CATIE News - Casual sex study calls for interventions
14/05/2010 - Research from high-income countries suggests that there are increasing numbers of men who have unprotected anal sex with casual
male partners. Not surprisingly, rates of sexually transmitted infections (STIs), including syphilis and HIV, are on the rise among some gay and bisexual men
in these countries. The reasons for the increase in unprotected sex in this population are complex but may in part be related to perceptions about HIV infection and its treatment.
Negotiated safety
Over the course of the HIV epidemic, some gay men have developed strategies to try to reduce their risk of HIV transmission while still engaging in unprotected
anal sex. One way some men do this is by having a steady partner with whom they can develop and negotiate sexual safety. Such partnerships rely on "trust, closeness
and open communication to reach agreements about unprotected intercourse," according to a team of Australian researchers who have spent years exploring the
behaviour of gay and bisexual men.
However, the researchers note that despite these agreements, "communication about these issues is not always consistent and trust can sometimes be broken." They add that "the practice of negotiated safety is not completely free of HIV risk."
Serosorting
Another strategy to reduce the risk of HIV transmission is to have sex only with a partner(s) of the same HIV serostatus, a behaviour called serosorting.
One of several drawbacks of this strategy for HIV-negative men is as follows: "Unlike in regular relationships, familiar casual partners may not always revisit
the discussion of HIV testing and serostatus", noted the researchers.
The Australian researchers previously found that men "often make assumptions as to the serostatus of their casual sex partners"-a behaviour called sero-guessing.
So, even familiarity with casual partners may not help prevent HIV transmission.
The Australian researchers undertook a study to better understand what familiarity with casual partners might mean for HIV prevention. As a result of their study,
they made the following points:
- Familiarity with and a previous history of sex between casual partners may result in a false sense of trust and may increase the risk of HIV transmission.
- HIV prevention services should address this issue and develop programs to improve men's skills in negotiating safer sex.
Study details
Researchers recruited participants for a periodic survey in Sydney, Australia, at different gay community events, venues and sexual health clinics. The survey
collected information about unprotected anal sex with regular and casual partners, STIs, substance use and socio-economic data.
The present study was based on results from a 2007 survey with 677 men who reported sex with casual partners in the past six months. Their average profile was as follows:
- age - 36 years
- 75% were employed full-time
- 75% had college or university degrees
- 71% were HIV-negative
- 17% were HIV-positive
- 12% did not know or did not report their HIV status
Results
When asked how well they knew their last casual sex partner, here are the men's responses:
- not at all - 49%
- somewhat - 36%
- very well - 15%
According to the research team, among men who discussed the use of condoms, "a higher proportion appeared not to use condoms at their last than among those who did not
discuss condoms."
The Australian team also found that as the men became more familiar with their casual sex partners, "unprotected anal sex became significantly more common." This
trend occurred regardless of the men's HIV status. The frequency of unprotected anal intercourse among casual partners increased to the point where it was similar to that
among men in regular relationships.
The researchers stated that "the association between familiarity and unprotected anal intercourse with casual partners may be due to the greater trust and confidence
which develops in parallel with intimacy." This issue could pose difficulties for HIV prevention.
In this study, the decision among HIV-negative men to have unprotected anal intercourse with a casual partner did not seem to be connected with that partner's HIV status.
The researchers explain that this may be because HIV disclosure and guessing about a casual partner's serostatus, if they do occur, are "complex issues."
Another important point made by the research team is as follows:
".most casual sexual encounters do not offer the same risk reduction opportunities as regular relationships." This includes feeling a sense of "responsibility to partners
over time." A similar point has been made by professor Barry Adam, a sociologist at the University of Windsor, as a result of his research findings.
Trust and seroguessing
The Australian researchers suggested that "the sense of trust between familiar casual partners may often be combined with assumptions that both partners are still HIV negative.
Seroguessing among casual partners is not uncommon and many men engage in unprotected anal intercourse when seroguessing about status of their casual partners." Therefore, they said
that ".reliance on trust and serostatus assumptions between casual partners may further increase the probability of HIV transmission."
What is to be done?
Although the Australian study has some limitations, it does provide valuable insight into risky behaviour that can occur during casual sex encounters. The study team notes
that unprotected anal intercourse with casual partners carries the highest risk of HIV infection. So they ask that community-based HIV prevention programs address issues of "trust
and HIV disclosure in the context of casual sexual encounters."
The researchers conclude their report by calling for the strengthening of gay men's abilities to negotiate "sexual encounters, relationships and risk minimization," so
that precautions to minimize HIV transmission "are promoted in any context where the cannot be firmly and reliably ascertained."
-Sean R. Hosein
REFERENCES:
1. Zablotska IB, Grulich AE, De Wit J, et al. Casual sexual encounters among gay men: Familiarity, trust and unprotected anal intercourse. AIDS and Behavior. 2010; in press.
2. Adam BD, Husbands W, Murray J, et al. Silence, assent and HIV risk. Culture, Health and Sexuality. 2008 Nov;10(8):759-72.
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CATIE-News is written by Sean Hosein, with the collaboration of other members of the Canadian AIDS Treatment Information Exchange, in Toronto.
From Canadian AIDS Treatment Information Exchange (CATIE). For more information visit CATIE's Information Network at http://www.catie.ca
Source: CATIE: CANADIAN AIDS TREATMENT INFORMATION EXCHANGE
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