BMJ 2000;320:1510-1511 ( 3 June )

Papers

Increase in high risk sexual behaviour among homosexual men, London 1996-8: cross sectional, questionnaire study

Editorial by Grulich

Julie P Dodds, research fellow,  Anthony Nardone, senior research fellow,  Danielle E Mercey, senior lecturer,  Anne M Johnson, professor, epidemiology group. 

Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, London WC1E 6AU

Correspondence to: J P Dodds JDodds{at}gum.ucl.ac.uk

The incidence of HIV infection among homosexual men in the United Kingdom is increasing despite efforts to reduce high risk sexual behaviour.¹ The likelihood of engaging in high risk sexual behaviour may be increasing as new treatments reduce concern about infection.² We report the results of a repeated survey of sexual behaviour among gay men in London.

	Methods and results

Top Methods and results Comment References

A survey was conducted in 1996, 1997, and 1998 using the same methodology each year.³ A sampling frame was compiled of all commercial gay venues (bars, clubs, and saunas) and genitourinary medicine clinics within inner London. A sample of venue types and locations was then selected. Between 59 and 72 venues were sampled each year. Whenever possible the same venues were selected each year; if venues had closed they were replaced in the sample by similar ones. Health promotion workers distributed questionnaires with 16 items that covered demographic information and sexual behaviour. All men present at or queuing to enter a venue during a specific period were invited to participate. Altogether 6671 of 8384 (80%) questionnaires distributed were returned; similar numbers were returned each year. Data were analysed using SPSS.

Respondents were aged from 15 to 78 years (median 31). Men sampled in 1998 were significantly older than in previous years (table). Altogether, 5660 of 6354 (89%) of men were white and 4410 of 6232 (71%) resided in inner London.

View this table: [in this window] [in a new window]   Changes in two measures of high risk sexual behaviour among gay men completing anonymous questionnaires in London. Odds ratios calculated using logistic regression and adjusted for age and place of recruitment

In each year, about a third of the men (729/2263 (32%), 694/1943 (36%), 730/1916 (38%), respectively) reported having had unprotected anal intercourse during the previous year. However, in every year high risk sexual behaviour (for example, unprotected anal intercourse in the previous year) was significantly associated with younger age (occurring among 108/252 (43%) of those aged under 25 and 103/340 (30%) of those over 40, P<0.01 in 1998) and recruitment from a genitourinary medicine clinic (odds ratio 1.39, 95% confidence interval 1.13 to 1.71, P<0.01 in 1998).

Using 1996 as the baseline, there was a significant increase in the reporting of unprotected anal intercourse after adjusting for age and place of recruitment (1997 odds ratio 1.17 (1.03 to 1.33); 1998 odds ratio 1.23 (1.12 to 1.45)) (table). The adjusted odds of having had unprotected anal intercourse with partners whose HIV status was unknown or discordant also increased. However, there may be some misclassification error: of the 724 men who reported having had unprotected anal intercourse with partners of the same status, 118 (16%) had never had an HIV test. There was no significant increase in the adjusted odds of having had an HIV test.

When only those 25 venues sampled every year were selected for analysis the increase in the adjusted odds of having had unprotected anal intercourse in the past year remained significant.

	Comment

Top Methods and results Comment References

This is the first report of an increase in unsafe sex occurring among gay men in England; this increase has recently been observed in the United States.²

The 80% response rate showed that the survey was acceptable to participants. However, only those men who were socially active or using genitourinary medicine services were invited to participate. Although there are difficulties in interpreting trends in repeated cross sectional surveys, we believe that these results are important as they represent an apparent change in behaviour among gay men using the most frequented venues in London. ^{3 4}

HIV transmission can be reduced by ensuring that men have unprotected anal intercourse only with partners of a concordant HIV status; for this strategy to succeed, the importance of HIV testing must be promoted. Despite recent campaigns and the availability of new treatments, we found no evidence of an increase in the uptake of testing.

Our results, combined with the reported increase in gonorrhoea cases among gay men⁵ and the increasing prevalence of HIV infection associated with longer survival, highlight the potential for the continuing spread of the epidemic and the need for more health promotion initiatives that have been shown to be effective.

