Number of Risk Acts by Relationship Status and Partner Serostatus: Findings from the HIM Cohort of Homosexually Active Men in Sydney, Australia

National Centre in HIV Social Research, University of New South Wales, Sydney, Australia.
AIDS and Behavior (Impact Factor: 3.49). 06/2006; 10(3):325-31. DOI: 10.1007/s10461-005-9057-3
Source: PubMed


In recent years, increases in both risk behavior and in seroconversion among homosexually active men have been noted in a number of parts of the world. Data were available from 903 HIV negative homosexual men regarding number of acts of unprotected anal intercourse (UAI), separated into receptive and insertive UAI, with and without ejaculation, with steady and with casual partners. Partners were classified according to serostatus as reported by respondents. Men (N = 325) reported 13,692 UAI acts, most of which were with steady partners, of whom most were reported to be HIV-negative. With HIV-positive partners, both steady and casual, and with casual partners of unknown serostatus, receptive UAI with ejaculation was relatively rare. Insertive UAI without ejaculation was relatively common with casual partners of unknown serostatus. Patterns of UAI suggest that risk of transmission may be greater with steady partners. Men appear to modify practice according to both the nature of the relationship (steady or casual) and (assumed) serostatus of partner.

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    • "In Australia, the average number of overall partnerships in the past 6 months have been reported to be 12–14 during the period 1999–2006 [24], almost two-fold the corresponding finding of 6.17 (3.45-9.96) in China. In addition, the average number of anal intercourse acts per regular partner in the past 6 months is 42–62 (1.6-2.4 acts/wk) in the US [24,25], whereas the number of acts per casual partnership is 26–52 (1–2 acts/wk [24-26]) in Australia. These are 5–10 times higher than our estimated number of acts among MSM in China. "
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    ABSTRACT: Background HIV prevalence is increasing at a concerning rate among men who have sex with men (MSM) in China. Numerous studies have reported on levels of behaviors of Chinese MSM for different types of sexual partnerships, such as regular, non-commercial casual and commercial. This study aims to investigate the trends HIV incidence rates in relation to their risk sexual behaviors and partnership types among Chinese MSM. Method Through a comprehensive literature research from available English and Chinese literature databases, we collated relevant information of sexual behaviors of Chinese MSM. Further, with the utilization of a mathematical optimization approach, this study reconciles the distributions of sexual behavioral data over the last decade and infers the heterogeneous distributions of behavioral patterns among Chinese MSM. Distributions of high-risk behavioural indicators, including the number of sexual partners, number of sexual acts and condom usage in the past 6 months, are calibrated to available empirical data. Based on the resultant temporal trends in these distributions, the trends in HIV incidence rates associated with each type of partnership among MSM in China are also estimated. Results A total of 55 qualified articles have been identified. An average MSM has approximately 0.96 (95% CI, 0.59-1.18) regular, 3.75 (1.72-6.25) casual and 1.61 (0.97-2.78) commercial partners over a 6 month period and 4.33 (2.81-6.46), 1.42 (0.62-3.08), 1.48 (0.79-3.30) sexual acts per partnership respectively, corresponding to a total of 11.87 (8.87-15.25) acts. Condom usage has increased significantly during 2002–2010, at annual increases of 3.58% (2.98-4.12%), 5.55% (4.55-6.54%), and 5.03% (4.19-5.74%) for regular, casual and commercial partners respectively. These behavioral data implies an increase in HIV incidence of approximately 3.3-fold, from 2.04 (1.96-2.12) to 7.02 (6.71-7.35) per 1000 person-years during the same period. The proportion of new infections attributed to regular partnerships increased from 34% to 40%, whereas infections attributed to commercial partnerships reduced from 29% to 23% during 2002–2010. Conclusion Regular partnerships are the main contributor of new HIV cases among MSM in China, public health intervention strategies are required to increase condom usage and HIV testing rates among regular partners to curb the growing trend HIV incidence.
    Full-text · Article · Jul 2012 · BMC Public Health
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    • "Sexual behavior among gay men has been found to vary depending on partner type (primary vs. outside) [4, 36–39] and serostatus [40, 41]. For example, studies show that rates of UAI increase when primary partners are concordant [42, 43], however, when primary partners are discordant, studies show men making conscious choices about positioning for UAI [44]. "
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    ABSTRACT: We investigated the influence of partner-provided HIV-specific and general social support on the sexual risk behavior of gay male couples with concordant, discordant, or serostatus-unknown outside partners. Participants were 566 gay male couples from the San Francisco Bay Area. HIV-specific social support was a consistent predictor for reduced unprotected anal intercourse (UAI) with both concordant outside partners (all couple types) and outside partners of discordant or unknown serostatus (concordant negative and discordant couples). General social support was associated with increased UAI with concordant outside partners for concordant negative and concordant positive couples (i.e., serosorting). Our findings suggest that prevention efforts should target couples and identify the level of HIV-specific support that partners provide. Partner-provided support for HIV-related behaviors could be an additional construct to consider in gay male relationships, akin to relationship satisfaction and commitment, as well as an important component of future HIV prevention interventions. Electronic supplementary material The online version of this article (doi:10.1007/s10461-010-9868-8) contains supplementary material, which is available to authorized users.
    Full-text · Article · Jan 2011 · AIDS and Behavior
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    • "One possible explanation, as consistently reported by behavioral studies, may be that gay men in relationships engage in substantially higher rates of unprotected anal intercourse (UAI) with their primary partners than do single men with their casual partners (Cáceres & Rosasco, 1997; Ekstrand, Stall, Paul, Osmond, & Coates, 1999; Elford, Bolding, Maguire, & Sherr, 1999; Fitzpatrick, McLean, Dawson, Boulton, & Hart, 1990; Hays, Kegeles, & Coates, 1990, 1997; Hoff, Coates, Barrett, Collette, & Ekstrand, 1996; Hoff et al., 1997; Hope & MacArthur, 1998; Kippax, Crawford, Davis, Rodden, & Dowsett, 1993; Schmidt, Fouchard, Krasnik, & Zoffmann, 1992). Recent studies confirm high rates of unprotected sex among gay couples (Crawford et al., 2006; Davidovich et al., 2001; Stolte, Dukers, Geskus, Coutinho, & de Wit, 2004; Xiridou, Geskus, De Wit, Coutinho, & Kretzschmar, 2003). While UAI may not inherently present risk for HIV transmission (e.g., if the couple is concordant negative and monogamous), other factors, such as serostatus differences between partners, may increase the likelihood of HIV transmission. "
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    ABSTRACT: This article describes agreements gay male couples make about sex outside the relationship and how the process of making those agreements, and their perceived quality, varies depending on couple serostatus. Data include 191 couples recruited in the San Francisco Bay Area from June to December 2004. Monogamous agreements were reported by 56% of participants in concordant-negative, 47% in concordant-positive, and 36% in discordant relationships. The remaining participants reported agreements allowing sex with outside partners in some form. Agreement quality was lowest among men in discordant relationships. Overall, few (30%) reported breaking their agreements; only half of whom reported disclosing those breaks to their partners. Although differences in agreement type, quality, and satisfaction were found among the three couple serostatus groups, rates of breaks and their disclosure did not vary significantly by group. Future HIV prevention efforts aimed at couples must integrate both couple serostatus and relationship-based issues.
    Preview · Article · Mar 2009 · AIDS education and prevention: official publication of the International Society for AIDS Education
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