High risk pool of gay men with multiple partners growing in UK

The number of British gay men who report more than 30 partners in a year has grown substantially since 1993, and this group is more likely to report unprotected anal intercourse with casual partners. The group represents an important target for HIV health promotion, according to a newly published report from SIGMA Research at the University of Portsmouth.

SIGMA Research has carried out research in the UK on behalf of the Community HIV & AIDS Prevention Strategy, which links community-based prevention projects targeting gay men across England and Wales. Its data is largely derived from an annual Gay Men’s Sex Survey which questions men attending Gay Pride festivals in British cities; in 2000, over 9,000 men were interviewed.

Until now, HIV prevention strategies have not targeted men with large numbers of partners, partly due to lack of evidence, but also because previous research had shown that unprotected anal intercourse occurs most frequently within regular partnerships. However, the 2000 findings indicate that sexual behaviour is shifting among gay men in the UK after what may have been a contraction in the number of sexual partners during the mid 1980s and early 1990s.

Changes in sexual behaviour between 1993 and 2000

The mean number of partners for all men interviewed rose slightly, from 15 to 18. The mean number of partners with whom UAI occurred rose from two to five, but the median remained one partner.

Behaviour

32.4% of men who had more than 30 partners in the preceding year had unprotected anal intercourse with at least one casual partner, and were much more likely to have anal intercourse than men who reported two to four partners in the preceding year. They were also more likely to report unprotected anal intercourse with partners they knew to have a different HIV status, and to have UAI with three or more partners in one year. Despite their high rates of partner change and unprotected anal intercourse, men in this group still placed a high degree of responsibility on their partners for reducing the risk of unprotected anal intercourse: fifty per cent of the group expected their partners to disclose if they were HIV-positive.

A correlation between high partner numbers and meeting partners in public sex environments such as cruising areas and saunas was also found. Those using cruising areas had unprotected anal intercourse with more casual partners than the rest of the population, and the more public sex venues that were used by an individual, the greater the median number of sexual partners. However, the research is not able to demonstrate whether there is a correlation between the increasing availability of public sex venues and an increase in the number of men reporting large numbers of partners.

Men with 30+ partners were more likely to have contracted an STI in the previous year (28.6% vs 16.5% of men with 5 -12 partners). Perhaps inevitably, they were also more likely to have experienced condom failure. 19% of men with more than 30 partners reported condom failure when they were the insertive partner in the preceding year, compared with 8% of those with one partner.

18% of men in their thirties reported more than 30 partners, compared with 12% of men in their twenties; 31% of HIV-positive men reported more than 30 partners, compared with 18% of HIV-negative men and 10% of untested men.

The authors suggest that given the geographical clustering of this group – in large urban centres, with disproportionate use of public sex venues and cruising areas – face to face interventions may be more appropriate than mass media and small media campaigns.

The survey also identified that men with higher numbers of partners were more likely to report that they were not always having sex that was as safe as they wanted it to be, and that they had difficulties in saying no to unwanted sex more frequently than other groups. Focussing on issues of self-efficacy and personal agency and control during sex may be especially important in any intervention.