	Acknowledgments

We thank the Camden and Islington Health Authority for its financial support. We thank Dr Andrew Copas for statistical advice. We also thank members of the working group.

Contributors: AN, DEM, and AMJ initiated and designed the study. JPD and AN managed the project. JPD analysed the data, wrote the first draft, and coordinated subsequent revisions of the paper. All authors contributed to the final version of this paper. JPD and DEM are the guarantors.

	Footnotes

Funding: Camden and Islington Health Authority.

Competing interests: None declared.

The members of the working group appear on the BMJ's website

	References

Top Methods and results Comment References

1.	Communicable Disease Surveillance Centre. AIDS and HIV infection in the UK: monthly report. Commun Dis Rep CDR Wkly 1999; 9: 121-122[Medline].
2.	From the Centers for Disease Control and Prevention. Increases in unsafe sex and rectal gonorrhea among men who have sex with menSan Francisco, California, 1994-1997. JAMA 1999; 281: 696-697[Free Full Text].
3.	Nardone A, Mercey DE, Johnson AM. Surveillance of high risk behaviour amongst homosexual men in a central London health authority. Genitourin Med 1997; 73: 198-202[Medline].
4.	Nardone A, Dodds JP, Mercey DE, Johnson AM. Active surveillance of sexual behaviour among homosexual men in London. Commun Dis Public Health 1998; 1: 197-201[Medline].
5.	Sexually transmitted disease quarterly report: gonorrhoea in England and Wales. Commun Dis Rep CDR Wkly 1998; 8: 194-196.

(Accepted 22 February 2000)

---

© BMJ 2000
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Increased high risk sexual behaviour in homosexual men

Neil Macdonald, Barry Evans, Ranjana Rani, Paul D Woolley, Swatantrata Chandiok, Gavin Fairburn, Kevin McDonald, Julie Dodds, Anthony Nardone, Danielle Mercey, and Anne Johnson
BMJ 2000 321: 1531. [Extract] [Full Text]

Unsafe sexual practices are increasing among gay men in London
BMJ 2000 320: 0. [Full Text]

HIV risk behaviour in gay men: on the rise?

