Prevalence and Correlates of Sexual Partner Concurrency Among Australian Gay Men Aged 18–39 Years

Mathematical models predict higher rates of HIV and sexually transmitted infections (STIs) in populations with higher rates of concurrent sexual partnerships. Although gay men and other men who have sex with men (MSM) have disproportionately high rates of HIV/STIs, little is known about the prevalence and correlates of sexual concurrency in these populations. This paper reports findings from a national community-based survey of 1,034 Australian gay-identified men aged 18–39 years, who gave detailed information about their sexual partners over the past 12 months. In all, 237 (23 %) reported two or more concurrent sexual partners. For their most recent period of concurrency, 44 % reported three or more partners and 66 % reported unprotected sex with one or more of their partners. A multivariate logistic regression found sexual concurrency was significantly more likely among men on higher incomes (P = 0.02), who first had anal sex at a relatively young age (P = 0.03), and who reported a large number of partners in the past 12 months (P < 0.001). Age, education, HIV status, and other sociodemographic and sexual behavior variables were not significant correlates. However, men who reported sexual concurrency were significantly more likely to have been diagnosed with an STI in the past 12 months (P = 0.04). Findings from this study suggest sexual concurrency is common among younger Australian gay men. With many of these men not always using condoms, health agencies should consider the potential impact of concurrency on HIV/STI epidemics among gay men and other MSM.     

Partner-Level Factors Associated with Insertive and Receptive Condomless Anal Intercourse Among Transgender Women in Lima,Peru

Condomless anal intercourse among transgender women (TW) in Peru has been shown to vary by the type of partner involved (e.g. primary vs. casual vs. transactional sex partner), but no previous studies have explored variations in partner-level patterns of condom use according to type of anal intercourse. We evaluated the relationship between partnership characteristics and condom use during insertive (IAI) versus receptive anal intercourse (RAI) among TW with recent, non-female partners. Condomless IAI was more common with transactional and casual sex partners and by TW who self-reported HIV-uninfected serostatus (p < 0.05), alcohol use disorders, or substance use before sex. Condomless RAI was more common with primary partners and by TW who described their HIV serostatus as unknown (p < 0.05). Examining partner-level differences between condomless IAI and RAI reveals distinct patterns of HIV/STI risk among TW, suggesting a need for HIV prevention strategies tailored to the specific contexts of partners, practices, and networks.     

Sexual Partner’s Age as a Risk Factor for HIV Seroconversion in a Cohort of HIV-Negative Homosexual Men in Sydney

Increasing partner age may be an important risk factor for HIV infection in homosexual men. About 20 % of 1,427 participants in the Health in Men study in Sydney, Australia, reported that half or more of their partners were much older. Having more partners who were much older was associated with an increased risk of HIV seroconversion (p trend = 0.002), and this remained significant after adjustment for participants’ age, number of regular and casual partners, and sexual risk behaviour (p trend = 0.027). Men who reported much older partners were at increased risk of HIV infection, independent of unprotected anal intercourse with sero-nonconcordant partners.     

Epidemiology of Sexual Health in the Virtual Environment: A Multinational Online Survey of Spanish- and Portuguese-Speaking Men who use an Internet Sexual Networking Site

There is limited data on the sexual health of users of sexual networking websites for men who have sex with men (MSM) in Latin America. Members of a MSM-targeted social/sexual networking website in Latin America, Spain, and Portugal participated in an online sexual health survey. Among 36,063 respondents, nearly 90 % reported having anal or vaginal intercourse in the past 3 months. Among sexually active men, 53.2 % used condoms inconsistently. In the past year, 54 % of respondents reported undergoing sexually transmitted infections (STI) testing and 67 % reported testing yearly or more often for HIV. Self-reported HIV prevalence was 9.1 %. Differences were seen by geographic region. Unprotected intercourse with partners of different or unknown HIV status was associated with recent STI diagnosis (OR = 1.83, t = 13.15, d.f. = 21, p < .001) and HIV diagnosis (OR = 2.20, t = 14.00, d.f. = 21, p < .001). Online surveys are a promising tool for HIV/STI surveillance and prevention internationally to reach an important subset of MSM.     

