Abstract
BackgroundRelationship status is an important factor associated with condomless anal intercourse (CAI) amongst men who have sex with men (MSM).MethodsA multi-centre bio-behavioural survey with MSM was conducted in 13 European cities (n = 4901) exploring factors associated with CAI via bivariate and multivariate multilevel logistic regression analyses.ResultsLikelihood of CAI with casual partners was associated with being ‘out’ to a majority (AOR = 1.19;95% CI 1,1.42); knowing their HIV status (AOR = 1.86; 95% CI 1.25,2.76); using substances (1–2 AOR = 1.39; 95% CI 1.16,1.63, 2+ AOR = 1.81; 95% CI 1.35,2.42); being older (AOR = 0.98; 95% CI 0.97,0.99); successful sero-communication (AOR = 0.79; 95% CI 0.67,0.94); and, not having a recent HIV test (AOR = 0.78; 95% CI 0.66,0.92). CAI with steady partners was associated with successful sero-communication (AOR = 2.72; 95% CI 2.72,3.66); not having a recent HIV test (AOR = 1.26; 95% CI 1.09,1.46), and; being older (AOR = 0.99; 95% CI 0.98,0.99).ConclusionsUnderstandings of partner type and/or relationship status in relation to CAI amongst MSM can potentially play an important role in the development of culturally appropriate HIV/STI prevention and risk-reduction efforts targeting at-risk MSM. Our results speak to the need to consider segmented and tailored public health and health promotion initiatives for MSM with differing CAI behaviours and relationship profiles.
Highlights
Epidemiological evidence suggests that sex between men continues to be the main mode of HIV transmission accounting for 40% of all new diagnoses in 2016 across the European Union (EU) and the European Economic Area (EEA).[1]
Research demonstrates that relationship status and/or partnership type is an important factor associated with condomless anal intercourse (CAI) and subsequent risk for HIV and sexually transmitted infections (STIs).[3,4,5,6,7]
Kramer and colleagues have drawn attention to this issue and note that prevention initiatives commonly target individualisticbehaviours regarding CAI as an inherently ‘risky’ sexual behaviour, such approaches can be unhelpful as they may mask more complex and dynamic issues occurring within men who have sex with men (MSM) in both steady and casual or non-steady relationships including the use of risk-reduction strategies.[8,9,10]
Summary
Epidemiological evidence suggests that sex between men continues to be the main mode of HIV transmission accounting for 40% of all new diagnoses in 2016 across the European Union (EU) and the European Economic Area (EEA).[1]. Research demonstrates that relationship status and/or partnership type is an important factor associated with condomless anal intercourse (CAI) and subsequent risk for HIV and sexually transmitted infections (STIs).[3,4,5,6,7]. Kramer and colleagues have drawn attention to this issue and note that prevention initiatives commonly target individualisticbehaviours regarding CAI as an inherently ‘risky’ sexual behaviour, such approaches can be unhelpful as they may mask more complex and dynamic issues occurring within MSM in both steady and casual or non-steady relationships including the use of risk-reduction strategies.[8,9,10] For instance the number of partners as well as knowledge of own and partner’s HIV serostatus, the use of ‘negotiated safety’ agreements,[11] serosorting, and the effective use of anti-retroviral drugs to lower viral load as well as the use of pre-exposure prophylaxis (PreP)[12,13] may be contingent on the perception of the type of relations. Relationship status is an important factor associated with condomless anal intercourse (CAI) amongst men who have sex with men (MSM)
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