P. M. Davies

No connection between alcohol use and unsafe sex among gay and bisexual men

OBJECTIVE To investigate the relationship between alcohol use and unsafe sexual behaviour. METHODS The paper discusses data collected from 461 gay and bisexual men interviewed in England and Wales by Project SIGMA during 1991-1992. These data were collected during face-to-face interviews using retrospective weekly diary techniques and include details of all sexual sessions and alcohol use. The 819 reported sexual sessions with other men are divided into those that involved alcohol use (30.6%) and those that did not. RESULTS Differences in the incidence of HIV risk behaviours between sexual sessions that involved alcohol use and those that did not are small, and none are statistically significant. Furthermore, for those men who engaged in sexual behaviour whilst under the influence of alcohol, the quantity of alcohol consumed had no effect on sexual behaviour. CONCLUSIONS Among gay and bisexual men, sex under the influence of alcohol is no more likely to be unsafe than sex among men who have not consumed alcohol.

Maintenance of open gay relationships: Some strategies for protection against HIV

The role of sexual exclusivity (monogamy) in relation to HIV, and the use of rule making in non-exclusive (open) relationships, are discussed. Data from interviews with 387 homosexually active men are presented. The most common sexual/relational configuration amongst these men is that of open relationships. Sexual non-exclusivity was found to be associated with longer relationships, and a greater age difference between partners. The strategies some of these men are using to maintain sexually non-exclusive relationships are outlined. These rules pertain both to interpersonal dynamics and HIV prevention. Differing epidemiological significance of the rules and some implications for health education are discussed.

No aggregate change in homosexual HIV risk behaviour among gay men attending the Gay Pride festivals, United Kingdom, 1993-1995.

ObjectivesTo examine aggregate changes in homosexual HIV risk-taking among gay men attending the Gay Pride festival in the United Kingdom over a 3-year period during which HIV prevention activity targeted at this population increased considerably. DesignThree cross-sectional self-completion questionnaires at yearly intervals asking identical questions on sexual behaviour in the preceding year. SettingLesbian and Gay Pride festival held in London, June 1993, 1994 and 1995. ParticipantsMen attending the festival who were UK resident, had ever had sex with another man and who were willing to fill out a questionnaire (n = 1620, 1753 and 1168 in 1993, 1994 and 1995, respectively). Main outcome measuresSelf-reported numbers of sexual partners, sexual partners with whom anopenile intercourse occurred and sexual partners with whom anopenile intercourse occurred without a condom. ResultsOver the 3-year period there were no changes in the proportion of men engaging in any of the sexual behaviour measures. At each cross-section, one in three men (514 out of 1566, 511 out of 1612, 351 out of 1059 in 1993, 1994 and 1995, respectively) had engaged in anopenile intercourse without a condom with at least one male partner in the preceding year and one in 10 (162 out of 1566, 156 out of 1612, 103 out of 1059 in 1993, 1994 and 1995, respectively) had done so with more than one male partner. ConclusionDespite an increase in prevention work targeted at this population, aggregate levels of sexual risk-taking have remained very stable. A reassessment of the efficacy of current HIV prevention messages and methods with this population is urgently required.

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.

Condom use in a large cohort of homosexually active men in England and wales

As part of a prospective study of the seroprevalence of HIV, a cohort of 930 men were interviewed regarding their condom use. Of the 270 respondents that engaged in insertive anal intercourse in the month preceding interview 38.9% always used a condom, 49.6% never used one, and 11.5% sometimes used one. Of the 254 respondents that engaged in receptive anal intercourse in the same time period 42.5% always used a condom, 45.7% never used one, and 11.8% sometimes used one. Compared to other research the proportion of respondents who always use a condom for anal intercourse is relatively high, though use is by no means universal. Condom use is more widespread and consistent with casual rather than regular sexual partners, and it is significantly more common within open rather than monogamous relationships. Out of a wide range of other factors only geographical location (London against outside), marital status, perceived HIV status, number of sexual partners, and how seriously respondents take safer sex are correlated with condom use.

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.

Changes in condom use by gay men

Cross sectional and longitudinal data on condom use among homosexually active men is presented. Data pertain to two waves of interviewing (1987/8 and 1991) from Project SIGMA, a large longitudinal study of male homosexual behaviour in the light of HIV. Aggregate changes across the time-period indicate an increase in condom use for both insertive and receptive anal intercourse, particularly with casual partners. Condom use is still much more prevalent with casual rather than regular partners. Longitudinal analysis show considerable changes at the individual level, with almost a third of men changing their practices. Half of those decreased their risk behaviours, whilst the other half increased them. Less than 1% used condoms for fellatio in the year preceding the 1991 interview, but 8.3% had used other barriers during sex, primarily for hygiene and fun reasons, rather than as disease prophylaxis. Some implications are drawn for condom promotion and HIV prevention.

Safer sex maintenance among gay men: are we moving in the right direction?

Public health messages aimed at checking the sexual spread of HIV call for an end to unsafe sex practices. This goal, is however, unrealistic. The position is neither sustainable nor epidemiologically necessary, but is an unnecessary restriction on the desire and action of individuals and couples trying to create a sustainable combination of safety and pleasure based on a thorough understanding of what is safer sex. Focusing exclusively upon the practice of anal intercourse between men who have sex with men, the author argues that while unprotected anal intercourse is unsafe, it is not always and in every circumstance equally unsafe. For example, 2 men may be regular sex partners who enjoy an honest, trusting, and steady relationship. When and if 1 of the men has casual sex with a 3rd men, he does not engage in anal sex. While this behavior is not absolutely safe, it is safer than having, for example, unprotected anal sex with both his regular partner an casual partners. Humans function under heuristic rules where risk tends not to be eliminated but simply minimized. This behavior is an extremely deep feature of human interaction and should be encouraged instead of condemned. A high proportion of recent returns to unsafe sex among these men involves this sort of negotiated instead of absolute safer sex. These emergent strategies of negotiated safety must be encouraged and facilitated instead of condemned as irresponsible. Finally, the author recommends caution in translating epidemiological markers into prescriptions for individual behavior; he also recommends trying to reflect the complexity of what is happening in study populations in epidemiological categories and recognizing the robust humanity of men under study instead of seeking out their weaknesses.

Sexual partners, penetrative sexual partners and HIV risk

This paper argues that the notion of sexual partners per se is insufficient for estimating levels of HIV risk behaviour or changes in HIV risk over time, even though it is a crucial element of most epidemiological models of HIV. The concept of a penetrative sexual partner (PSP) is introduced as a considerably more accurate measure of HIV risk. Using data from a longitudinal study of 930 homosexually active men in England and Wales, this paper demonstrates that variation in numbers of PSPs (and thus HIV risk) is not related to variation in the gross numbers of sexual partners.