F Hickson

Sex role separation in sexual diaries of homosexual men

ObjectiveTo measure types of sex role prevalence in common and risk-related behaviours among gay men for modelling HIV transmission. DesignCohort study of 385 homosexually active men recording sexual diaries over 1-month periods. MethodsMeasures of incidence of behavioural sex roles for masturbation, fellatio, anal intercourse and anilingus by relationship type, derived from 1-month sexual diary data. ResultsLow behavioural role rigidity for masturbation and fellatio, but higher rigidity for anal intercourse and anilingus. Participants with no regular partner showed a relatively low frequency of anal intercourse, whereas those in closed relationships showed a high frequency. ConclusionAlthough anal intercourse shows a certain degree of behavioural role rigidity, this rigidity is not large enough to conclude that gay men exclusively engage in either an active or a passive role. Typical rates for exclusive active and passive roles for anal intercourse during the month the diaries were recorded were in the range of 12–15%; the dual role was significantly higher.

Methamphetamine use among gay men across the UK

BACKGROUNDnConcerns about gay mens methamphetamine use reflect its physical and psychological harms, and association with sexual-risk behaviour and HIV infection. Existing research suggests gay mens use in the UK is low and may be largely confined to London.nnnMETHODSnCross-sectional survey of convenience sample of UK gay men.nnnRESULTSnMethamphetamine was used by a significant minority of gay men in London but also in other regions. Overall, use was highest among those men aged 30-49, HIV-positive and reporting sexual-risk behaviours.nnnCONCLUSIONnMethamphetamine was used by a significant minority of gay men in and outside London. Targeted prevention and treatment services should be developed and evaluated.

HIV, sexual risk, and ethnicity among men in England who have sex with men

Objectives: To examine ethnic group differences in HIV testing history and sexual HIV risk behaviours that may account for such differences, among men in England who have sex with men (MSM), in order to inform HIV prevention planning priorities. Methods: A self completion survey in the summer of 2001 was carried out in collaboration with community based health promoters. Three recruitment methods were used: “gay pride” festivals, health promoter distributed leaflets, internet version advertised with gay service providers. The leaflet was produced with an alternative cover for targeted recruitment of black men. Results: In a sample of 13 369 MSM living in England, 17.0% were from minority ethnic groups and 5.4% had tested HIV positive. Compared to the white British majority, Asian men were 0.32 times as likely to be living with diagnosed HIV infection, while black men were 2.06 times as likely to be doing so. Among men who had not tested HIV positive, Asian men were less likely to have sex with a known HIV positive partner, while black men were more likely to have insertive unprotected anal intercourse both with a partner they knew to be HIV positive and with a partner whose HIV status they did not know. Conclusions: Among MSM in England, HIV prevalence is higher among black men and lower among Asian men compared with the white British majority. Increased sexual HIV risk behaviour, especially exposure during insertive anal intercourse, accounts for some of this difference. HIV prevention programmes for MSM and African people should both prioritise black MSM.

Sexual HIV risk behaviour among men who have sex with both men and women

The aim of this study was to describe the sexual behaviour of men who had sex with both men and women in the preceding five years (behaviourally bisexual men), specifically to examine their needs in relation to HIV prevention. Anonymous telephone interviews were carried out with respondents recruited though advertisements in UK newspapers and magazines with (sexual) personal or contact sections. Data are reported from 745 respondents. Respondents report relatively high and approximately equal numbers of male and female sexual partners in the year preceding interview. There is a clear patterning of sexual activity by type of partner (regular or casual). A high proportion report anal intercourse with female and male partners. A third disclose their homosexual practices to regular female partners. Although self-reported HIV seroprevalence is low (less than 1%), the levels of unprotected sex with multiple sexual partners indicate substantial potential for transmission of sexually transmitted infections, including HIV. While low seroprevalence suggests that there is little overlap with existing core groups of HIV infection, the study provides information to judge the priority of targeting HIV prevention initiatives and suggests ways in which initiatives could be undertaken.

Sexually transmitted infection as a risk factor for homosexual HIV transmission: a systematic review of epidemiological studies.

