A major survey of gay men in London has found a 23% increase in the number of men of reporting unprotected anal intercourse with more than one partner between 1996 and 1998 (p Julie Dodds and colleagues at University College Hospital Medical School report a 26% increase in the likelihood of UAI with a partner of unknown or the opposite HIV status between 1996 and 1998. Peter Weatherburn, Director of SIGMA Research says that the increase in UAI detected in the Pride surveys is due to more UAI with partners of the same HIV status. Unprotected anal intercourse with partners of unknown HIV status increased by only 1.6% between 1998 and 1999 in London gay men, and there was no change in the reported level of UAI with serodiscordant partners.
The two sample groups may have differed slightly. Whilst the SIGMA survey interviewed men at the annual Pride festivals in several cities including London, the University College survey distributed a self-completion questionnaire to men at more than 60 gay venues each year (with a response rate of 80%).
"I would expect the out of London sample to have diluted the increase in UAI between 1998 and 1999, but if anything, the effect that we recorded in the Pride surveys was more pronounced" said Peter Weatherburn. The SIGMA group also analysed data for London gay men separately, and came to the same conclusion: unprotected sex between men of the same HIV status has continued to increase year on year since the mid-90s.
An accompanying editorial in the British Medical Journal suggests that one reason for the increase in unprotected anal intercourse is a perception amongst gay men that HIV is a less serious infection due to combination therapy. Peter Weatherburn says there is no evidence to support this explanation for behaviour changes in London.
"When asked to agree or disagree with the statement "HIV is still a very serious medical condition", there was no change in the attitudes of HIV-negative or untested men living in London between 1997 and 1999, according to the Pride survey", Peter Weatherburn told aidsmap.
The University College survey also asked gay men whether they had taken an HIV test in the previous year. The final survey took place in November 1998, nearly one year after the first major campaigns about HIV testing began in the gay press. These were mounted by the Terrence Higgins Trust and by Crusaid. Paradoxically, Julie Dodds and colleagues found no evidence of an increase in the likelihood of having taken an HIV test during 1998, and SIGMA Research found that the people most likely to take an HIV test during 1997-98 were those who had done so previously.
SIGMA Research presented findings from the 1998 and 1999 Pride surveys at the CHAPS national gay men's HIV prevention conference in March.
Reference
Dodds J et al. Increase in high risk sexual behaviour among homosexual men, London 1996-8: cross-sectional, questionnaire study. British Medical Journal 320: 1510-11, 2000.
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