At Home and Away: Gay Men and High Risk Sexual Practices

We aimed to describe HIV risk practices of gay men who travel locally, regionally and overseas. We analysed data from the Sydney Gay Community Periodic Survey 2009 about high-risk sexual practices in four locations (locally, while travelling in NSW, Australia and overseas) and with partners of HIV positive, negative and unknown serostatus in each location. Analyses of associations used generalized log-binomial estimation procedures with Type I error of 5 %. Of 1,839 sexually active participants, 70.1 % reported having sex locally. 19.7 % elsewhere in NSW, 20.1 % interstate and 18 % overseas. Unprotected anal intercourse (UAI) was reported by 29.9, 28.6, 21.3 and 19.3 % of men in each location respectively. There was no difference in the levels of UAI locally and elsewhere in NSW, but UAI levels were lower in other Australian locations [adjusted prevalence rate ratio (APRR) = 0.76; 95 % confidence interval (95 % CI) 0.66–0.88] and overseas (APRR = 0.76; 95 % CI 0.65–0.89). UAI was more likely if partners were seroconcordant HIV positive (APRR = 1.67; 95 % CI 1.32–2.11) and less likely if partners were of different HIV serostatus (APRR = 0.39; 95 % CI 0.33–0.47) as compared to seroconcordant HIV negative partners. UAI was associated with group sex and use of party drugs. In this community sample, UAI levels were higher in the local context than in travel destinations, suggesting that familiarity between partners may play a role. High-risk sexual practices can nevertheless contribute to bridging different HIV epidemics and HIV transmission across borders. HIV prevention programs should develop effective approaches to target sexually adventurous gay men and HIV transmission associated with travel.     

Adapted Personalized Cognitive Counseling for Episodic Substance-Using Men Who Have Sex with Men: A Randomized Controlled Trial

Episodic drug use and binge drinking are associated with HIV risk among substance-using men who have sex with men (SUMSM), yet no evidence-based interventions exist for these men. We adapted personalized cognitive counseling (PCC) to address self-justifications for high-risk sex among HIV-negative, episodic SUMSM, then randomized men to PCC (n = 162) with HIV testing or control (n = 164) with HIV testing alone. No significant between-group differences were found in the three primary study outcomes: number of unprotected anal intercourse events (UAI), number of UAI partners, and UAI with three most recent non-primary partners. In a planned subgroup analysis of non-substance dependent men, there were significant reductions in UAI with most recent non-primary partners among PCC participants (RR = 0.56; 95 %CI 0.34–0.92; P = 0.02). We did not find evidence that PCC reduced sexual risk behaviors overall, but observed significant reductions in UAI events among non-dependent SUMSM. PCC may be beneficial among SUMSM screening negative for substance dependence.     

Individual-Level,Partnership-Level,and Sexual Event-Level Predictors of Condom Use During Receptive Anal Intercourse Among HIV-Negative Men Who Have Sex with Men in Los Angeles

We examined individual-level, partnership-level, and sexual event-level factors associated with condom use during receptive anal intercourse (RAI) among 163 low-income, racially/ethnically diverse, HIV-negative men who have sex with men (MSM) in Los Angeles (2007–2010). At baseline, 3-month, and 12-month visits, computer-assisted self-interviews collected information on ≤3 recent male partners and the last sexual event with those partners. Factors associated with condom use during RAI at the last sexual event were identified using logistic generalized linear mixed models. Condom use during RAI was negatively associated with reporting ≥ high school education (adjusted odds ratio [AOR] = 0.32, 95 % confidence interval [CI] 0.11–0.96) and methamphetamine use, specifically during RAI events with non-main partners (AOR = 0.20, 95 % CI 0.07–0.53) and those that included lubricant use (AOR = 0.20, 95 % CI 0.08–0.53). Condom use during RAI varies according to individual-level, partnership-level, and sexual event-level factors that should be considered in the development of risk reduction strategies for this population.     

Personal or Relational? Examining Sexual Health in the Context of HIV Serodiscordant Same-Sex Male Couples

Couples’ ability to adopt a “we” orientation has been associated with optimal health outcomes. This study examined how personal and relational motivations are uniquely associated with unprotected anal intercourse (UAI), protected anal intercourse (PAI), and the absence of sexual activity within HIV-serodiscordant same-sex male couples. HIV-positive men and their HIV-negative partners (N = 116 couples, 232 men) completed questionnaires and HIV-positive men had blood drawn for viral load. Results of a multinomial logistic regression illustrated that sexual satisfaction was positively associated with PAI among HIV-negative partners and negatively associated with PAI among HIV-positive partners. Endorsing a “we” orientation was positively associated with PAI among HIV-positive partners. Findings suggest that HIV-positive partners who espouse a “we” orientation may be willing to forgo their personal interests to protect their HIV-negative partners from HIV transmission. Couples-based interventions are warranted to help strengthen relationship dynamics to enhance the sexual health of serodiscordant couples.     

