Cultures of sexual adventurism as markers of HIV seroconversion: A case control study in a cohort of Sydney gay men

Abstract

A case control analysis within an ongoing cohort study was used to examine differences between seroconverters and men who remained HIV-negative. The cases were interviewed within one to 13 months prior to their seroconversion. Their responses to a structured questionnaire were compared with those of HIV-negative controls drawn from the same time period and from the same longitudinal study, Sydney Men and Sexual Health. Data collected from both cases and controls included: demographic and contextual variables, knowledge of HIV transmission, sexual practices, drug and alcohol use and attitudinal factors. The aim was to compare the sexual behaviours, and the social and cultural contexts of such behaviours, of men prior to their HIV seroconversion with men who did not seroconvert. Twenty-three men had seroconverted within the cohort. Cases were identified by a positive HIV antibody test or self-report of positive HIV status following a previous negative HIV test. Three-hundred-and-sixty-nine controls were selected on the basis of being HIV negative at interview in 1994, and having at least one subsequent medically-confirmed negative HIV antibody test. Univariate predictors of seroconversion were: being in a regular relationship with a known HIV-positive partner, drug use, and engaging in a range of anal and esoteric sexual practices. Practices commonly used to enhance sexual pleasure, such as group sex, watching and being watched having sex, the use of sex toys and dressing up/fantasy, were engaged in more frequently by seroconverters. Engaging in these esoteric sexual practices was highly correlated with drug use, involvement in the gay community and engagement in a wide range of anal practices. In the multivariate analysis independent predictors of seroconversion were: younger age; being in a regular relationship with a known HIV-positive partner; believing withdrawal to be safe with regard to HIV transmission; and range of esoteric practices. These results indicate the importance of the social and cultural contexts of particular sexual practices and consequent HIV transmission. Sexually adventurous men may be at increased risk for HIV because they seek sex within particular sexual sub-cultures.

Unconventional sexual behaviors and their associations with physical, mental and sexual health parameters: a study in 18 large Brazilian cities

“…According to the above-mentioned study carried out in Sydney, Australia, homosexual men who engaged in unconventional sexual activities were at higher risk of acquiring HIV, probably due to the fact that they looked for partners within particular sexual subcultural contexts. 28 In the same way as with paraphilias and SC, there was a more frequent history of sexual violence in group 1. 20,29 Although group 1 had higher risk of STD and HIV infections and use of "morning after pill," there was more reference to fear of contracting STD in this group, a fact that can be associated with higher frequency of sexual activity.…”

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

“…One potential underlying factor may involve sexual adventurism [35]. Men who tend toward higher-risk sexual behavior, and who are therefore more vulnerable to infection, may also be less inclined toward having monogamous partnerships.…”

Sex in Australia: Autoerotic, esoteric and other sexual practices engaged in by a representative sample of adults

“…35 Although most of these activities do not appear to pose an HIV transmission risk in themselves, a case-control study of gay men in Sydney found that engagement in 'esoteric' practices including fisting, sadomasochism and use of sex toys was an important predictor of whether men acquired HIV. 36 Sexually adventurous men who engage in such esoteric practices may be at heightened risk for HIV because they seek partners within particular sexual subcultures. One important purpose of the study reported here is to 'anchor' the estimates obtained from targeted gay community research such as Male Call 35 and the gay community cohort studies 36 to a representative household sample.…”