Andrew Grulich
BMJ 2000 320: 1487-1488. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Snowden, J M, Raymond, H F, McFarland, W (2009). Prevalence of seroadaptive behaviours of men who have sex with men, San Francisco, 2004. Sex. Transm. Infect. 85: 469-476 [Abstract] [Full text]  
• Delpech, V, Martin, I M C, Hughes, G, Nichols, T, James, L, Ison, C A, on behalf of the GRASP steering group, (2009). Epidemiology and clinical presentation of gonorrhoea in England and Wales: findings from the Gonococcal Resistance to Antimicrobials Surveillance Programme 2001-2006. Sex. Transm. Infect. 85: 317-321 [Abstract] [Full text]  
• Llewellyn, C., Pollard, A., Smith, H., Fisher, M., on behalf of the Home Sampling Kit Study Group, (2009). Are home sampling kits for sexually transmitted infections acceptable among men who have sex with men?. J Health Serv Res Policy 14: 35-43 [Abstract] [Full text]  
• Steward, W. T., Charlebois, E. D., Johnson, M. O., Remien, R. H., Goldstein, R. B., Wong, F. L., Morin, S. F. (2008). Receipt of Prevention Services Among HIV-Infected Men Who Have Sex with Men. AJPH 98: 1011-1014 [Abstract] [Full text]  
• Dodds, J. P, Johnson, A. M, Parry, J. V, Mercey, D. E (2007). A tale of three cities: persisting high HIV prevalence, risk behaviour and undiagnosed infection in community samples of men who have sex with men. Sex. Transm. Infect. 83: 392-396 [Abstract] [Full text]  
• Dougan, S., Elford, J., Chadborn, T. R, Brown, A. E, Roy, K., Murphy, G., Gill, O N., on behalf of the group investigating rising HIV di, , Dukers, N H T M (2007). Does the recent increase in HIV diagnoses among men who have sex with men in the UK reflect a rise in HIV incidence or increased uptake of HIV testing?. Sex. Transm. Infect. 83: 120-125 [Full text]  
• Truong, H-H M, Kellogg, T, Klausner, J D, Katz, M H, Dilley, J, Knapper, K, Chen, S, Prabhu, R, Grant, R M, Louie, B, McFarland, W (2006). Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting?. Sex. Transm. Infect. 82: 461-466 [Abstract] [Full text]  
• Cassell, J A, Mercer, C H, Imrie, J, Copas, A J, Johnson, A M (2006). Who uses condoms with whom? Evidence from national probability sample surveys. Sex. Transm. Infect. 82: 467-473 [Abstract] [Full text]  
• Hart, G J, Williamson, L M (2005). Increase in HIV sexual risk behaviour in homosexual men in Scotland, 1996-2002: prevention failure?. Sex. Transm. Infect. 81: 367-372 [Abstract] [Full text]  
• Fergus, S., Lewis, M. A., Darbes, L. A., Butterfield, R. M. (2005). HIV Risk and Protection Among Gay Male Couples: The Role of Gay Community Integration. Health Educ Behav 32: 151-171 [Abstract]  
• van der Bij, A K, Stolte, I G, Coutinho, R A, Dukers, N H T M (2005). Increase of sexually transmitted infections, but not HIV, among young homosexual men in Amsterdam: are STIs still reliable markers for HIV transmission?. Sex. Transm. Infect. 81: 34-37 [Abstract] [Full text]  
• Mayon-White, R. (2004). Re-emerging infections: Part 2: Sexually transmitted infections. British Journal of Infection Control 5: 14-16 [Abstract]  
• Fenton, K A, Lowndes, C M (2004). Recent trends in the epidemiology of sexually transmitted infections in the European Union. Sex. Transm. Infect. 80: 255-263 [Abstract] [Full text]  
• Crepaz, N., Hart, T. A., Marks, G. (2004). Highly Active Antiretroviral Therapy and Sexual Risk Behavior: A Meta-analytic Review. JAMA 292: 224-236 [Abstract] [Full text]  
• Dodds, J P, Mercey, D E, Parry, J V, Johnson, A M (2004). Increasing risk behaviour and high levels of undiagnosed HIV infection in a community sample of homosexual men. Sex. Transm. Infect. 80: 236-240 [Abstract] [Full text]  
• Fergus, S. (2003). Book Review: Beyond Condoms: Alternative Approaches to HIV Prevention, Ann O'Leary (ed.). New York: Kluwer Academic/Plenum Publishers, 2002, 242 pp.. Health Educ Behav 30: 245-247  
• Adler, M W (2003). Sexual health--health of the nation. Sex. Transm. Infect. 79: 85-87 [Full text]  
• Stephenson, J M, Imrie, J, Davis, M M D, Mercer, C, Black, S, Copas, A J, Hart, G J, Davidson, O R, Williams, I G (2003). Is use of antiretroviral therapy among homosexual men associated with increased risk of transmission of HIV infection?. Sex. Transm. Infect. 79: 7-10 [Abstract] [Full text]  