High Prevalence of Substance Use Among Men Who have Sex with Men in Buenos Aires, Argentina: Implications for HIV Risk Behavior

Five hundred gay and other men who have sex with men (G&MSM) from Buenos Aires, Argentina completed an assessment regarding substance use and sexual behavior. During the past 2 months, 78 % of participants consumed alcohol and 61 % drugs. Over 20 % of participants reporting alcohol, marijuana, cocaine sulfate, or tranquilizer use, did so daily. Heavy alcohol use was more likely among participants with greater mood reactivity (AOR = 1.64) and less likely among those who identified as gay (AOR = 0.38). Weekly drug use was less likely among older (AOR = 0.98), and gay-identified participants (AOR = 0.50), but more likely among participants with greater mood reactivity (AOR = 1.49). Drug use was correlated with unprotected anal and vaginal intercourse with men, women, and transvestites among non-gay identified participants (r = 0.22). Findings highlight the need to reduce substance use and sexual risk behavior in this population.     

Prevalence and Correlates of Unprotected Anal Intercourse Among Hong Kong Men Who Have Sex with Men Traveling to Shenzhen, China

In China, the HIV prevalence among men who have sex with men (MSM) has been increasing sharply. A total of 195 Hong Kong MSM having had sex with men in Shenzhen, a mainland China city separated from Hong Kong by a border, were recruited from some randomly selected gay venues in Shenzhen. Participants were face-to-face and anonymously interviewed. The results showed that in the last six months, respectively 62.1, 84.6, and 31.3 % of the participants from Hong Kong had had sex with commercial sex partners (CSP), non-regular partners (NRP) and regular partners (RP) in Shenzhen. The prevalence of unprotected anal intercourse (UAI) with these three types of sex partners was respectively 29.8, 27.9, and 78.7 %. Factors associated with UAI with any MSM in Shenzhen in the last six months included perceived chances of contracting HIV, perceived non-availability of condoms, giving money/gifts to Shenzhen MSM sex partners, and perception that MSM partners in Shenzhen would not always insist on condom use (multivariate OR = 2.9–13.90, p < 0.05), whilst factors of inverse associations included university education, having had sex with NRP but not with CSP and RP in Shenzhen and self-efficacy of insisting on condom use (multivariate OR = 0.04–0.22, p < 0.05). In sum, the prevalence of having multiple types of male sex partners and UAI was high. This was especially true when anal sex with RP was involved. Cross-border HIV prevention is greatly warranted. It should ensure condom availability and modify perceptions toward UAI.     

Exploring the Psychological Impact of HIV: Health Comparisons of Older Australian HIV-Positive and HIV-Negative Gay Men

Little is known about the impact of HIV on the mental health of older gay men. In a nationwide online survey, 1,135 Australian gay men aged 40 years and older reported on their physical and mental health. Compared with HIV-negative men, those with HIV were more likely to report currently receiving treatment for a mental health condition (37 vs. 25 %, p = 0.001), but no more likely to report treatment for a major physical health condition other than HIV (39 % vs. 40 %). On a measure of psychological distress, more HIV-positive men were highly distressed (14 vs. 8 %, p = 0.01). There were no significant differences in mental health across age groups for either HIV-positive or HIV-negative men. Underlying factors for poorer mental health included lower income (p = 0.003), not working (p = 0.004), living alone (p = 0.03), treatment for a major physical health condition (p < 0.001), recent experiences of discrimination (p = 0.03), and regarding one’s sexual orientation as an essential part of self-identity (p < 0.001). With disparities between older HIV-positive and HIV-negative gay men greater for mental than physical health, more attention may need to be given to the psychological well-being of those living with HIV, particularly by addressing underlying psychosocial factors.     

