Thomas J. McManus

Gay men as victims of nonconsensual sex

Incidents of nonconsensual sexual activity among 930 homosexually active men living in England and Wales are analyzed. Of these men, 27.6% said they had been sexually assaulted or had sex against their will at some point in their lives; one third had been forced into sexual activity (usually anal intercourse) by men with whom they had previously had, or were currently having, consensual sexual activity. The contention that male rape is usually committed by heterosexually identified men, primarily as an expression of power and control, is not supported. Recognition that gay men rape other gay men is needed, both by the gay community and support services for victims.

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.

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.

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.

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.

Seroprevalence of HIV-1 infection in a cohort of homosexually active men.

A non-clinic cohort of 525 homosexually active men from London and South Wales were recruited in 1988 for a study by interview of sexual behaviour. A sample of blood was tested for HIV-1 antibodies. Seropositivity in London was 9.2% compared with 3.4% in South Wales. Men who were not regular STD clinic attenders had a lower rate of seropositivity than did those who were regular attenders. Men who were seropositive reported more sexual partners with whom they had anal intercourse and also reported more episodes of syphilis. Overall, rates of seropositivity were lower than those reported by studies from STD clinics.

The structure of sexual behaviour

In a national study of gay mens sexual behaviour in the context of HIV transmission, a schema was evolved for encoding and reporting the structure of sexual activity: the Sexual Behaviour Code (SBC). It has linguistic properties, is easily learned and employed, and generalizes easily to heterosexual behaviour. Each sexual session (sentence) comprises a sequence of sexual acts (words), which in turn consists of a sexual behaviour (root), the modality (prefix), and the outcome/ejaculation (suffix). Other aspects (partner/s, drugs, condoms) are encoded as precedents and accompaniments of the acts. The SBC is also used to define a comparable and flexible research instrument for eliciting systematic information on sexual behaviour: the Inventory of Sexual Behaviour (ISB), now used in all WHO/GPA studies of homosexual response. Issues of validity and reliability are addressed, and forms of analysis of the resulting data are discussed for sexual diaries and inventories.