Central London Gyms Research Articles

Circumcision Among Men Who Have Sex With Men in London, United Kingdom: An Unlikely Strategy for HIV Prevention

To explore attitudes toward circumcision among men who have sex with men (MSM) in London and the feasibility of conducting research into circumcision and HIV prevention in this population. A convenience sample of MSM visiting central London gyms completed a confidential, self-administered questionnaire between May and June 2008. Information was collected on participants' demographic characteristics, self-reported HIV status, sexual behavior, circumcision status, attitudes toward circumcision, and willingness to participate in research on circumcision and HIV prevention. Of 653 MSM, 29.0% reported that they were circumcised. Overall, HIV prevalence was 23.3%; this did not differ significantly between circumcised and uncircumcised men (18.6% vs. 25.2%, respectively; adjusted odds ratio 0.79, 95% confidence interval: 0.50-1.26). A similar proportion of circumcised and uncircumcised men reported unprotected anal intercourse in the previous 3 months (38.8% vs. 36.7%, adjusted odds ratio 1.06, 95% confidence interval: 0.72-1.55). Uncircumcised men were less likely to think that there were benefits of circumcision than circumcised men (31.2% vs. 65.4, P < 0.001). Only 10.3% of uncircumcised men said that they would be willing to participate in research on circumcision as an HIV prevention strategy. Most uncircumcised MSM in this London survey were unwilling to participate in research on circumcision and HIV prevention. Only a minority of uncircumcised men thought that there were benefits of circumcision. It is unlikely that circumcision would be a feasible strategy for HIV prevention among MSM in London.

High-risk sexual behaviour among London gay men: no longer increasing

Among gay men surveyed annually in central London gyms, the percentage reporting high-risk sexual behaviour with a casual partner increased from 6.7% in 1998 to 15.2% in 2001 (P < 0.001). However, between 2002 and 2005 the percentage reporting high-risk sexual behaviour with a casual partner remained stable for HIV-negative and never-tested men (P > or = 0.3), with some evidence of a decline for HIV-positive men (adjusted odds ratio 0.69 per year, 95% confidence interval 0.48, 0.99, P = 0.047).

Recruiting London gay men into an HIV vaccine trial: Is it feasible?

This paper describes a study among HIV-negative gay men in London to examine willingness to volunteer for an HIV vaccine trial. HIV-negative gay men (n=506) were surveyed in central London gyms in February–March 2002. Information was collected on willingness to volunteer for an HIV vaccine trial, attitudes toward HIV vaccines and sexual risk behaviour. Men reporting unprotected anal intercourse (UAI) in the previous three months with a man of unknown or discordant HIV status were classified as being at high risk of exposure to HIV (n=94, 18.6%). The remainder, who reported no UAI or UAI only with another HIV-negative man, were considered to be at low risk (n=412, 81.4%). Just under a quarter of the HIV-negative men in the study (23.4%) said they were either quite likely or very likely to volunteer for an HIV vaccine trial. High-risk men were more likely to say they would volunteer for a trial than low-risk men (37.2% versus 20.2%, p<0.001). Of the 506 HIV-negative men surveyed, eight (1.6%) were both high risk and very likely to volunteer for an HIV vaccine trial, while a further 27 (5.3%) were both high risk and quite likely to volunteer. Based on these figures, we estimated that to recruit 1,000 high-risk HIV-negative men into a vaccine trial between 15,000 and 62,000 HIV-negative men would need to be approached in the community. Compared with those at low risk, a greater proportion of high-risk men said that if they were in an HIV vaccine trial they would be more likely to have unprotected sex (23.4% versus 7.8%, p<0.001); that an effective vaccine will make safe sex less important (45.7% versus 31.3%, p=0.01); and that they would participate in an HIV vaccine trial even if they thought the vaccine might not work (46.8% versus 29.9%, p<0.01). This study suggests that, in London, to recruit high-risk HIV-negative gay men for an HIV vaccine trial many thousands of gay men may need to be approached in the community. Some HIV-negative men said that they would be more likely to have unprotected sex if they took part in a trial.

