Lack of 'vigour' in HIV prevention has led to increase in risky sex in Scottish gay men says study

The proportion of gay men in Scotland reporting unprotected anal sex with a casual partner increased significantly between 1999 and 2002, according to a study published in the October edition of Sexually Transmitted Infections. The study also revealed that unprotected sex was associated with age, frequency of bar attendance and HIV treatment optimism.

Concern is expressed by the investigators that the proportion of men engaging in unprotected sex who said that they knew their casual partners’ HIV status increased, even though there was no increase in the proportion of gay men testing for HIV. The investigators suggest that there is “a direct link between increased (but undue) confidence on the part of homosexual men that they share the (negative) serostatus of their casual partners and the apparent failure to deliver prevention messages by health promotion agencies.”

Studies from the United States, Europe and Australia suggest that since effective anti-HIV treatment became available, there has been an increase in the proportion of gay men reporting unprotected anal sex with partners of a different or unknown HIV status. Investigators wished to determine if there had been an increase in sexual risk-taking by Scottish gay men; what the relationship was between HIV testing and sexual behaviour; and, to see what explanations could be offered for changes in sexual behaviour.

A total of 6,500 men were recruited to the study at gay bars in Edinburgh and Glasgow in three waves in 1996, 1999 and 2002. In self-completed questionnaires, men were asked to provide demographic information, give information about their sexual behaviour, answer questions designed to assess their HIV “treatment optimism”, and say if they had had an HIV test.

In 1996 three quarters of men reported anal sex and 32% said that they had had unprotected anal sex. These figures remained stable in 1999, but in 2002 a total of 80% of men said that they had had anal sex and 43% reported unprotected anal sex. Both increases were highly statistically significant (p

The proportion of men who said that they had had an HIV test was 39% in 1996, 40% in 1999 and 42% in 2002. This increase was not statistically significant.

However, the proportion of men saying that they always knew their casual partners’ HIV status increased from 15% in 1996 and 1999 to a statistically significant 25% in 2002 (p = 0.004).

The investigators found that factors significantly associated with unprotected sex included being aged over 26, increased frequency of attendance at gay bars, level of education and HIV treatment optimism. However, the investigators found that risk factors differed according to HIV testing history and the number of partners an individual reported having unprotected sex with.

For example, frequency of bar attendance was the only significant risk factor for men who reported having had an HIV test and having unprotected sex with only one partner. However, for men who had never tested and had had unprotected sex with a single partner, not only was frequency of bar attendance a risk factor, but also age over 26 and level of education. The investigators found that in men who had had unprotected sex with more than one man, age, frequency of bar attendance and HIV treatment optimism were significantly related with unprotected sex regardless of HIV testing history.

“The sexual risk behaviour of homosexual men in Scotland increased between 1996 and 2002”, comment the authors.

HIV treatment optimism has been suggested as a cause for increased levels of sexual risk-taking amongst gay men since 1996. The Scottish investigators note that the number of men reporting unprotected sex remained stable between 1996 and 1999, a period when well focused health promotion initiatives were targeted at gay men in Edinburgh and Glasgow. The increases in risk behavior occurred after 1999 when HIV prevention efforts were less focused. The investigators label this as “prevention failure” and write “the safer sex message has simply not been communicated with any vigour for such a long period of time.”