Beyond Anal Sex: Sexual Practices of Men Who Have Sex with Men and Associations with HIV and Other Sexually Transmitted Infections

INTRODUCTION:

Unprotected anal intercourse is often used as a single indicator of risky behavior in men who have sex with men (MSM), yet MSM engage in a variety of behaviors that have unknown associations with sexually transmitted infection (STI) and HIV.

AIM:

To assess the prevalence of a wide range of sexual behaviors and their associations with prevalent STI and HIV.

METHODS:

We used a standardized, self-administered survey to collect behavioral data for this cross-sectional study of 235 MSM seeking care in a public clinic for sexually transmitted diseases.

MEAN OUTCOME MEASURES:

Using modified Poisson regression, we generated unadjusted and adjusted prevalence ratios (PRs) to characterize associations between recent participation in each behavior and prevalent STI and HIV.

RESULTS:

Participants' median age was 26 years. One third (35%) were positive for STI. STI prevalence was significantly associated with using sex slings, felching, group sex, fisting, anonymous sex, and sex toys. HIV prevalence was 17% and was significantly associated with fisting, felching, enemas, and group sex.

CONCLUSION:

Multiple behaviors were significantly associated with prevalent STI and HIV in adjusted analyses. To provide a more comprehensive understanding of sexual risk in MSM, prospective studies are needed to examine whether these behaviors are causally associated with HIV and STI acquisition.

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By:  Rice CE1, Maierhofer C2, Fields KS3, Ervin M3, Lanza ST4, Turner AN2.

• 1Department of Biobehavioral Health, The Methodology Center (https://methodology.psu.edu/), College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA. Electronic address: cer5374@psu.edu.
• 2Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA.
• 3Sexual Health Clinic, Columbus Public Health, Columbus, OH, USA.
• 4Department of Biobehavioral Health, The Methodology Center, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA. 
• J Sex Med. 2016 Feb 4. pii: S1743-6095(16)00074-6. doi: 10.1016/j.jsxm.2016.01.001.

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Risk Factors for HCV Acquisition among HIV-Positive MSM in Belgium

OBJECTIVE:

To better understand risk factors for the sexual transmission of hepatitis C viral (HCV) infection among men who have sex with men (MSM).

DESIGN:

Case-control study among HIV-infected MSM, attending AIDS Reference Centers in Belgium.

METHODS:

Cases were HIV-infected MSM who were diagnosed with HCV between January 2010 and December 2013. For each case, 2 controls were randomly selected among the HIV-positive MSM who tested negative for HCV around the same time as the cases were identified. Consenting participants were interviewed with a questionnaire on risk factors. Medical records were abstracted to document past episodes of sexually transmitted infections (STIs). Associations between HCV infection and risk factors were explored using bivariate analysis followed by multiple logistic regression analysis.

RESULTS:

A total of 52 cases and 90 controls were recruited. In multivariate analysis, douching before anal intercourse, fisting, having intercourse with HIV-positive men, and a documented gonorrhoea or chlamydial infection in the year before inclusion in the study were independently associated with incident HCV infection.

CONCLUSIONS:

Our study confirmed fisting and suffering from other STIs as risk factors for HCV and suggested an increased risk of HCV associated with serosorting. Furthermore, we identified anal douching as being associated with HCV infection. The role that douching plays in the acquisition of HCV infection and other STIs requires further research, as well as the effect of serosorting on STI transmission.

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By:  Apers L1, Vanden Berghe W, De Wit S, Kabeya K, Callens S, Buyze J, Kenyon C, Florence E, Buvé A.

• 1Departments of *Clinical Sciences; †Public Health, Institute of Tropical Medicine, Antwerp, Belgium; ‡Department of Infectious Diseases, St. Pierre University Hospital, Brussels, Belgium; and §Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgium. 

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The Road Less Travelled: Exploring Gay and Bisexual Men's Explanations of 'Uncommon' Routes of HIV Transmission

Although there are practices other than condomless anal intercourse that may result in HIV transmission among gay and bisexual men, very little is known about these 'uncommon' transmission explanations. 

To address this topic, the free text survey responses from 465 HIV positive gay men in Australia were thematically analysed; 123 participants offered uncommon explanations for their seroconversion. Men described several sexual acts they believed led to infection, categorised as adventurous sex (e.g., fisting) and foreplay (e.g., oral sex). Participants also identified mediating factors associated with their seroconversion, either internal (e.g., cum/pre-cum) or external (e.g., sores, illness) to sex. Finally, contextual forces associated with infection were also explored, namely physical spaces (e.g., sex on premises venues) or mental states (e.g., depression). 

