial sex workers (CSWs)/prostitutes in Sydney. METHODS: Retrospective, cross sectional study with two comparison groups. Demographic, behavioural, and morbidity data were analysed from standardised medical records of patients attending a public STI and HIV service in Sydney between January 1991 and March 1998. Two comparison groups were used: female CSWs and non-CSW working homosexual men who attended over the same time. RESULTS: 94 male CSWs, 1671 female CSWs, and 3541 non-CSW working homosexual men were included. The prevalence of HIV in male CSWs tested (6.5%) was significantly greater than in female CSWs (0.4%, p = 0.0001), but less than in non-CSW homosexual men (23.9%, p < 0.0001). Genital warts occurred significantly more frequently in male CSWs than in comparison groups. Prevalence of other STIs was similar in all groups. Male CSWs saw significantly fewer clients per week than female CSWs and male and female CSWs used condoms with almost all clients. Male CSWs reported significantly more non-work sexual partners than female CSWs and non-CSW homosexual men and were significantly more likely to have unprotected penetrative sex with their non-work partners than non-CSW homosexual men. Injecting drug use was significantly more frequent in male CSWs than in both comparison groups. CONCLUSIONS: Although male CSWs use condoms with clients, they are more likely to practise unsafe sex with non-work partners (especially women) and inject drugs than female CSWs and non-CSW homosexual men. Some men with HIV are working within the commercial sex industry. Targeted health education to encourage safer drug use and safer sex outside work is needed.     

HIV/AIDS knowledge and high risk sexual practices among southern California Vietnamese.

OBJECTIVES--Vietnamese immigration to the U.S. since the conclusion of the Vietnam war has been substantial and in Orange County, CA, Vietnamese Americans comprise 3% of the population (the largest community in the US). Our objective was to collect data on the HIV/AIDS knowledge, attitudes and self-reported high risk behaviours within this community. METHODS--A survey instrument was administered anonymously in Vietnamese to 532 respondents in their homes. Individuals from three population strata were randomly sampled: men 18 to 35 years old (N = 193); men 36 to 45 years old (N = 137); and women 18 to 35 years old (N = 202). Data were gathered on: (1) degree of acculturation; (2) knowledge and attitudes towards HIV/AIDS; and (3) self-reported sexual and other high risk practices. RESULTS--Survey data indicated that 38% of respondents were very worried about themselves and 83% were worried about a family member getting AIDS. Knowledge about actual modes of HIV transmission was generally accurate, but a substantial minority still believed that HIV can be transmitted through casual contact, and 68% from needles used in hospitals. Women demonstrated less accurate knowledge than men on five key items. Quarantine of the HIV infected was agreed to by 45%. Twenty-nine percent did not believe that the epidemic would affect them personally, and 49% stated that they did not have enough information about AIDS to protect themselves. Regarding sexual practices, 31% reported never having had sex. Of the others, 8% had two or more sexual partners in the prior 12 months. No same sex behaviour was reported. Six percent of men had visited a female prostitute; of these, 24% had visited 2 or more in the prior 12 months; half of encounters in this time period were outside the US. Substantial percentages of sexually active, unmarried respondents indicated that they never use (17-40%) or only sometimes use (10-32%) condoms. Less than 1% had used injection drugs. CONCLUSIONS--Education should be targeted at the Vietnamese community of southern California to improve knowledge that HIV cannot be contracted through casual contact, to convey information about methods for self-protection, and to reduce high risk sexual practices such as unprotected sex, sex with multiple partners and sex with prostitutes.     

Sexual risk behavior of married men and women in Bangladesh associated with husbands' work migration and living apart

OBJECTIVES: This study aimed to ascertain the prevalence of sexual risk behavior among married men and women who had, or had not, lived apart from their spouse as a result of the husbands' work migration. METHODS: A cross-sectional survey was conducted among a random sample of 1,175 married women and 703 married men in 2 rural areas of Bangladesh. RESULTS: Extramarital sex was reported by 64.2% (95% confidence interval [CI] = 58.7-69.7) of 296 men and 8.6% (95% CI = 7.6-9.6) of 779 women who had lived apart from their spouse, 2 to 3 times higher than the proportions among those who had not lived apart (P <0.05). The proportions of men who reported sex with a female sex worker (50.7%; 95% CI = 45.0-56.4) or with another male (5.4%; 95% CI = 2.8-8.0), while living away, were double the proportions reporting they had done so before living away or among men who had not lived away (P <0.05). Only 2 men had ever used had a condom during sex with another male, and less than one third of men had used a condom during sex with a sex worker or during marital sex. CONCLUSIONS: The sexual risk behavior of married men living away from home may put themselves and their wives at risk for HIV infection and other sexually transmitted diseases.     

