Abstract
BackgroundRecent evidence suggests that the majority of HIV transmissions among men who have sex with men (MSM) occur between steady partners. We sought to determine factors associated with HIV transmission risks in steady partnerships.MethodsData is from the German cross-sectional 2013 Gay Men and AIDS survey. The study population was HIV-negative or untested men reporting a steady partnership and at least one non-steady anal sex partner in the previous year. Bivariate and multivariate logistic regression was used to determine which of several independent variables best predicted both unprotected anal intercourse (UAI) with a non-steady partner and lack of HIV testing in the past year (high-risk outcome group).ResultsThe study population consisted of 1731 men. Among individuals in the outcome group (n = 271), 67 % reported UAI with a non-steady partner of unknown status and 9 % reported UAI with a non-steady HIV-positive partner in the past 12 months; 55 % considered themselves to be at low risk for HIV acquisition. In multivariate analyses (n = 1304), participants were statistically more likely to belong to the outcome group if they reported UAI with their steady partner in the past year (OR = 2.21), did not know their steady partner’s HIV status (OR = 1.98), or agreed that condoms were disruptive during sex (OR = 3.82 (strongly agree), OR = 2.19 (agree)). Participants were less likely to belong to the outcome group if they were out to their primary doctor (OR = 0.54), were well-educated about post-exposure prophylaxis (OR = 0.46), had sought information on HIV in the past year and kept condoms in an accessible place (OR = 0.20), or believed that insisting on condoms would lead partners to assume they were HIV-negative (OR = 0.20). Participants in the outcome group were more likely to say they would use HIV home tests (OR = 1.58) or pre-exposure prophylaxis (OR = 2.11).ConclusionsBased on our results, we reflect on HIV prevention measures that should be improved in order to better target behaviors that may lead to HIV transmission between MSM in steady relationships. In particular, we highlight the need for multifaceted interventions focusing not only on members of the at-risk community themselves, but on communities as a whole.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1987-8) contains supplementary material, which is available to authorized users.
Highlights
Recent evidence suggests that the majority of HIV transmissions among men who have sex with men (MSM) occur between steady partners
The European MSM Internet Survey (EMIS) which collected testing data for 38 European countries in 2010 showed that rates of HIV testing in the past 12 months in Germany (33.8 %) fell slightly below the median rate for Europe (34.5 %), and rates of never testing were 30.2 % in Germany compared to an European median of 37.1 %; rates of unprotected anal intercourse (UAI) with non-steady partners were 64.1 % in the German sample compared with an European median of 69.1 % [9]
While all these data are not representative, they show that the situation in Germany is not exceptional for Europe, and that it is important to understand the factors associated with UAI with non-steady partners in the absence of a recent HIV test among MSM in steady relationships if HIV transmission between steady partners is to be reduced
Summary
Recent evidence suggests that the majority of HIV transmissions among men who have sex with men (MSM) occur between steady partners. HIV prevention measures targeted toward MSM often focus on individual-level risks, emphasizing factors such as condom use and overall number of partners, and painting unprotected anal intercourse (UAI) as an inherently risky behavior Such efforts may be overly simplistic, and may ignore more complex dynamics occurring between MSM in steady relationships [2, 3]. Such agreements include the decision to engage in sexual activities with only the steady partner, the decision to always use condoms with non-steady partners, and the decision to refrain from engaging in anal sex with non-steady partners If both of these conditions are met, UAI between two men in a steady relationship becomes a low-risk behavior. While all these data are not representative, they show that the situation in Germany is not exceptional for Europe, and that it is important to understand the factors associated with UAI with non-steady partners in the absence of a recent HIV test among MSM in steady relationships if HIV transmission between steady partners is to be reduced
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