Sex while abroad appears to be contributing to the ongoing epidemics of HIV and other sexually transmitted infections (STIs) in European gay men, results of a large internet-based survey show. Over a quarter of European gay men reporting sex with another man they met while visiting another country engaged in unprotected anal intercourse. Respondents living with HIV were especially likely to report unprotected anal sex while visiting another country.
These findings are especially significant in light of epidemiological evidence showing European transmission networks of HIV, hepatitis C and Lymphogranuloma venereum (LGV).
Approximately 180,000 participants from 38 European countries completed the European Men-Who-Have-Sex-with-Men Internet Survey (EMIS) in 2010. This is the largest international study of men who have sex with men ever conducted.
The survey gathered a large amount of data on the demographics, sexual behaviour and drug use of men who have sex with men. A section of the survey was concerned with sex while visiting other countries.
Participants were asked “When did you last have sex in a country outside the one you live in, with a man who does not also live in [your country of residence]?”
Overall, 26.3% of men stated that they had had sex abroad in the previous twelve months. The countries with the highest proportion of participants reporting sex abroad tended to be in western Europe and Scandinavia, especially Luxembourg (57%), Switzerland (48%), Malta (45%) and the Netherlands (44%).
Men living with HIV were almost twice as likely to report sex abroad than HIV-negative and untested men (40 vs 24%; OR = 1.81). Men aged over 25 years were also more likely to report sex abroad than younger men (28 vs 16%), as were individuals with a higher level of education (32 vs 18%) and men living in larger cities (31 vs 20%).
The European countries in which respondents were most likely to report having sex while abroad were Spain (18%) and Germany (22%). Spain was visited most commonly by men from western European countries, and Germany by men from eastern European countries.
Other countries where men commonly had sex while abroad were France (7%), the UK (6%), Italy (4%) and the Netherlands (3%).
Sex while visiting non-European destinations was also widely reported. Overall, 7% of respondents said they had had sex while visiting the United States, 3% reported sex in Thailand and 2% in Brazil.
The most common way of meeting sexual partners while abroad was the internet. A third of men reporting sex while abroad said they had met their partners in this way.
“Potential sex partners can be contacted this way before or during a trip abroad,” write the authors.
Saunas were also a common meeting place (14%), as were gay discos or nightclubs.
Almost two-thirds (61%) of men reporting sex while abroad said they had had anal sex. Higher rates of anal sex (71%) were reported by men visiting Latin America and the Caribbean.
Men who had anal sex with a partner they had met abroad were asked “On that occasion did you and that partner have anal intercourse…without a condom?” A total of 26% of men who reported having sex abroad in the previous twelve months said they had had unprotected anal sex.
Men from Malta (38%), the Netherlands (35%), the UK (32%), Estonia (29%) and Sweden (29%) were especially likely to report unprotected anal sex with a sexual partner they met while abroad.
Almost half (49%) of men living with HIV having sex abroad reported unprotected anal sex compared to 21% of HIV-negative and untested men.
After controlling for factors such as country of residence, age and education, the investigators found that men living with HIV were 3.75 times more likely (CI, 3.47-4.04) to report unprotected anal sex with partners met abroad than men who were HIV negative or of unknown HIV status.
Almost all the men (89%) reporting unprotected anal sex while abroad also reported this behaviour with a casual partner in their country of residence.
The most common countries where men had unprotected anal sex while travelling abroad were the Netherlands (32%), Germany (29%) and the United States (26%).
Data were also gathered on where men met partners for unprotected sex. The most common venue (52%) was private sex parties, followed by “backrooms” in a bar or club, or a sex party in a public venue (35%).
Overall, the findings suggest that HIV and many STIs have international transmission networks. Men who have while abroad could be a target population for health education campaigns before travelling - perhaps delivered via the internet - and sexual health screens and HIV testing on return.
EMIS 2010: The European men-who-have-sex-with-men internet survey. Findings from 38 Countries. Click here to download.