HIV treatment adherence and unprotected sex practices in people receiving antiretroviral therapy

BACKGROUND: Poor HIV treatment adherence can result in the development of drug resistant strains of HIV and HIV positive people may transmit drug resistant virus to their sex partners. OBJECTIVE: To examine the association between HIV treatment adherence and sexual risk behaviour practices in people living with HIV-AIDS. METHODS: Surveys and interviews with 255 men and women living with HIV and receiving antiretroviral therapy. RESULTS: People who were currently taking antiretroviral medications and missed at least one dose of their medications in the past week scored significantly higher on a hopelessness scale and reported more current use of marijuana. People who had been non-adherent also reported significantly more sex partners, greater rates of unprotected vaginal intercourse, and less protected sex behaviours including less protected sex with partners who were HIV negative or of unknown HIV status. CONCLUSIONS: Associations between HIV treatment adherence and sexual transmission risk behaviours indicate the need for comprehensive and integrated health behaviour interventions for people living with HIV-AIDS.     

Gonorrhoea reinfection in heterosexual STD clinic attendees: longitudinal analysis of risks for first reinfection

OBJECTIVES: Gonorrhoea is associated with adverse reproductive health outcomes, including pelvic inflammatory disease and increased HIV transmission. Our objective was to determine the association of demographic factors, sexual risk behaviours, and drug use with incident gonorrhoea reinfection among public STD clinic clients. METHODS: A retrospective cohort study conducted from January 1994 through October 1998, of heterosexual public STD clinic attendees age >/=12 years having at least one gonorrhoea infection in Baltimore, MD. The outcome was first incident gonorrhoea reinfection over a maximum 4.8 years, compared in STD clinic clients with or without sexual risk behaviours and drug use at initial gonorrhoea infection. RESULTS: 910 reinfections occurred among 8327 individuals and 21 246 person years of observation, for an overall incidence of 4.28 reinfections per 100 person years (95% CI 4.03 to 4.53). Median time to reinfection was 1.00 year (95% CI 0.91 to 1.07 years). In multivariate Cox regression, increased reinfection risk was associated with male sex, younger age, greater number of recent sex partners, and having a sex partner who is a commercial sex worker. Injection drug use and coming to the clinic as an STD contact were protective. Among risk factors that differed significantly between men and women, injection drug use was protective of reinfection in men, and "any" condom use was a risk factor for reinfection in women CONCLUSIONS: Reinfection represents a significant proportion of STD clinic visits for gonorrhoea. Prevention counselling and routine screening for patients at high risk for reinfection should be considered to maximally reduce transmission and resource utilisation.     

Factors associated with hepatitis B vaccination among men having sexual relations with men in Montreal, Quebec, Canada. Omega Study Group.

OBJECTIVE: To determine factors associated with hepatitis B virus (HBV) vaccination status among HIV-uninfected men who have affective and sexual relations with men (MASM) in Montreal, Quebec, Canada. METHODS: The Omega Cohort is a study of the incidence and psychosocial determinants of HIV infection among MASM in Montreal. Participants complete a questionnaire and are HIV-tested every 6 months. At baseline, we also performed testing for HBV markers and collected data on HBV vaccination history. RESULTS: Forty-six percent of 653 participants had received at least one dose of HBV vaccination, whereas 28% were completely vaccinated. Lack of vaccination was associated with injection drug use, having > or =20 regular lifetime partners, living outside Montreal, not having sex in bathhouses, and not having consulted a physician aware of the participant's sexual orientation. Among vaccinated MASM, incomplete vaccination was associated with having <20 lifetime casual partners, trading sex for drugs, having given goods for sex, having had unprotected anal sex with regular partners, and having no history of a previous sexually transmitted disease. CONCLUSION: A significant proportion of Montreal's MASM, some of whom are at risk of contracting HBV through sexual and parenteral transmission, have not been vaccinated for HBV. Men who have affective and sexual relations with men should be educated about the risk of HBV transmission and the seriousness of the disease.     

