Rates of condom and non-condom-based anal intercourse practices among homosexually active men in Australia: deliberate HIV risk reduction?
- Limin Mao1,
- Susan C Kippax2,
- Martin Holt1,
- Garrett P Prestage3,
- Iryna B Zablotska3,
- John B F de Wit1
- 1National Centre in HIV Social Research, University of New South Wales, Sydney, Australia
- 2Social Research Policy Centre, University of New South Wales, Sydney, Australia
- 3The Kirby Institute, University of New South Wales, Sydney, Australia
- Correspondence to Dr Limin Mao, National Centre in HIV Social Research, Level 2, Webster Building, University of New South Wales, Sydney, NSW 2052, Australia;
Contributors IBZ and GPP were responsible for the overall study design, data collection and project management. LM, MH and SCK formulated the research questions. LM designed the analytical method, conducted the data analysis and drafted the paper. MH, SCK and JBFdW provided critical inputs into the earlier drafts. All authors have commented on and approved the final version of this paper.
- Accepted 16 June 2011
- Published Online First 15 July 2011
Objective Three decades into the HIV epidemic and with the advancement of HIV treatments, condom and non-condom-based anal intercourse among gay men in resource-rich countries needs to be re-assessed.
Methods The proportions of men engaging in a range of anal intercourse practices were estimated from the ongoing cross-sectional Gay Community Periodic Surveys in six states in Australia from 2007 to 2009. Comparisons were made between HIV-negative men, HIV-positive men with an undetectable viral load and those with a detectable viral load.
Results Condoms play a key role in gay men's anal intercourse practices: 33.8% of HIV-negative men, 25.1% of HIV-positive men with an undetectable viral load and 22.5% of those with a detectable viral load reported consistent condom use with all male partners in the 6 months before the survey. Among HIV-negative men, the second largest group were men who had unprotected anal intercourse (UAI) only in the context of HIV-negative seroconcordant regular relationships. Among HIV-positive men, the second largest group was men who had UAI in casual encounters preceded by HIV status disclosure to some, but not all, casual partners.
Conclusions A minority, yet sizeable proportion, of men consistently engaged in a number of UAI practices in specific contexts, suggesting they have adopted deliberate HIV risk-reduction strategies. While it is important that HIV behavioural prevention continues to reinforce condom use, it needs to address both the challenges and opportunities of the substantial uptake of non-condom-based risk-reduction strategies.
- behavioural interv
- men who have sex with men (MSM)
- prevention of sexual transmission
- risk behaviours
- sexual behaviour
- sexual practices
- viral load
Funding The Gay Community Periodic Surveys are funded by the departments of health in each participating state or territory in Australia. The National Centre in HIV Social Research and The Kirby Institute receive project funding from the Australian government Department of Health and Ageing.
Competing interests None.
Ethics approval Ethics approval was received from the Human Research Ethics Committee at the University of New South Wales.
Provenance and peer review Not commissioned; externally peer reviewed.