Six in ten European gay men have had unprotected sex in the past year – more common with steady partners

Across Europe, 58% of gay and other men who have sex with men (MSM) report at least one incident of unprotected anal intercourse in the past year, according to results from the European MSM Internet Survey (EMIS) released last month. Whereas 39% of men had had unprotected sex with a steady partner, 26% had done so with a casual partner.

Younger and less educated men reported higher rates of unprotected sex with a steady partner whose HIV status was either unknown or thought to be different from the respondent’s. In relation to casual partners, these factors were not relevant.

The EMIS project involved an internet-based questionnaire, that was made available in 25 languages across Europe in 2010, recruiting around 180,000 participants. Because the survey used the same recruitment methods, questions and definitions of risky behaviour with respondents across Europe, the data it produces on different countries are comparable.  

In the previous year, 58% of respondents had had sex with a steady partner (and sometimes more than one). Also, 67% had had sex with a casual partner – half of them had five or fewer partners in the past year, 19% had between six and ten, and 30% had more than ten partners.

Among those who had a steady partner:

• 67% had unprotected anal intercourse, at least once.
• 23% consistently used condoms.
• 10% did not have anal intercourse.

Among those with a casual partner:

• 39% had unprotected anal intercourse, at least once.
• 44% consistently used condoms.
• 17% did not have anal intercourse.

Expressed as a proportion of the whole sample, 39% of European MSM had unprotected anal intercourse with a steady partner, and 26% with a casual partner, in the previous twelve months.

The survey also asked some detailed questions about the most recent casual partner that men had met. Looking at this measure, rates of unprotected sex are lower than when considering all partners in the previous year.

• 19% had unprotected anal intercourse.
• 42% used condoms.
• 39% did not have anal intercourse.

On that occasion, around two-thirds of men did not discuss their HIV status with this partner. Amongst those who had unprotected sex, 47% of men with diagnosed HIV and 42% of other men discussed their HIV status.

Returning to the data on unprotected anal intercourse in the past year, the survey also gathered information on the HIV status of the respondent and his partners, as some unprotected sex is likely to be between men who believe they have the same HIV status. However, if the respondent did not know his own HIV status or that of his partner, of if he knew that his partner’s HIV status was different, the investigators describe the sex as ‘non-concordant’.

They found that 22% of men with a steady partner had had non-concordant unprotected anal intercourse, and 25% of those who had had casual partnerships had done so.

Moreover, they looked at whether certain demographic factors were associated with increased rates of non-concordant sex, as outlined below. These differences were statistically significant.

In terms of country of residence, the authors say that there appears to be a west-east divide in rates of risky sex.

The countries with the highest rates of non-concordant unprotected anal intercourse with a steady partner were Turkey, Bosnia & Herzegovina, Lithuania, Romania, Slovakia, Latvia, Croatia, Moldova, Ukraine and Cyprus.

Those living in the following countries were the least likely to report this behaviour with a steady partner – France, Luxembourg, Switzerland, Belgium, Denmark, the Netherlands, Sweden, Austria, the United Kingdom and Germany. 

In part this reflects high testing rates in these countries, although there are exceptions – Spain and Portugal have extremely high testing rates, but rates of risky sex closer to the European average.

And while the data on casual partners are similar in many ways, there are some intriguing differences. The UK, Sweden and Denmark recorded relatively high rates of non-concordant unprotected anal intercourse with casual partners, whereas their scores with steady partners were more encouraging. While Slovenia and Greece had some of the lowest rates of non-concordant sex with casual partners, their scores in relation to steady partners were much closer to the average.

Conclusions

The authors say that their data suggest that the great majority of men with steady partners consider their HIV status, and that of their partner, when deciding whether or not to use condoms. However, with a fifth of men reporting non-concordant unprotected sex, prevention work on mutual HIV testing and disclosure of status is needed, especially for younger and less educated men.

They note that men with diagnosed HIV report high rates of unprotected sex with casual partners and that half do not disclose their HIV status on such occasions – continued HIV prevention work is required.

In relation to the west-east divide in rates of risky sex, further investigation of its causes is needed. National differences in the availability of HIV testing, exposure to prevention activities, discrimination against men who have sex with men and gay community support may all play a part.