• McGarrigle, C A, Fenton, K A, Gill, O N, Hughes, G, Morgan, D, Evans, B (2002). Behavioural surveillance: the value of national coordination. Sex. Transm. Infect. 78: 398-405 [Abstract] [Full text]  
• Doherty, L., Fenton, K. A, Jones, J., Paine, T. C, Higgins, S. P, Williams, D., Palfreeman, A. (2002). Syphilis: old problem, new strategy. BMJ 325: 153-156 [Full text]  
• Johnson, A M, Fenton, K A, Mercer, C (2002). Phase specific strategies for the prevention, control, and elimination of sexually transmitted diseases: background country profile, England and Wales. Sex. Transm. Infect. 78: i125-132 [Abstract] [Full text]  
• Katz, M. H., Schwarcz, S. K., Kellogg, T. A., Klausner, J. D., Dilley, J. W., Gibson, S., McFarland, W. (2002). Impact of Highly Active Antiretroviral Treatment on HIV Seroincidence Among Men Who Have Sex With Men: San Francisco. AJPH 92: 388-394 [Abstract] [Full text]  
• Williamson, L. M, Hart, G. J, Flowers, P., Frankis, J. S, Der, G. J (2001). The Gay Men's Task Force: the impact of peer education on the sexual health behaviour of homosexual men in Glasgow. Sex. Transm. Infect. 77: 427-432 [Abstract] [Full text]  
• Khan, W. A, Richardson, C., Mandalia, S., Barton, S. E (2001). Safer sex in HIV infected patients in London: practices and risks. Sex. Transm. Infect. 77: 394-394 [Full text]  
• Kegg, S., Pittrof, R., Lau, R. (2001). Homosexual men, HIV, and sexual risk in 2001. Sex. Transm. Infect. 77 : 325-326 [Full text]  
• Nicoll, A., Hughes, G., Donnelly, M., Livingstone, S., De Angelis, D., Fenton, K., Evans, B., Gill, O N., Catchpole, M. (2001). Assessing the impact of national anti-HIV sexual health campaigns: trends in the transmission of HIV and other sexually transmitted infections in England. Sex. Transm. Infect. 77: 242-247 [Abstract] [Full text]  
• Imrie, J., Stephenson, J. M, Cowan, F. M, Wanigaratne, S., Billington, A. J P, Copas, A. J, French, L., French, P. D, Johnson, A. M (2001). A cognitive behavioural intervention to reduce sexually transmitted infections among gay men: randomised trial. BMJ 322: 1451-1456 [Abstract] [Full text]  
• Elford, J., Bolding, G., Maguire, M., Sherr, L. (2001). HIV positive and negative homosexual men have adopted different strategies for reducing the risk of HIV transmission. Sex. Transm. Infect. 77 : 224-225 [Full text]  
• UK Collaborative Group on Monitoring the Transmiss, (2001). Analysis of prevalence of HIV-1 drug resistance in primary infections in the United Kingdom. BMJ 322: 1087-1088 [Abstract] [Full text]  
• Fenton, K. A, Johnson, A. M, McManus, S., Erens, B. (2001). Measuring sexual behaviour: methodological challenges in survey research. Sex. Transm. Infect. 77: 84-92 [Full text]  
• Crossley, M. L. (2001). 'Resistance' and health promotion. Health Education Journal 60: 197-204 [Abstract]  
• Macdonald, N., Evans, B., Rani, R., Woolley, P. D, Chandiok, S., Fairburn, G., McDonald, K., Dodds, J., Nardone, A., Mercey, D., Johnson, A. (2000). Increased high risk sexual behaviour in homosexual men. BMJ 321: 1531-1531 [Full text]  
• (2000). HIV Infection Increasing Among MSM in England. JWatch Infect. Diseases 2000: 6-6 [Full text]  
• Grulich, A. (2000). HIV risk behaviour in gay men: on the rise?. BMJ 320: 1487-1488 [Full text]  

Rapid Responses:

Read all Rapid Responses

High risk homosexual practices

Gavin Fairburn, et al.
bmj.com, 7 Jun 2000 [Full text]

Shared concern about high risk sexual behaviour - data from a pilot study in a rural area in the UK

B Stanley
bmj.com, 18 Jun 2000 [Full text]

"High Risk Sexual Behaviour amongst homosexual men in Manchester".

Ranjana R Jarvis
bmj.com, 19 Jun 2000 [Full text]

HIGH RISK SEXUAL BEHAVIOUR AMONG HOMOSEXUAL MEN IN MANCHESTER

Ranjana R Jarvis
bmj.com, 12 Jul 2000 [Full text]

Increase in high risk sexual behaviour among homosexual men, London 1996-8

Neil Macdonald
bmj.com, 16 Aug 2000 [Full text]

Safer sex in HIV infected patients in London-practices and risks

Waheed Khan
bmj.com, 12 Dec 2000 [Full text]

Online poll

Find out more >>