An accident or a habit? Unsafe sex among men who have sex with men (MSM) in Denmark
Background: An increasing percentage of Danish MSM practise unsafe sex (US, unprotected anal intercourse with a partner of opposite or unknown HIV-status).
The risk of becoming infected or infecting others with HIV increases with the number of US encounters. Therefore it is not immaterial whether US is practised once or twice per year, or if it is practised more frequently.
Methods: In the Gay Men’s Sex Life Survey in Denmark in 2006, participants were asked to state their HIV-status, and how many times they had had US during the last 12 months.
Results: Among 3,141 respondents an overall 33% had practised US. Among these, 675 stated number of US encounters: 48% reported US 1 or 2 times, 39% reported US 3-20 times, and 13% more than 20 times. Among HIV-negative MSM who had practised US, 56% reported US 1 or 2 times, while this was true for 36% of HIV-positive MSM (p=0.002). Among HIV-negative MSM, 7% had practised US more than 20 times, in contrast to 18% of HIV-positive MSM (p=0.002). Among HIV-negative MSM the median number of US encounters was 2, and among HIV-positive MSM the median number was 5.
In a logistic regression-analysis controlling for age, homo-/bisexual preference, urban/rural dwelling, education, and having tested for HIV within the last year, HIV-status remained the only significant independent variable for having had US more than twice. Compared to HIV-negative, HIV-positive MSM had an OR of 2.2 (CI95% 1.3-3.7) for having had US more than twice.
Conclusions: Whereas US encounters reported by HIV-negative MSM most often occurred only once or twice (i.e. an accident), HIV-positive MSM reported a high incidence of US encounters. This indicates that US is a habit among a considerable group of HIV-positive MSM. It is important to find ways to target this group in order to improve HIV prevention among MSM.
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