Nonnegligible Increasing Temporal Trends in Unprotected Anal Intercourse Among Men Who Have Sexual Relations With Other Men in Montreal

Trends in Sexual Behavior Among Men Who have Sex with Men (MSM) in High-Income Countries, 1990-2013: A Systematic Review

HIV diagnoses among men who have sex with men (MSM) have been increasing in several high-income countries. A better understanding of the sexual behavior trends among MSM can be useful for informing HIV prevention. We conducted a systematic review of studies that examined behavioral trends (1990-2013) in any condomless anal sex, condomless anal sex with an HIV-discordant partner, and number of partners. Studies included come from the United States, Europe, and Australia. We found increasing trends in condomless anal sex and condomless anal sex with an HIV-discordant partner, and a decreasing trend in number of partners. The increase in condomless anal sex may help to explain the increase in HIV infections. More explanatory research is needed to provide insight into factors that contribute to these behavior trends. Continuous monitoring of HIV, risk behaviors, and use of prevention and treatment is needed to evaluate prevention efforts and monitor HIV transmission risk.

Beyond Condoms: Risk Reduction Strategies Among Gay, Bisexual, and Other Men Who Have Sex With Men Receiving Rapid HIV Testing in Montreal, Canada

Gay, bisexual, and other men who have sex with men (MSM) have adapted their sexual practices over the course of the HIV/AIDS epidemic based on available data and knowledge about HIV. This study sought to identify and compare patterns in condom use among gay, bisexual, and other MSM who were tested for HIV at a community-based testing site in Montreal, Canada. Results showed that while study participants use condoms to a certain extent with HIV-positive partners and partners of unknown HIV status, they also make use of various other strategies such as adjusting to a partner's presumed or known HIV status and viral load, avoiding certain types of partners, taking PEP, and getting tested for HIV. These findings suggest that MSM who use condoms less systematically are not necessarily taking fewer precautions but may instead be combining or replacing condom use with other approaches to risk reduction.

Actual sexual risk and perceived risk of HIV acquisition among HIV-negative men who have sex with men in Toronto, Canada

Background

Theory suggests that perceived human immunodeficiency virus (HIV) risk and actual HIV risk behaviour are cyclical whereby engaging in high risk behaviour can increase perceived risk, which initiates precautionary behaviour that reduces actual risk, and with time reduces perceived risk. While current perceived risk may impact future actual risk, it is less clear how previous actual risk shapes current perceived risk. If individuals do not base their current perceived risk on past behaviour, they lose the protective effect of perceived risk motivating precautionary behaviour. Our goal was to determine the impact of actual risk on perceived risk.

Methods

Sexually active men who have sex with men (MSM) were recruited at the Maple Leaf Medical Clinic in downtown Toronto from September 2010 to June 2012. Participants completed a socio-behavioural questionnaire using an Audio Computer Assisted Self-Interview (ACASI). Actual HIV risk (primary predictor) was constructed by applying principal component analysis (PCA) to eight sexual risk survey questions and comprised three components which reflected sex with casual partners, sex with HIV-positive regular partners and sex with HIV unknown status regular partners. Perceived HIV risk (outcome) was measured by asking participants what the chances were that they would ever get HIV. Multivariable logistic regression was used to measure the association between actual and perceived HIV risk.

Results

One hundred and fifty HIV-negative MSM were recruited (median age 44.5 years [IQR 37–50 years]). Twenty percent of MSM perceived their HIV risk to be high. The odds of having a high perceived risk was significantly higher in those with high actual HIV risk indicated by low condom use with an HIV-positive regular partner compared to those with low actual HIV risk indicated by high condom use with an HIV-positive regular partner (Odds Ratio (OR) 18.33, 95 % confidence interval (CI) 1.65–203.45). Older age was associated with lower perceived risk but only age 40–49 compared to less than 30 was statistically significant (OR 0.12, 95 % CI 0.016–0.86). The odds of having high perceived risk was significantly associated with men who used poppers in the previous 6 months compared to those who did not use poppers (OR 5.64, 95 % CI 1.20–26.48).

Conclusions

Perceived HIV risk increased significantly as condom use with an HIV-positive regular partner decreased. However, perceived HIV risk was not associated with condom use with casual partners or HIV unknown status regular partners, even though these behaviours could be considered risky. The relationship between perceived and actual risk in HIV studies is complex and has implications on how health care workers address the issue of risky sexual behaviour and perceived risk.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2859-6) contains supplementary material, which is available to authorized users.

