The proportion of gay men reporting unprotected anal sex with a casual partner has increased significantly in recent years, according to a poster presentation to last week’s Fifteenth International AIDS Conference in Bangkok. The investigators from London’s City University recommend that men having unprotected anal sex with casual partners should be targeted with HIV prevention initiatives.
Every year between 1998 to 2003 gay men attending gyms in central London were asked to complete a questionnaire enquiring about their HIV status and sexual activity. In particular, the men were asked if they had had unprotected anal sex with a casual partner of an unknown of different HIV status (non-concordant unprotected anal sex), and/or unprotected anal sex with a partner of the same HIV status (concordant unprotected anal sex).
In total 4,264 gay men completed the survey with a mean age of 34 years. A total of 15% of these men were HIV-positive, 62% were HIV-negative and 23% had never tested for HIV.
There was a significant increase in the percentage of men reporting non-concordant unprotected anal sex during the period of the study. In 1998 7.8% of men reported anal sex without a condom with a man of an unknown or different HIV status. This increased to 16.1% by 2003, a statistically significant increase (p < 0.001).
During the same period the proportion of men reporting concordant anal sex fell slightly from 6.7% in 1998 to 5.6% in 2003, however this change was not statistically significant (p = 0. 07).
Between 1998 and 2003 the percentage of men reporting non-discordant unprotected anal sex with a casual partner also increased significantly (p < 0.05). However the number of men reporting non-concordant anal sex with their main partner remained static.
The investigators also collected data on unprotected anal sex between men of the same HIV status. There was a significant increase in the percentage of HIV-positive gay men reporting unprotected anal sex with other HIV-positive men, rising from 6.8% in 1998 to 10.3% in 2003 (p < 0.05). However, the proportion of HIV-negative men reporting unprotected anal sex with other HIV-negative men remained static at 1.7% in 1998 and 2.1% in 2003 (p = 0.2).
The investigators conclude, “the increase in high risk sexual behaviour among London gay men between 1998-2003 was seen only with casual partners.” The investigators recommend that “HIV prevention among gay men in London should target high risk practices with casual partners since these account for the recent increase in risk.”
Elford J et al. Trends in sexual behaviour among London gay men 1998-2003: implications for HIV prevention. XV International AIDS Conference, Bangkok, WePeC6049, 2004.