P. Van De Ven

In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex

Abstract The aim of this analysis was to examine gay mens sexual risk practice to determine patterns of risk managemtent. Ten cross-sectional surveys of gay men were condtrcted six-monthly from February 1996 to August 2000 at Sydney gay community social, sex-on-prmises and sexual health sites (average n=827). Evely February during this period, five identical surveys were conducted at the annual Gay and Lesbian Mardi Gras Fair Day (average n=11 78). Among the minority of men who had umprotected and intercourse which involved ejaculation inside with a serodiscordant regular partner, there was a clear pattern of sexual positioning. Few regular couples mere both receptive and insertive. Most HIV-positive men were receptive and insertive. Most HIV-positive men were recptive and most HIV-negative men were insertive. Among the minority of men who had unprotected anal intercourse which involved ejaculation inside with casual partners, there was also a patterns of sexual positioning. Whereas many casual couples were both receptive and insertive (especially those involviug HIV-positive respondents), among the remainder HIV-positive men tended to be receptive and HIV-negative men tended to be insertive. These pattenu of HIV-positive/receptive and HIV-negative/insertive suggest strategic risk reduction positionings rather tlran rrlere sexrial preferences among a minority of gay men. If so, they point they point to complacency but to an ever more cornplex domain of HIV prevention.

Cultures of sexual adventurism as markers of HIV seroconversion: A case control study in a cohort of Sydney gay men

A case control analysis within an ongoing cohort study was used to examine differences between seroconverters and men who remained HIV-negative. The cases were interviewed within one to 13 months prior to their seroconversion. Their responses to a structured questionnaire were compared with those of HIV-negative controls drawn from the same time period and from the same longitudinal study, Sydney Men and Sexual Health. Data collected from both cases and controls included: demographic and contextual variables, knowledge of HIV transmission, sexual practices, drug and alcohol use and attitudinal factors. The aim was to compare the sexual behaviours, and the social and cultural contexts of such behaviours, of men prior to their HIV seroconversion with men who did not seroconvert. Twenty-three men had seroconverted within the cohort. Cases were identified by a positive HIV antibody test or self-report of positive HIV status following a previous negative HIV test. Three-hundred-and-sixty-nine controls were selected on the basis of being HIV negative at interview in 1994, and having at least one subsequent medically-confirmed negative HIV antibody test. Univariate predictors of seroconversion were: being in a regular relationship with a known HIV-positive partner, drug use, and engaging in a range of anal and esoteric sexual practices. Practices commonly used to enhance sexual pleasure, such as group sex, watching and being watched having sex, the use of sex toys and dressing up/fantasy, were engaged in more frequently by seroconverters. Engaging in these esoteric sexual practices was highly correlated with drug use, involvement in the gay community and engagement in a wide range of anal practices. In the multivariate analysis independent predictors of seroconversion were: younger age; being in a regular relationship with a known HIV-positive partner; believing withdrawal to be safe with regard to HIV transmission; and range of esoteric practices. These results indicate the importance of the social and cultural contexts of particular sexual practices and consequent HIV transmission. Sexually adventurous men may be at increased risk for HIV because they seek sex within particular sexual sub-cultures.

Predictors of recent HIV testing in homosexual men in Australia.

To describe time trends and other predictors of recent HIV testing among homosexual men enrolled in behavioural surveillance studies in Australia.

Gay men's casual sex encounters: Discussing HIV and using condoms

Some gay men disclose their HIV serostatus to enable them to decide to discard condoms in at least some casual encounters. In this paper we consider under what circumstances this occurs. We draw on data from the Sydney Men and Sexual Health cohort study, including both structured and semi-structured interviews. We find that casual sexual encounters among gay men are complex events, involving a broad range of types of partner and circumstance. A significant minority of men disclose their HIV serostatus; 36.3% of those who discussed their serostatus with casual partners engaged in unprotected anal intercourse (UAI) with those partners, while only 9.9% of those who did not discuss their serostatus engaged in UAI with those partners. We also find that disclosure of HIV serostatus, discussion and use of condoms during casual encounters are affected by the particular circumstances of those encounters, including the degree of familiarity between casual partners.

Increasing proportions of Australian gay and homosexually active men engage in unprotected anal intercourse with regular and with casual partners

We examined trends in sexual practice among gay and homosexually active men in Australia. Self-complete questionnaires were distributed with mail-order sex video catalogues in 2000 and returned anonymously through a reply-paid facility. The data were compared with those from men who responded to promotional material sent out with the same catalogues and who participated in national telephone surveys of men who have sex with men conducted in 1992 and 1996. A key independent variable was gay community attached (GCA) versus non-GCA (NGCA) derived from two items about number of gay friends and amount of free time spent with gay men. Responses came from 1,832 men ranging in age from 16 to 80 (median = 39) years. HIV status was 73% negative, 5% positive, 22% untested; 1,181 men were GCA and 651 men were NGCA. Overall, from 1992 to 2000 there was a significant upward trend in the proportion of men reporting any unprotected anal intercourse (UAI) in the previous six months with regular partners: 21.5%, 24.7%, 46.4% of the total sample ( p < 0.001). And similarly for UAI with casual partners: 12.4%, 16.2%, 25.5% ( p < 0.001). The upward trends in UAI-regular and UAI-casual were similar and significant ( p < 0.001) for both GCA and NGCA men. These nationwide Australian data provide evidence of continuing increases in unprotected anal intercourse with regular and with casual partners. Whereas the majority of men do not engage in any unprotected anal intercourse during a defined interval, ever increasing proportions of them do.