Temporal trends in sexual behavior among men who have sex with men in the United States, 2002 to 2006-2010

Little is known about national trends in sexual behavior among MSM in the US. Data from the 2002 and 2006-2010 National Survey of Family Growth were used to compare sexual behaviors of sexually active MSM. Mean number of recent male partners significantly decreased from 2.9 in 2002 to 2.1 in 2006-2010 (P = 0.027), particularly among young MSM. Other sexual risk behaviors did not change or decrease over time. Our findings that sexual risk decreased as HIV and syphilis increased among MSM suggest that factors in addition to individual-level sexual risk should also be examined in relation to recent disease increases.

Correlates of unprotected anal sex at last sexual episode: analysis from a surveillance study of men who have sex with men in Montreal

Recent increases in rates of unprotected anal sex (UAS) among men who have sex with men (MSM) signal the need to continually refine our understanding of factors associated with risky sexual behavior. Data were collected using a questionnaire eliciting information about the last sexual episode (LSE) with another man in the past 6 months. Logistic regression was used to identify both event-level and background correlates of UAS at LSE. 965 participants who reported having sex with a partner with whom they were not in a couple relationship at LSE were studied. Several event-level variables were significantly associated with UAS after adjusting for background factors, including finding the partner at LSE sexually attractive and using alcohol or cocaine at LSE. Our findings parallel the results of other HIV prevention studies which have highlighted the importance of interpersonal factors that influence risk-taking at the moment of a sexual act among MSM.

Use of a rapid HIV home test to screen sexual partners: an evaluation of its possible use and relative risk

We estimated the HIV risk reduction that could be attained by using a rapid HIV home test (HT) to screen sexual partners versus using condoms in different proportions of anal intercourse (AI) occasions among men who have sex with men (MSM). Special attention was paid to the role of the window period during which infected cases go undetected. Our results show that if MSM engage in AI without condoms following a non-reactive HT result, they have lower chances of becoming infected by someone still in the window period than by following heuristics and using condoms inconsistently. For MSM who do not use condoms, use of HT as a screening device may be a useful risk reduction strategy. This advantage increases with higher HIV population prevalence. With higher HIV incidence, this strategy will not provide any advantage if condoms are used in as little as one out of four occasions.

HIV and ethnicity in Canada: is the HIV risk-taking behaviour of young foreign-born MSM similar to Canadian born MSM?

There is a dearth of information on the HIV risk-taking behaviour of foreign-born men who have sex with men (MSM) in Canada. This study focused on identifying sexual risk behaviour among MSM who immigrated to Canada and compared them to MSM who were born in Canada. Baseline data from the Omega Cohort in Montreal and the Vanguard Project in Vancouver were combined to form four ethnicity/race analytical categories (n = 1,148): White born in Canada (WBIC), White born outside of Canada, non-White born in Canada (NBIC) and non-White born outside of Canada (NBOC). Psychological, demographic and sexual behaviour characteristics of the groups were similar except: NBOC were more likely to be unemployed, less likely to be tattooed, had fewer bisexual experiences and less likely worried of insufficient funds. WBOC were more likely to report unprotected sex with seropositives and more likely to have had unprotected sex while travelling. NBIC were more likely to have ever sold sex and to have had body piercing. WBOC are at high risk of acquiring as well as transmitting HIV. It is important to consider place of birth in addition to ethnicity when developing programmes to prevent the transmission of HIV.

Knowledge of sexual partner's HIV serostatus and serosorting practices in a California population-based sample of men who have sex with men

OBJECTIVES

To describe knowledge of primary and secondary sexual partner's HIV serostatus and sexual practices, including serosorting, among men who have sex with men (MSM) living in California.

METHODS

Men who self-identified as gay/bisexual in the 2001 California Health Interview Survey, a statewide biennial random-digit-dial survey interviewing more than 50,000 adults on a variety of health topics, were recontacted in 2002 and interviewed by telephone about injection drug use, their own and partner's HIV serostatus, and sexual risk behaviors.

RESULTS

Among 220 men who reported a primary partner, 86% [95% confidence interval (CI): 77-92] knew their primary partner's serostatus; 62% (95% CI, 52-70) of the 250 men who reported a secondary partner knew their most recent secondary partner's HIV serostatus. Knowledge of one's most recent secondary partner's HIV serostatus was inversely related to history of injecting recreational drugs (odds ratio, 0.22; P < 0.01), and reporting a primary partner in the past year (odds ratio, 0.37; P < 0.05). Two-fifths (41%) of HIV-positive men and three-fifths (62%) of HIV-negative men engaged in serosorting (serocordant unprotected anal intercourse) with their primary partners, whereas 33% HIV-positive men and 20% HIV-negative men did so with their most recent secondary partners.

CONCLUSIONS

This population-based survey documented the extent to which MSM know their partners' serostatus and practice serosorting behaviors. The findings emphasize the need for studies to report serocordant and serodiscordant unprotected anal intercourse separately, as the former presents significant lower risk of HIV transmission.