Background STI/HIV prevention messages targeting men who have sex with men (MSM) include recommendations to avoid unprotected anal intercourse. Beyond anal intercourse, MSM may engage in a range of alternative sexual practises, yet associations between these practises and STI/HIV have not been carefully examined.

Methods We are currently conducting a cross-sectional study of MSM who present to an urban, public STD clinic in the midwestern United States. Using a tablet computer, all participants self-administer a confidential survey capturing sexual behaviour data. Results of STI/HIV testing are abstracted from medical records after the visit.

Results Results are preliminary because data collection will continue through May 2013. To date 132 men have enrolled. Participants’ median age is 26 years. Most are white (70%) or black (30%), and 80% identify as gay. The median number of lifetime sex partners is 20. The majority (85%) report lifetime experience with unprotected anal sex. Endorsement of alternative sexual practises is also common, with men reporting lifetime history of sounding (5%), felching (10%), autoerotic asphyxiation (11%), fisting (12%), use of a sex sling (26%), oral exchange of semen between partners (27%), and group sex (66%). Experience with recreational drugs is also common, particularly methamphetamines (14%), poppers (24%), cocaine (29%), and marijuana (71%). STI/HIV results have been abstracted for 44 men to date: 11% had urethral N. gonorrhoea (GC), 9% had rectal GC, 9% had urethral C. trachomatis (CT), and 14% had rectal CT. Nearly one-quarter (23%) had tested positive for HIV previously, and another 7% were newly diagnosed at the clinic visit.

Conclusion In this preliminary analysis, endorsement of alternative sexual practises was common and the prevalence of HIV/STI was high. Analysis of the complete sample will permit robust, quantitative characterizations of associations between previously uninvestigated sexual practises and prevalent HIV and STI.