Considerable increase in unprotected sex found in French/Canadian gay survey

A French and Canadian online survey of gay men and other men who have sex with men (MSM) appears to have uncovered a dramatic increase in the rates of unprotected sex with casual partners, potentially serodiscordant sex, and sexually transmitted infections.

It also appears to document an increased proportion of men who identify as bisexual, and finds that only a minority of men identify themselves as belonging to a distinct gay community.

Aidsmap.com reported on interim figures from this survey on 15 August ; the survey is now complete and the revised figures are below.

The survey

Every three years, the French Centre National de la Recherche Scientifique (CNRS – France's national scientific research centre) and the University of Quebec have organised the Gay Net Barometer, a behavioural survey of gay men and MSM recruited using gay dating websites and social networks.

Although the survey results document considerable changes from the last survey in 2009, this may in part be due to changes in who answered the survey, as well as to actual behavioural changes, because there is no way of determining any differences between the men who answered the last survey and the present one. These differences may be significant because, as the researchers note, gay contact media have changed a lot in the last few years. The researchers comment that recruitment to the survey has been slower in 2013: in 2009, 20,000 men answered the survey but only 14,000 answered the 2013 survey. This could tilt the profile towards 'higher-risk' men. Thirteen per cent of respondents in the 2013 survey said they had HIV.

The researchers comment that, with phone-app sites like Grindr now popular, with an increasing number of MSM contacting each other via specialist media rather than gay-specific sites, and with people accessing the internet via an increasing variety of mobile devices, online interaction can be carried on anywhere and often more briefly: fewer men may be taking the time to sit down at their computer in the evening and devote time to answering an online survey.

Increases in risk behaviour

Nonetheless, although the groups answering the two surveys are not identical, the data show what seems to be a large increase in sexual risk behaviour. While in 2009 34% of participants reported having had at least one experience of unprotected anal sex with a casual partner, in 2013 it was 43%. Furthermore, the proportion reporting regular unprotected sex with casual partners has risen from 21 to 35%.

In 2009, only 15% reported having unprotected sex with partners of different or unknown HIV status: in 2013, the figure was almost twice this at 28.5%. However, principal researcher Alain Léobon warned that this figure could be influenced by changes in the rate of HIV status disclosure, the perceived social desirability of serodiscordant sex, and people’s guesses at their partners’ HIV status.

These increases in risk behaviour appeared to be having health consequences, too. In 2009, 9% of participants reported being diagnosed with a sexually transmitted infection (STI) in the past year. In 2013, the proportion was 22%: 13% of those entering the survey on social network sites, 17% of those using gay-specific dating sites, and 25% of those using ‘specialised’ sites such as fetish sites and 'bareback' sites.

The proportion co-infected with HIV and hepatitis C has also increased, from 1.4% in 2009 to 3.7% in 2013.

Generational and site-usage differences

There was a significant difference in reported HIV status according to how participants accessed the survey. While the mean HIV prevalence in participants was 13%, in participants accessing the site via general social networking sites – rather than gay-specific ones – it was only 4.8%.

The researchers interpret this as a difference in the age of those reporting: young people are both less likely to have HIV, and less likely to have taken a test and know their status. Using gay-specific sites seems to be something mainly done by older gay men, and their membership may be “stagnating”, the researchers say: the average age of men responding from the general social network sites was 32, but on gay-specific sites was 37.

The surveys appear to show a slight increase in the proportion of participants who regard themselves as bisexual, from 16% in 2009 to 20% in 2013.

Gay socialising and discrimination

Fewer than a third (30%) of respondents reported feeling that they belonged to a distinct “gay community”. Only one in six attended gay-specific bars and clubs; one in ten reported meeting sexual partners at general bars and clubs.

Despite the fact that only 8.5% of men said that they were "visibly" gay, 23% said they had been discriminated against because of their homosexuality. These figures increased to 11 and 33% in the predominantly younger respondents from the general social networking sites, who reported being discriminated against more often because of how they looked or behaved rather than because they were openly gay.

A quarter of respondents on the bareback sites, who were predominantly HIV positive, reported discrimination by other gay men because of their HIV status.