Gay Men Who Are Not Getting Tested for HIV

Using data from Australian Gay Community Periodic Surveys 1998-2010, we assessed the prevalence, trends and characteristics of gay men not tested for HIV. In 2010, one in eight Australian gay socially-engaged men were never tested for HIV, most of them sexually active and 56.5?% reporting unprotected anal intercourse. The proportion of not tested men was significantly higher in men younger than 30, of non-European origin and living outside of gay metropolitan areas. Although frequency of testing was associated with sexual practices, significant proportions of men with multiple sex partners and reporting unprotected anal intercourse were not tested as recommended. There were issues with using gay-friendly testing services in gay metropolitan areas. Despite Australia's success in HIV testing, improvement is needed for early detection of HIV infections. Interventions should encourage regular testing, engage with young gay men, improve access and convenience of testing, train service providers and expand testing options.     

Low Numeracy Predicts Reduced Accuracy of Retrospective Reports of Frequency of Sexual Behavior

Assessment of the frequency of sexual behavior relies on participants’ ability to arithmetically aggregate information over time and across partners. This study examines the effect of numeracy (arithmetic skills) on the accuracy of retrospective reports of sexual behavior. For 91 days, the participants completed daily reports about their sexual activity. Participants then completed a survey on sexual behavior over the same period. The discrepancies between the survey-based and the diary-based measures of frequency of vaginal and anal intercourse were evaluated. Multiple regression analysis showed that the discrepancy between retrospective and diary measurements of sexual intercourse increased with lower numeracy (P = 0.026), lower education (P = 0.001), aggregate question format compared to partner-by-partner format (P = 0.031) and higher frequency of intercourse occasions (P < 0.001). Lower numeracy led to a 1.5-fold increase (adjusted mean = 14.1–20.9) in the discrepancy for those using the aggregate question format and a 2.0-fold increase (adjusted mean = 3.7–7.6) for those using the partner-by-partner format.     

Ascertaining Partner HIV Status and its Association with Sexual Risk Behavior Among Internet-Using Men Who Have Sex with Men

The aims of this study were to understand strategies and consistency of strategy used by HIV-negative and HIV-positive men who have sex with men (MSM) to ascertain the HIV status of their male sexual partners and their associations with unprotected anal intercourse (UAI) and serodiscordant UAI (SDUAI) in the past 3 months. Participants (n = 640) completed an online survey in December 2007. The most commonly reported strategy was checking online profiles (85%), followed by talking before sex (82%), talking after sex (42%), and guessing (29%). Adjusting for demographic and behavioral factors, guessing the HIV status of sex partners was associated with greater UAI and SDUAI partners, as was using an inconsistent strategy. Ascertaining HIV status before having sex was associated with fewer SDUAI partners. Prevention should target MSM who guess the HIV status of their sex partners and emphasize explicit safer sex agreements.     

HIV-Negative Gay Men’s Perceived HIV Risk Hierarchy: Imaginary or Real?

HIV-related risk perceptions and risk practices among gay men have changed over time. We revisited perceived HIV risk and engagement in anal intercourse with casual partners among HIV-negative gay men who participated in one of the Sydney Gay Community Periodic Surveys (GCPS). Perceived HIV risk was assessed by a range of anal intercourse practices combined with pre-specified casual partners’ HIV status and viral load levels. Perceived HIV risk forms a potential hierarchy, broadly reflecting differences in the probability of HIV transmission through various anal intercourse practices. To a lesser extent, it also varies by casual partners’ HIV status and viral load. Men who had unprotected anal intercourse with casual partners (UAIC) perceived lower HIV risk than those who used condoms consistently in the 6 months prior to survey. Recognising the complex associations between risk perceptions and risk practices helps to better address challenges arising from the ‘Treatment as Prevention’ (TasP).     

Correlates of Unprotected Vaginal or Anal Intercourse with Women Among Substance-Using Men Who Have Sex with Men

The role men who have sex with men and women (MSMW) play in heterosexual HIV transmission is not well understood. We analyzed baseline data from Project MIX, a behavioral intervention study of substance-using men who have sex with men (MSM), and identified correlates of unprotected vaginal intercourse, anal intercourse, or both with women (UVAI). Approximately 10 % (n = 194) of the men reported vaginal sex, anal sex, or both with a woman; of these substance-using MSMW, 66 % (129) reported UVAI. Among substance-using MSMW, multivariate analyses found unemployment relative to full/part-time employment (OR = 2.28; 95 % CI 1.01, 5.17), having a primary female partner relative to no primary female partner (OR = 3.44; CI 1.4, 8.46), and higher levels of treatment optimism (OR = 1.73; 95 % CI 1.18, 2.54) increased odds of UVAI. Strong feelings of connection to a same-race gay community (OR = 0.71; 95 % CI 0.56, 0.91) and Viagra use (OR = 0.31; 95 % CI 0.10, 0.95) decreased odds of UVAI. This work suggests that although the proportion of substance-using MSM who also have sex with women is low, these men engage in unprotected sex with women, particularly with primary female partners. This work highlights the need for further research with the substance using MSMW population to inform HIV prevention interventions specifically for MSMW.     