While some uncommon explanations are unlikely to have resulted in HIV transmission, these accounts reveal the diverse and intersecting ways that men attempt to make sense of their seroconversion.

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By:  Callander D^1,2, Prestage G^3,4, Ellard J⁴, Triffitt K³, Brown G⁴, Down I³.

¹Kirby Institute for Infection and Immunity in Society, UNSW Australia, Level 6 Wallace Wurth Building, Sydney, NSW, 2052, Australia. d.callander@unsw.edu.au.

²Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia. d.callander@unsw.edu.au.

³Kirby Institute for Infection and Immunity in Society, UNSW Australia, Level 6 Wallace Wurth Building, Sydney, NSW, 2052, Australia.

⁴Australian Research Centre in Sex, Health and Society, UNSW Australia, Sydney, NSW, Australia.

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Experimentals, Bottoms, Risk-Reducers & Clubbers: Exploring Diverse Sexual Practice in an Internet-Active High-Risk Behaviour Group of Men Who Have Sex with Men in Sweden

This study aimed to identify sub-groups of men who have sex with men at high risk of HIV infection. Data from the Swedish MSM2013 survey were analysed with a focus on respondents (n = 714) who reported having had unprotected anal intercourse with male casual partner(s) in the past 12 months. 

Weighted Latent Class Analysis with covariates and distal outcomes was conducted to identify sub-groups of men sharing the same sexual practice characteristics. Four latent classes emerged: experimentals, bottoms, risk-reducers and clubbers. 

Experimentals appeared to differ most from the other classes. They had extensive experience of barebacking, the use of poppers and fisting. Higher number of casual male sex partners and reporting having HIV were predictors for belonging to experimentals. 

No evidence for an association between self-rated HIV prevention knowledge and taking less part in risky practices was found. Hence, knowledge-intensive interventions may not be the best fit for reducing HIV transmission. 

This diversity of men based on similar sexual practice patterns should be taken into account when designing future HIV prevention interventions.

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By:  Persson KI1,2, Tikkanen R3, Bergström J4, Berglund T5, Thorson A1, Forsberg BC1.

• 1 Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.
• 2 Department of Knowledge Development, Unit for Health and Sexuality , Public Health Agency of Sweden , Solna , Sweden.
• 3 Department of Social Work , University of Gothenburg , Göteborg , Sweden.
• 4 Department of Monitoring and Evaluation, Unit for Statistics and Surveillance , Public Health Agency of Sweden , Solna , Sweden.
• 5 Department of Monitoring and Evaluation, Unit for Epidemiology and Health Economics , Public Health Agency of Sweden , Solna , Sweden.

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Substance Use, Sexual Behaviour & Prevention Strategies of Vancouver Gay & Bisexual Men Who Recently Attended Group Sex Events

Group sex events are an epidemiologically important part of some gay and bisexual men's sexual culture in Canada. Associated with condomless anal intercourse and polysubstance use, such events have been cited as disproportionally contributing to HIV infection rates. 

We analysed questionnaire data from the Momentum Health Study in Vancouver, Canada, to understand substance use, sexual behaviour, psychosocial variables (Sexual Sensation Seeking, Sexual Escape Motivation, Treatment Optimism) and HIV prevention strategies (sero-sorting, strategic positioning, avoiding anal sex, disclosure, treatment as prevention) of men attending such events, which were defined as group (n ≥ 4 partners) sex parties, blackout events and darkrooms. Analysis by multivariable logistic regression compared men attending group sex events within the past six months (n = 180) with non-attendees (n = 539). 

Results showed that attendees reported:

1. significantly higher use of sex drugs and alcohol consumption, 
2. higher scores on the Sexual Sensation Scale, more anal sex partners, greater odds of any condomless anal sex with sero-discordant partners and greater odds of reporting fisting and sex toy use and
3. different prevention practices that varied by HIV-serostatus. 

Findings are interpreted in light of the importance of pleasure, sociality and HIV/STI prevention strategies associated with group sex events. 

Findings contribute to the development of appropriate education and intervention for attendees.

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By: Rich AJ1, Lachowsky NJ1,2, Cui Z1, Sereda P1, Lal A1, Birch R3,4, Montaner J1,2, Moore D1,2, Hogg RS1,5, Roth EA3,4.

• 1a Department of Epidemiology and Population Health , BC Centre for Excellence in HIV/AIDS , Vancouver , Canada.
• 2b Faculty of Medicine , University of British Columbia , Vancouver , Canada.
• 3d Department of Anthropology , University of Victoria , Victoria , Canada.
• 4e Centre for Addictions Research of British Columbia , University of Victoria , Victoria , Canada.
• 5c Faculty of Health Sciences , Simon Fraser University , Burnaby , Canada. 

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