Who pays for sex? An analysis of the increasing prevalence of female commercial sex contacts among men in Britain

BACKGROUND: In the United Kingdom the incidence of sexually transmitted infections (STI) and risky sexual behaviours is increasing. The role of commercial sex in this trend is poorly understood. Little is known about the men who pay for sex. We examined the epidemiology of female commercial sex contacts reported by men in 1990 and 2000. METHODS: National probability sample surveys of sexual attitudes and lifestyles (Natsal) of men aged 16-44 resident in Britain in 1990 (n = 6000) and 2000 (n = 4762). RESULTS: The proportion of men who reported paying women for sex in the previous 5 years increased from 2.0% (95% CI 1.6 to 2.5) in 1990 to 4.2% in 2000 (95% CI 3.6 to 4.9). In both surveys, paying for sex was more frequent in men aged between 25 years and 34 years, who were never or previously married, and who lived in London. There was no association with ethnicity, social class, homosexual contact, or injecting drug use. Men who paid for sex were more likely to report 10 or more sexual partners in the previous 5 years; only a minority of their lifetime sexual partners (19.3%) were commercial. They were more likely to meet partners abroad and to report previous STI. Only 15% reported having had an HIV test. CONCLUSION: The proportion of men who reported paying for heterosexual sex has increased, and these men have multiple commercial and non-commercial partners. Their higher rates of STI and low level of HIV testing suggest the need for prevention interventions for clients as well as sex workers.     

Early sexual debut among young men in rural South Africa: heightened vulnerability to sexual risk?

OBJECTIVE: This report examines early sexual debut ( or = 3 partners in the past 3 years (OR = 10.26, p<0.01). CONCLUSIONS: Men who initiate sex before age 15 form a distinct risk group in this setting. Specific interventions are needed for young men in the pre-teen years, before sexual debut.     

Risk factors leading to Cryptosporidium infection in men who have sex with men

OBJECTIVES: Cryptosporidiosis is a devastating illness in people with HIV/AIDS yet there have been no analytical epidemiological studies measuring risk factors leading to cryptosporidiosis in men who have sex with men (MSM). The objective of this study was to measure the risk factors for exposure to Cryptosporidium among MSM. METHODS: The study was a case-control design. It recruited MSM who had laboratory confirmed Cryptosporidium infection between 1997 and 2000. Participants answered a questionnaire about potential risk factors leading to exposure to Cryptosporidium. RESULTS: 10 cases and 24 controls were recruited. Men having more than one sexual partner in the past month were more likely to have had Cryptosporidium diarrhoea p=0.034 (OR 6.67, CI (1.15 to 38.60). Insertive anal sex (p=0.059) and attending a sex venue one or more times (p=0.059) also increased the odds of having cryptosporidiosis. CONCLUSION: The study results suggest that sexual behaviour is a significant risk factor for cryptosporidial diarrhoea in MSM. The results will be used to inform risk groups about behaviours that may put them at increased risk of cryptosporidial diarrhoea.     

Sexually transmitted infections and risk behaviours in women who have sex with women

OBJECTIVES: To assess the prevalence of sexually transmitted infections (STIs) and blood borne viruses, risk behaviours, and demographics in women who have sex with women (WSW). METHODS: Retrospective cross sectional study using a multivariate model. Demographic, behavioural, and morbidity data were analysed from standardised medical records of patients attending a public STI and HIV service in Sydney between March 1991 and December 1998. All women with any history of sex with a woman were compared with women who denied ever having sex with another woman (controls). RESULTS: 1408 WSW and 1423 controls were included in the study. Bacterial vaginosis (BV) was significantly more common among WSW (OR 1.7, p < 0.001). Abnormalities on cervical cytology were equally prevalent in both groups, except for the higher cytological BV detection rate in WSW (OR 5.3, p = 0.003). Genital herpes and genital warts were common in both groups, although warts were significantly less common in WSW (OR 0.7, p = 0.001). Prevalence of gonorrhoea and chlamydia were low and there were no differences between the groups. The prevalence of hepatitis C was significantly greater in WSW (OR 7.7, p < 0.001), consistent with the more frequent history of injecting drug use in this group (OR 8.0, p < 0.001). WSW were more likely to report previous sexual contact with a homo/bisexual man (OR 3.4, p < 0.001), or with an injecting drug user (OR 4.2, p < 0.001). Only 7% of the WSW reported never having had sexual contact with a male. CONCLUSION: We demonstrated a higher prevalence of BV, hepatitis C, and HIV risk behaviours in WSW compared with controls. A similar prevalence of cervical cytology abnormalities was found in both groups. Measures are required to improve our understanding of STI/HIV transmission dynamics in WSW, to facilitate better health service provision and targeted education initiatives.     