Existing reviews suggest some sexually transmitted infections (STIs) are risk factors in heterosexual HIV transmission. This may not be so in homosexual HIV transmission, about which reviews make no specific conclusions. This paper reviews published studies which report on the relative risk of STIs in HIV seroconversion in homosexually-active men in order to examine this matter. Papers obtained via various searches were judged adequate if they were prospective cohort or cohort-nested case-control studies; used HIV seroconversion as the outcome; assessed STI exposure objectively; and controlled for potential confounding from age and sexual behaviour. Sixteen papers were obtained, of these 3 were judged adequate. Adequate papers reported little association. Inadequate papers were more likely to report association. Evidence from adequate studies does not suggest STIs are risk factors in homosexual HIV transmission. Some caution is needed in interpreting the results because of the paucity of adequate studies.

The sexual behaviour of young gay men in England and Wales.

Much research has concluded that young gay men are at disproportionately higher risk of HIV infection through unsafe sexual behaviour. This paper is the first report on this particular group in the UK. As part of a larger cohort study, 111 young (less than 21) gay and bisexual men were interviewed about their sexual behaviour, knowledge of AIDS and HIV, particularly safer sexual practices and other factors. Three per cent had not had sex and 13% had not had anal intercourse with a man at the time of interview. Forty-five per cent had sexual experience with a woman and 34% had engaged in vaginal intercourse. The average age at first homosexual experience was just under 15 years and this is higher than other age groups in the cohort. Median number of male partners in the year before interview was 5, with 1 of whom anal intercourse occurred. Sexual repertoire was relatively restricted compared to older men. Condom use was slightly more consistent and levels of knowledge not significantly different. From these findings, the contention that young gay men are at higher risk of HIV infection through risky sexual behaviour is not supported.

The testing of saliva samples for HIV-1 antibodies: reliability in a non-clinic setting.

AIMS--To assess the reliability of saliva samples as a means of testing for HIV-antibodies outside clinic settings. METHODS--Men taking part in a non-clinic longitudinal study of homosexually active men provided samples of saliva and blood. Sera were screened using a competitive ELISA (Wellcozyme) and positive sera were confirmed by an indirect ELISA (Abbott). Saliva samples were screened either using an IgG captive radioimmunoassay or an amplified ELISA. RESULTS--A total of 534 paired saliva and blood samples were tested. Overall sensitivity was 96.2% and specificity was 100%. None of the saliva tests were falsely positive for HIV-1 antibodies. CONCLUSIONS--HIV-1 saliva tests can reliably be used in a non-clinic or field setting. However, if results are to be given to respondents, it is necessary to offer adequate counselling and consider the mechanisms for referral and follow-up for those that are found to be HIV-1 antibody positive.

HIV infection in a cohort of homosexual and bisexual men.

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Illicit drug use among men who have sex with men in England and Wales

This article aims to examine patterns of and concerns about drug use among a convenience sample of MSM in 2005, and compare the prevalence of illicit drug use among 1999 and 2005 samples of MSM in England and Wales. It draws on data from cross-sectional surveys of MSM in gay community venues and services across England and Wales, 2480 in 1999 and 3913 in 2005. We report that in 2005, cocaine, cannabis and alkyl nitrites were the drugs most commonly used in the previous year by MSM inside and outside London. Drug use was significantly more common among men who were younger and resided in London, and among those who reported greater numbers of male sexual partners and were HIV-positive. Frequency of use was generally high among those who used a drug, and poly-drug use was also high. A substantial minority of men who used illicit drugs were worried about use. More men in 2005 than in 1999 reported using various drugs including cocaine, ecstasy and ketamine. We conclude that use of drugs is widespread among the MSM surveyed. Exclusive use of any one drug is rare. There is an urgent need for drug prevention and treatment interventions, which are accessible and acceptable to MSM.

Addressing gay men's use of methamphetamine and other substances

Gay mens use of methamphetamine has aroused great anxiety. In some countries such as the USA and Australia as many as 40% of gay men use this drug, while use is lower in others such as the UK. However, across all these countries gay mens use of other substances such as alcohol, poppers and cannabis surpasses that of methamphetamine. Recent evidence from case-crossover studies suggests that use of not only methamphetamine but also of alcohol, cannabis, poppers, cocaine, amphetamines and Viagra is associated with increased risk behaviour during episodes of anal intercourse. However national drugs and alcohol strategies do not refer to gay men, drug treatment services tend to focus on opiates and do not target gay men, and HIV prevention for gay men rarely mentions use of substances other than methamphetamine. This is a missed opportunity given the evidence for the effectiveness or drug treatment and prevention interventions, and evidence that such interventions can be tailored to gay clients.