Gender Differences in Heterosexual Anal Sex Practices Among Women and Men in Substance Abuse Treatment

Heterosexual anal intercourse (HAI) is an understudied risk behavior among women and men in substance abuse treatment. Rates of HAI for women (n = 441) and men (n = 539) were identified for any, main and casual partners. More men (32.8 %) than women (27.1 %) reported engaging in HAI in the previous 90 days. These rates are higher than those reported for both men (6.0–15.9 %) and women (3.5–13.0 %) ages 25–59 in the National Survey of Sexual Health and Behavior. Men were significantly more likely to report HAI with their casual partners (34.1 %) than women (16.7 %). In a logistic regression model generated to identify associations between HAI and variables previously shown to be related to high risk sexual behavior, being younger, bisexual, and White were significantly associated with HAI. For men, having more sex partners was also a significant correlate. HAI is a logical target for increased focus in HIV prevention interventions.     

The sexual behaviour of young gay men in England and Wales.

Much research has concluded that young gay men are at disproportionately higher risk of HIV infection through unsafe sexual behaviour. This paper is the first report on this particular group in the UK. As part of a larger cohort study, 111 young (less than 21) gay and bisexual men were interviewed about their sexual behaviour, knowledge of AIDS and HIV, particularly safer sexual practices and other factors. Three per cent had not had sex and 13% had not had anal intercourse with a man at the time of interview. Forty-five per cent had sexual experience with a woman and 34% had engaged in vaginal intercourse. The average age at first homosexual experience was just under 15 years and this is higher than other age groups in the cohort. Median number of male partners in the year before interview was 5, with 1 of whom anal intercourse occurred. Sexual repertoire was relatively restricted compared to older men. Condom use was slightly more consistent and levels of knowledge not significantly different. From these findings, the contention that young gay men are at higher risk of HIV infection through risky sexual behaviour is not supported.     

Seroadaptation in a Sample of Very Poor Los Angeles Area Men Who Have Sex with Men

Data from 635 very poor men who have sex with men (MSM) were used to identify seroadaptation with 1,102 male partners reported between 2005 and 2007 in Los Angeles as part of the Sexual Acquisition and Transmission of HIV Cooperative Agreement Program. The mean age of the sample was 41.7 years; 53 % had experienced homelessness in the past year. Condoms were reported in 51 % of sexual events involving anal intercourse. HIV seroconcordance was reported in 41 % of sexual partnerships among HIV-positive participants. HIV-positive men were more likely to have oral-only or unprotected receptive anal intercourse and less likely to have unprotected insertive anal intercourse with HIV-negative or unknown partners compared to HIV-positive partners. Even in the face of poverty, HIV-positive MSM report mitigating risks of HIV-transmission though seroadaptation in the context of modest rates of condom use.     

Childhood Sexual Abuse and HIV Risk-Taking Behavior Among Gay and Bisexual Men

We explored the prevalence of childhood sexual abuse among adult gay and bisexual men and measured the association between childhood sexual abuse and high-risk sexual behavior in adulthood. Two separate population-based samples of gay and bisexual men (n = 1,941) residing in Portland and Tucson were surveyed. Over one quarter reported a history of childhood sexual abuse (sexual behavior with someone at least 5 years older prior to age 13, or with someone at least 10 years older when between ages 13 and 15). Men who were abused were more likely to engage in sexual risk behavior than men who were not abused (e.g., unprotected anal intercourse with non-primary partners in the previous 12 months: 21.4% vs. 15.0%, p < .001). Perception of having been coerced was associated with greater sexual risk. Furthermore, childhood sexual abuse and level of coercion were associated with reported levels of HIV infection among gay and bisexual men. It is recommended that existing programs for those at risk for HIV be modified to deal with these issues, and that efforts to bring about behavior change will require approaches that go beyond simply increasing knowledge and awareness.