Associations between internet sex seeking and STI associated risk behaviours among men who have sex with men

OBJECTIVE: This exploratory study identified associations between internet sex seeking and HIV associated risk behaviours among a high risk sample of men who have sex with men (MSM). METHODS: A cross sectional survey of men attending a sex resort was conducted. Of 164 men asked to participate, 91% completed a self administered questionnaire. The questionnaire assessed demographic variables and (using a 3 month recall period) men's HIV associated sexual risk behaviours. Potential confounding variables were assessed and controlled, as needed, by multivariate analysis. RESULTS: Men currently resided in 14 states. One sixth reported being HIV positive. 57% of the men reported using the internet to seek sex. Differences in critical behaviours (unprotected anal sex and number of partners) were not found. However, compared to those not seeking sex by internet, men using the internet to meet sex partners were more likely to report fisting (adjusted odds ratio = 3.3, p = 0.04), having group sex (prevalence ratio (PR) = 1.2, p = 0.0001), using poppers during sex (PR = 1.94, p = 0.0001), and using ecstasy during sex (PR = 2.7, p = 0.04). Internet sex seeking men were also significantly more likely to report meeting sex partners in bathhouses (PR = 2.2, p = 0.0001), bars (PR = 1.5, p = 0.001), parks (PR = 3.2, p = 0.006), and circuit parties (PR = 8.9, p = 0.007). CONCLUSION: Among MSM attending a sex resort, those using the internet to seek sex partners may have modestly elevated risks for acquiring or transmitting sexually transmitted infections. Subsequent studies should investigate the utility of using the internet as forum for promoting safer sex behaviours among high risk MSM.     

The association between gang involvement and sexual behaviours among detained adolescent males

OBJECTIVE: Data were collected from 270 detained male adolescents (aged 14-18 years) to determine the association between ever having been in a gang and a range of sexual behaviours such as sexual activity, male condom use, sex with multiple partners, and drug use during sex. METHODS: Participants answered survey questions using audio computer assisted self interviewing (A-CASI) procedures, which assessed demographic, family factors, history of gang membership, and sexual behaviours. RESULTS: Multiple logistic regression analyses, controlling for demographic, socioeconomic status, and family factors, indicated that adolescents who reported having been in a gang, relative to their peers reporting no gang involvement, were 5.7 times more likely to have had sex, 3.2 times more likely to have got a girl pregnant, and almost four times more likely to have been "high" on alcohol or other drugs during sexual intercourse, have had sex with a partner who was "high" on alcohol or other drugs, or have had sex with multiple partners concurrently. CONCLUSIONS: Findings suggest that having been in a gang can discriminate between levels of STI associated risk behaviours among an otherwise high risk population-detained adolescent males.     

Prevalence and risk behaviors of Hong Kong males who seek cross-border same-sex partners in mainland China

BACKGROUND: Little is known about cross-border sex-networking behaviors among men who have sex with men (MSM) GOAL: The goal of this study was to determine the prevalence of cross-border sex-networking in mainland China among MSM in Hong Kong and the associated risk behaviors STUDY: A telephone survey was conducted. A total of 15,230 Hong Kong Chinese men aged 18 to 60 participated in the study. RESULTS: Of the 283 MSM engaged in some MSM behaviors in the last 6 months, 15.2% had engaged in sexual activity with a man in mainland China in the 6 months before the survey. These "cross-border MSM" were more likely than others to have practiced risk behaviors such as having patronized male commercial sex workers, having contracted a sexually transmitted disease (STD), having had > or = 3 MSM partners, and having higher prevalence of HIV testing in the last 6 months (adjusted odds ratio, 3.32-43.83). CONCLUSIONS: There is an urgent need for a regional approach to HIV/STD prevention for MSM in southern China.     

Prevalence and correlates of exchanging sex for drugs or money among adolescents in the United States

OBJECTIVE: This study examined the prevalence and correlates of exchanging sex for drugs or money among a nationally representative sample of 13,294 adolescents in the United States. METHODS: Data are from the National Longitudinal Study of Adolescent Health, waves I and II. The lifetime prevalence of exchanging sex was estimated and a cross sectional analysis of sociodemographic and behavioural correlates was conducted. Unadjusted odds ratios were obtained. RESULTS: 3.5% of adolescents had ever exchanged sex for drugs or money. Two thirds of these youths were boys. The odds of having exchanged sex were higher for youths who had used drugs, had run away from home, were depressed, and had engaged in various sexual risk behaviours. 15% of boys and 20% of girls who had exchanged sex reported they had ever been told they have HIV or another sexually transmitted infection (STI). CONCLUSIONS: Adolescents with a history of exchanging sex have engaged in other high risk behaviours and may experience poor health outcomes, including depression and HIV/STIs. These findings should help inform strategies to prevent this high risk sexual behaviour and its potential consequences.     

