Increase in high risk sexual behaviour among homosexual men, London 1996-8: cross sectional, questionnaire study

Abstract

The incidence of HIV infection among homosexual men in the United Kingdom is increasing despite efforts to reduce high risk sexual behaviour.1 The likelihood of engaging in high risk sexual behaviour may be increasing as new treatments reduce concern about infection. 2 We report the results of a repeated survey of sexual behaviour among gay men in London. Methods and resultsA survey was conducted in 1996, 1997, and 1998 using the same methodology each year.3 A sampling frame was compiled of all commercial gay venues (bars, clubs, and saunas) and genitourinary medicine clinics within inner London. A sample of venue types and locations was then selected. Between 59 and 72 venues were sampled each year. Whenever possible the same venues were selected each year; if venues had closed they were replaced in the sample by similar ones. Health promotion workers distributed questionnaires with 16 items that covered demographic information and sexual behaviour. All men present at or queuing to enter a venue during a specific period were invited to participate. Altogether 6671 of 8384 (80%) questionnaires distributed were returned; similar numbers were returned each year. Data were analysed using SPSS.Respondents were aged from 15 to 78 years (median 31). Men sampled in 1998 were significantly older than in previous years (table). Altogether, 5660 of 6354 (89%) of men were white and 4410 of 6232 (71%) resided in inner London.In each year, about a third of the men (729/2263 (32%), 694/1943 (36%), 730/1916 (38%), respectively) reported having had unprotected anal intercourse during the previous year. However, in every year high risk sexual behaviour (for example, unprotected anal intercourse in the previous year) was significantly associated with younger age (occurring among 108/252 (43%) of those aged under 25 and 103/340 (30%) of those over 40, P < 0.01 in 1998) and recruitment from a genitourinary medicine clinic (odds ratio 1.39, 95% confidence interval 1.13 to 1.71, P < 0.01 in 1998).

Who uses condoms with whom? Evidence from national probability sample surveys

“…We have reported elsewhere an increase in recent and lifetime partners, and in rates of concurrency, between 1990 and 2000, 9 14 while others have shown an increase in unsafe sex among MSM. 8 These findings together suggest that it is possible that increased condom use at the population level is being offset by high rates of inconsistent and non-use by individuals with high rates of partner acquisition. Condoms can only reduce the increased potential for STI transmission associated with higher rates of partnership formation if rates of consistent and correct condom use are consistently high relative to the levels of STI/HIV prevalence in the population.…”

“…In 2002, a third of newly diagnosed HIV infections were considered to have been acquired in the United Kingdom, with 80% of these 1850 cases occurring in MSM. 7 During the period 1996-8, the proportion of MSM engaging in unprotected anal intercourse increased, 8 as gonorrhoea diagnoses increased in this group. Our analysis therefore focuses on patterns of condom use in the more recent 2000 survey.…”

How has the sexual behaviour of gay men changed since the onset of AIDS: 1986–2003

“…[7][8][9] In the late 1990s, crosssectional surveys found increasing proportions of gay men had engaged in UAI, both in Sydney [10][11][12] and internationally. [13][14][15][16] Fisting (brachioproctic intercourse), sadomasochism, watersports (urolagnia), group sex (more than one partner in a single sexual encounter) and use of sex on premises venues, and recreational drug use are sometimes identified with "cultures of sexual adventurism". 17 The men who engage in such behaviours have been found to be at increased risk of infection with sexually transmissible diseases, including HIV, and to be more likely to report UAI, at least with casual partners.…”

Sexual behaviour in Britain: why sexually transmitted infections are common

“…The proportion of gay men in London reporting unprotected anal intercourse with both regular and casual partners in the past year rose from 32% in 1996 to 44% in 2000. 14 Recent growth in traditional (eg saunas and cruising grounds) and new (eg websites and internet chat rooms) venues for meeting prospective sexual partners has substantially increased the opportunities for men who have sex with men to acquire new sexual partners. Cultural background has a powerful influence on sexual behaviour and attitudes, which may partly explain variations in STI distribution across ethnic groups.…”