Peer-led HIV prevention among gay men in London: Process evaluation

A peer-led HIV prevention initiative, based on a diffusion of innovation model, was developed for gay men attending gyms in central London. Peer educators were recruited from people who used the gym regularly according to standard selection criteria. After initial training, peer educators agreed to talk to gay men at their gym about HIV prevention, focusing on sexual risk and steroid injecting behaviour. Outcome evaluation revealed that the peer education programme had no significant impact on the risk behaviours of gay men using the gyms. Process evaluation, based on interviews with peer educators, the health promotion team and gym managers threw light on this finding. While it was feasible to set up a peer education programme among gay men in central London gyms, attrition was an important factor. Only one in five potential peer educators initially identified remained with the project throughout, thus limiting the potential for diffusion. Those who did work as peer educators reported barriers to communication within the gyms further limiting the extent to which diffusion occurred. In fact, it appears that the critical mass required for diffusion was never established. This could explain why the intervention had no significant impact on gay men's risk behaviours. A person-time analysis demonstrated that the peer education programme required a substantial input from the health promotion team, equivalent to one team member devoting 2.5 days a week to recruit, train and support peer educators over 18 months. Peer education should not, therefore, be viewed as a low-cost approach to prevention. Many of the insights gained through this process evaluation can inform others planning peer education programmes in other settings.

Use of anabolic steroids and associated health risks among gay men attending London gyms.

To examine, by HIV status, the use of anabolic steroids among London gay men and their effect on physical and mental health. Cross-sectional survey using self-administered questionnaire. Six gyms in central London. 772 gay men using the gyms in January-February 2000. Proportion of gay men who reported (i) using steroids, (ii) sharing injecting equipment, (iii) experiencing side-effects and (iv) having suicidal thoughts or feeling depressed. Of 772 gay men, 117 (15.2%) had used and 90 (11.7%) had injected steroids in the previous 12 months: HIV positive men (steroid use) 31.7% (40/126), HIV negative men 14.5% (69/477), never-tested for HIV 4.7% (8/169) (p < 0.001). No one reported sharing needles or syringes. HIV positive men were more likely to have used steroids for medical reasons than other men (24.3% versus 5.9%, p=0.01). Nearly all steroid users (96.4%) reported side effects including testicular atrophy (51.0%), insomnia (47.7%), depression between cycles (25.2%) and hypertension (19.0%). Steroid users were more likely to have had suicidal thoughts in the previous 6 months than non-users (22.6% versus 11.2%, adjusted odds ratio after controlling for HIV status 1.84; 95% CI 1.10-3.12, p=0.02) or to have felt depressed (49.1% versus 38.5%, adjusted OR 1.52, 95% CI 1.01-2.30, p=0.047) One in seven gay men surveyed in central London gyms in 2000 said they had used steroids in the previous 12 months. HIV positive men were more likely to have used steroids than other men, some therapeutically. Side effects were reported widely and steroid use was associated with having had suicidal thoughts and feeling depressed, although cause and effect could not be established. Our findings suggest that steroid use among gay men may have serious consequences for both physical and mental health.

Peer education has no significant impact on HIV risk behaviours among gay men in London.

Peer education has no significant impact on HIV risk behaviours among gay men in London.

Do gay men discuss HIV risk reduction with their GP?

In September/October 1997, 1,004 gay men using one of five gyms in central London completed a confidential anonymous questionnaire which included items on sexual as well as steroid-related injecting behaviour and whether they had ever discussed these behaviours with friends, sexual partners or a general practitioner (GP). Nearly all the men reported having had sex with another man in the previous six months, while a quarter had had unprotected anal intercourse in the previous three months. Less than one-third of the men (30%) had discussed safer sex with their GP, compared with 92% who had talked about it with friends and 87% with lovers (p < 0.001). Of those who had discussed safer sex with their GP, one in six (17%) had not found it easy-this was significantly higher than the proportion who had not found it easy to discuss safer sex with friends, lovers or casual partners (3-9%, p < 0.01). More than 10% of the men had ever injected anabolic steroids. Of those who had injected anabolic steroids, just over one-third (36%) had ever discussed this with their GP. It appears that the majority of gay men in this study had not discussed HIV risk reduction with their GP. Until obstacles to discussing risk reduction and HIV prevention are overcome, the routine consultation in general practice will not be able to fulfill its potential for health promotion.

Combination therapies for HIV and sexual risk behavior among gay men.