Contexts for last occasions of unprotected anal intercourse among HIV-negative gay men in Sydney: The health in men cohort

The objective of the paper was to compare encounters involving unprotected anal intercourse (UAI) and protected anal intercourse (PAI) among HIV-negative gay men in Sydney. Data were from those completing baseline face-to-face interviews to end June 2003 for the Health in Men open cohort of HIV-negative gay men in Sydney. The 1,148 participants ranged in age from 18 to 75 years (median=36). Three hundred and fifty-two (30.7%) reported an occasion of UAI with a casual partner in the previous 6 months and 531 (46.3%) reported an occasion of UAI with a regular partner in that same time. The mens most recent sexual contact with a casual partner involving UAI was distinguished from those involving PAI by a greater likelihood for both partners to disclose HIV serostatus (p=0.006) and by respondents being more inclined to restrict themselves to the insertive position or to practise withdrawal during occasions involving any UAI than when a condom was used (p=0.003 and p=0.001 respectively). Neither location nor recreational drug use differentiated mens most recent sexual contacts involving UAI from those involving PAI. The decision by HIV-negative gay men to use condoms during sexual encounters with either regular or casual partners is guided more by HIV serostatus and risk reduction strategies than by other factors.

Differences between men who report frequent, occasional or no unprotected anal intercourse with casual partners among a cohort of HIV-seronegative gay men in Sydney, Australia

Abstract Past research on unprotected anal intercourse with casual partners (UAIC) contrasts those who report no UAIC with any UAIC. This paper examines differences among three groups of men who had any UAIC on the basis of the number of UAIC acts reported in a six-month period, namely no UAIC (n = 507), occasional UAIC (1–5 acts, n = 251) and frequent UAIC (more than 5 acts, n = 148). The occasional UAIC group had values lying between those of the no- and the frequent-UAIC group. As compared with the frequent-UAIC group, men in the occasional-UAIC group were less likely to have a steady partner, held less favorable attitudes toward condoms and higher levels of HIV treatments optimism and were more likely to report some disclosure of serostatus to or by casual partners and a range of esoteric sexual practice. On the other hand, men in the no-UAIC group had lower levels of ‘feeling bad’ (distress) and were less likely to use drugs to enhance sexual pleasure in casual encounters. Disclosure of serostatus had a strong association with frequent UAIC and this finding calls for both more research and more community exploration of issues surrounding sexual decision-making.

Factors associated with unprotected anal intercourse in gay men's casual partnerships in Sydney, Australia.

We assessed the factors associated with unprotected anal intercourse in gay mens casual partnerships, using data from a longitudinal cohort study ongoing since October 1992. Participants were recruited through gay community and a variety of other sources and interviewed for the Sydney Men and Sexual Health study. Of 1,037 interviewees at outset, 834 men had casual partners during the six months prior to interview; 609 had any anal intercourse with a casual partner. Of 172 HIV-positive men, 58 (33.7%) engaged in unprotected anal intercourse with casual partners. Of 662 non-positive men, 111 (16.8%) engaged in unprotected anal intercourse with casual partners. Logistic regression analysis revealed that gay mens engagement in unprotected anal intercourse with casual partners (compared with engagement in safe sex--either no anal intercourse or protected anal intercourse) was predicted by positive HIV status, occupational differences (being out of the workforce or in white collar positions rather than in professional or managerial positions), engagement in a wider range of anal practices, believing withdrawal to be safe and less favourable attitudes towards condoms. Additional logistic regressions which, initially, excluded positive men who only engaged in unprotected anal intercourse with positive casual partners (n = 26) and then excluded men who did not engage in anal intercourse (n = 225) yielded quite similar sets of predictors of unprotected anal intercourse with casual partners. However, in both the additional analyses HIV status was not a significant predictor. It is concluded that gay men who engage in unprotected anal intercourse with casual partners do not comprise a singular group, although they commonly engage in a diversity of anal practices and they dislike condoms.

Trends in heterosexual tertiary students' knowledge of HIV and intentions to avoid people who might have HIV

This study investigated trends in HIV knowledge and endorsement of social avoidance of people who might be infected with HIV. The respondents (n = 7387) were self-identified heterosexual students. Most of them (n = 6500) were first-year behavioural or biological sciences students from annual surveys (1988-1995) at Macquarie University. The others (n = 887) were from four biennial (1987-1993) random samples of all students below 30 years of age at the University of Sydney. Students at both campuses completed self-administered questionnaires. Nine items were used to compute Partner Distinction Scale scores which indicated whether students had accurate knowledge that HIV may be transmitted through specific sexual practices with either casual or regular partners. Eleven items contributed to a Social Avoidance Scale. At Macquarie, male students had more accurate knowledge than female students, [F(1, 6024) = 9.20, p < 0.003], but at Sydney there were no significant sex differences in knowledge. Male students endorsed greater social avoidance at both Macquarie, [F(1, 6421) = 195.57, p < 0.00005], and Sydney, [F(1, 881) = 32.41, p < 0.00005]. Multiple linear regression on social avoidance revealed a significant reduction in social avoidance over time, with more rapid decrease among male students. Whereas less social avoidance was partly attributable to better knowledge over time, it is concluded that the improved social climate towards those most affected by HIV is mainly due to a shift in cultural norms.