Number of gay men in London reporting unsafe sex no longer increasing

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The percentage of gay men in London having unprotected anal sex with a casual partner has stabilised since 2002, according to the results of a survey presented in the 2nd December edition of AIDS. However, more men are still reporting unsafe sex now than in 1998, when the survey began.

Every year since 1998, researchers from London’s City University have asked gay men attending gyms in central London to complete questionnaires about their HIV status and sexual behaviour. The latest analysis confirms the trends seen in the previous presentation, with a total of almost 5420 men completing the questionnaire up to 2005.

The investigators defined 'risky sex' as unprotected anal intercourse with a partner of different or unknown HIV status. Between 1998 and 2001, the percentage of men reporting risky sex with a casual partner increased from 7 to 15% (p

Glossary

risky behaviour

In HIV, refers to any behaviour or action that increases an individual’s probability of acquiring or transmitting HIV, such as having unprotected sex, having multiple partners or sharing drug injection equipment.

unprotected anal intercourse (UAI)

In relation to sex, a term previously used to describe sex without condoms. However, we now know that protection from HIV can be achieved by taking PrEP or the HIV-positive partner having an undetectable viral load, without condoms being required. The term has fallen out of favour due to its ambiguity.

After breaking down the data by HIV status, the investigators found that the rates of risky sex increased significantly in HIV-positive and –negative men, as well as those who had never had an HIV test (p

However, between 2002 and 2005, the percentage of men reporting risky sex fell slightly, from 16 to 12% (p

“The percentage of London gay men reporting high-risk sexual behaviour with a casual partner has remained stable since 2002, with some evidence of a decline for HIV-positive men. This levelling off may reflect the impact of intensified HIV prevention programmes that followed the increase in high-risk behaviour in the late 1990s,” the researchers conclude.

“However, as the rates of high-risk sexual behaviour among London gay men are still higher than they were in the late 1990s there is no room for complacency,” they add. “Addressing this elevated level of risk will require a sustained programme of HIV prevention among London gay men.”

The survey revealed that the number of men believing that improved treatments have made people with HIV less infectious has increased from 14% in 2000 to 24% in 2005. This suggests that treatment optimism is not directly linked to increased sexual risk-taking.

Similarly, the proportion of men looking for sex through the Internet has increased from 28% in 2000 to 55% in 2005. “Internet use per se does not appear to present a risk for HIV transmission,” the investigators write.

Among HIV-positive men, the rates of unprotected sex with other HIV-positive men increased between 1998 and 2005, from 7 to 18% (p

The survey also found that rates of risky sex with a main partner of different or unknown HIV status remained stable across all three groups between 1998 and 2005. In contrast, rates of unprotected anal sex with steady partners of the same HIV status increased, both in HIV-positive men (5 to 10%; p = 0.03) and in men without HIV (12 to 19%; p = 0.04).

References

Elford J et al. High-risk sexual behaviour among London gay men: no longer increasing. AIDS 19: 2171-2174, 2005.