To examine optimism in the light of recent advances in HIV treatment among gay men and its association with sexual risk behavior. An anonymous questionnaire was completed by gay men who visited gyms in central London in March and April 1998 regarding their HIV status, unprotected anal intercourse (UAI) in the previous 3 months, and their response on a five-point linear scale to two measures of optimism: "I am less worried about HIV now that treatments have improved," and "I believe that new drug therapies make people with HIV less infectious." Two thirds of the men (67.5%, 522 of 773) did not agree with the statement, "I am less worried about HIV now that treatments have improved," and only 42 (5.4%) said they agreed quite a lot or a lot. HIV-positive men were more likely to agree with this statement than HIV-negative men (p = .001) and men who had never been tested (p < .001). There was no association between agreement with this statement and frequency of UAI among HIV-positive or never-tested men (p > .3); there was, however, a positive association among HIV-negative men who reported UAI with a partner of unknown or discordant status (p = .003). The vast majority of men (81.4%; 634 of 779) did not agree with the statement, "I believe that new drug therapies make people with HIV less infectious." Regardless of HIV status, no significant association was seen between agreement with this statement and frequency of UAI (p > .1 for all comparisons). Most gay men surveyed in central London gyms did not endorse the optimism statements concerning improved treatments or reduced infectivity. Although HIV-positive gay men were more likely to be optimistic than other men, there was no association between their optimism and sexual risk behavior. Among HIV-negative men, optimism around improved treatments (but not around reduced infectivity) was associated with UAI with a partner of unknown or discordant HIV status. For some HIV-negative men in London, optimism in the light of recent advances in HIV treatment may have triggered, or have been used as a justification for, sexual risk-taking.

HIV risk behaviours among gay men who use anabolic steroids.

To examine the injecting and sexual risk behaviours of gay men in London who use anabolic steroids or other fitness-enhancing substances (referred to as AS). Cross-sectional survey using self-administered questionnaire. Five gyms in central London. 1004 gay men using the gyms during September-October 1997. Proportion of men who report (i) injecting AS, (ii) sharing needles and (iii) HIV status-unknown unprotected and intercourse (UAI). Of 1004 men, 136 (13.5%) were current users of AS (range across the five gyms, 2.7-21.2%, p < 0.001), and 81 (8.1%) injected AS (range 0.4-17.5%, p < 0.001). None said they shared a needle with other users and more than 90% said they always used disposable units from sealed packets. Among current AS users, 20.9% (28/136) reported status-unknown UAI compared with 12.9% (107/827) of never-users (p = 0.02), a differential which remained significant after adjusting for confounding factors (adjusted odds ratio = 1.75, 95% CI 1.05, 2.91, p = 0.03). While nearly one in 10 gay men in this study injected anabolic steroids or other fitness-enhancing substances, none reported sharing needles. Steroid users were, however, more likely to report status-unknown UAI than other men, a differential that remained after adjusting for confounding factors. Since any change in injecting practice could dramatically increase the risk of HIV transmission in this population, behavioural surveillance to monitor risk behaviours among gay men using anabolic steroids is recommended, as are targeted HIV prevention programmes.

Sexual risk behaviour among gay men in a relationship.

To examine whether gay men in a relationship have adopted negotiated safety as an HIV risk reduction strategy. A confidential, anonymous questionnaire was completed by 1004 gay men attending gyms in central London in September-October 1997. Information was sought on sociodemographic characteristics, HIV testing and sexual risk behaviour. Men reporting unprotected anal intercourse (UAI) in the previous 3 months were classified as 'status-unknown' if they did not know their own HIV status, that of their UAI partner(s) or both. Men who knew their own and their UAI partner's HIV status were classified as 'status-known'. Of the 1004 men surveyed, 986 provided complete information on relationship, personal HIV test history and HIV status of UAI partner. Over half (539) said they were currently in a relationship with another man, of whom 173 reported UAI in the previous 3 months; 140 (80.9%) with their main partner only, 18 (10.4%) with a casual partner only and 15 (8.7%) with both their main and casual partners. Of the 140 men reporting UAI only with their main partner, 62 (44.3%) did not know their own HIV status or that of their partner. Overall, a quarter (26.0%) of the men in a relationship reported UAI only with their main partner in the previous 3 months; 11.5% status-unknown UAI, 14.5% status-known UAI. In a multivariate logistic model, both age and being in a relationship were significantly associated with UAI (status-unknown and status-known). Gay men in a relationship, surveyed in central London gyms, have for the most part adopted the first principle of negotiated safety: only to have UAI with their main partner. However, not all have embraced the second principle: to establish HIV seroconcordance. Nearly half the men reporting UAI only with their main partner were unaware of their own HIV status, their partner's or both. As a consequence, more than one in 10 men in a relationship reported high-risk (i.e. status-unknown) UAI with their main partner. Because the study population, from central London gyms, was not randomly selected, these findings may not be generalizable to all gay men in London. Nonetheless, HIV prevention programmes should continue to encourage gay men in a relationship to seek an HIV test and establish seroconcordance if they wish to have UAI with each other.