包头市娱乐场所服务小姐HIV/STD感染状况调查

目的:了解包头市娱乐场所服务小姐HIV/STD感染状况,流行情况,发展趋势。方法:于2010年12月～2011年12月对包头市娱乐场所,年龄在18～40岁能够并愿意签署口头/书面知情同意书的女性性服务工作者,开展性病/艾滋病的流行病学调查,并采集静脉血液、阴道分泌物进行相关性传播疾病/艾滋病的实验室检测。结果:本次调查共调查服务小姐247名,检测出STD 140例,感染率为56.7%,未检出HIV阳性者,非淋菌性(宫颈炎)尿道炎88例,细菌性阴道炎42例,梅毒5例,尖锐湿疣3例,淋病9例,霉菌8例,滴虫6例,混合感染19例。结论:247名服务小姐中140人检出一或两种STD,感染率56.7%。服务小姐多性伴,事后阴道冲洗及自我预防用药较普遍。     

Migrant men: a priority for HIV control in Pakistan?

OBJECTIVES: To assess sexual risk behaviour and prevalence of treatable sexually transmitted infections (STI) in migrant male workers in Lahore, Pakistan. METHODS: Behavioural interviews were conducted on a representative sample of 590 migrant men aged 20-49 years. Biological samples were collected from a subsample of 190 and tested for chlamydia, gonorrhoea, and syphilis. RESULTS: Over half (55%) of single men were sexually experienced and 36% of married men reported premarital sex. The median ages at first intercourse and first marriage were 21 years and 28 years, respectively. In the total sample (including virgins), 13% reported any female non-marital partner in the past 12 months, 7% contact with a female sex worker, and 2% sex with a man. Only 10% reported using a condom during most recent contact with a sex worker. STI symptoms in the past 3 months were reported by 8% of men. Laboratory tests disclosed that STI prevalence was 3.2%. CONCLUSIONS: If and when HIV infection spreads among sex workers in Lahore, the reported behaviour of migrant men suggests that they may act as a conduit for further transmission to the general population. Condom promotion focused on the sex trade is likely to be the most effective way of reducing this risk.     

Incidence and risk factors for urethral and anal gonorrhoea and chlamydia in a cohort of HIV-negative homosexual men: the Health in Men Study

BACKGROUND: Early detection and treatment of bacterial sexually transmitted infections has been advocated as an HIV prevention strategy. AIM: To inform screening guidelines, the incidence and risk factors for urethral and anal gonorrhoea and chlamydia were studied in a prospective cohort of community-based HIV negative homosexual men in Sydney, New South Wales, Australia. METHODS: All participants were offered annual screening for gonorrhoea and chlamydia (study-visit diagnoses) on urine and anal swabs using nucleic acid amplification. Participants also reported diagnoses of gonorrhoea and chlamydia made elsewhere between interviews (interval diagnoses). All diagnoses were summed to create a combined incidence rate, and detailed data on specific sexual practices with casual and regular partners were collected. RESULTS: Among 1427 men enrolled, the combined incidence rates were 3.49 and 2.96 per 100 person-years for urethral and anal gonorrhoea, respectively; and 7.43 and 4.98 per 100 person-years for urethral and anal chlamydia, respectively. Urethral infections were associated with unprotected anal intercourse (UAI) with HIV-positive partners (hazard ratio (HR) = 2.58, 95% CI 1.10 to 6.05 for urethral gonorrhoea) and with frequent insertive oral sex (p for trend 0.007 for urethral chlamydia). Anal infections were associated with receptive UAI (p for trend 0.001 for both anal gonorrhoea and chlamydia) and other receptive anal sexual practices. Stratified analyses showed the independence of the associations of insertive oral sex with urethral infections and of non-intercourse receptive anal practices with anal infections. CONCLUSION: Incident gonorrhoea and chlamydia were common. Risk behaviours for both urethral and anal infections were not restricted to UAI. Screening that includes tests for anal and urethral infections should be considered for all sexually active homosexual men, not just for those who report UAI.