High risk behaviour in steady and in casual relationships among men having sex with men in Israel
Z. Mor1, U. Davidovich2, N. Bassudu Manor1, M. McFarlane3, G. Feldshtein4, D. Chemtob1
1Ministry of Health, Tuberculosis and AIDS, Jerusalem, Israel, 2Amsterdam Health Services, Dep of Research, Amsterdam, Netherlands, 3Centers for Disease Control and Prevention, Division of STD prevention, Atlanta, United States, 4The Association of Gays, Lesbians, Bisexuals and Transgenders, Tel Aviv, Israel
Background: The annual number of newly diagnosed HIV/AIDS infections among men having sex with men (MSM) in Israel has tripled during the last decade. Steady partnerships may be protective for further HIV transmission due to reduction of sexual partners. This study explores the differences in sexual risk behavior MSM with a steady partner (SP) to MSM with casual partner/s (CP).
Methods: Cross-sectional study based on online, tailored, anonymous questionnaire launched between March and May 2005 assessing MSM´s knowledge, practices and motivation with regards to safe sex. Participants who performed insertive or receptive unprotected anal intercourse (UAI) with a partner whose HIV status was positive or unknown were considered "risky".
Results: Of all 2,569 questionnaire analyzed, 907 (35.3%) had a SP, and 896 (34.9%) had CP in the last 6 months. A total of 262 (28.9%) SP and 248 (27.7%) CP were risky. Of all participants with SP, 108 (36.5%) performed UAI with their partner without undergoing mutual HIV testing. Additionally, of all participants with SP, 476 (52.5%) had a concomitant CP, and 144/476 (30.3%) performed UAI with both SP and CP. Negotiation skills, difficulties in using condoms, individuals who identified themselves "risk takers" and longer relationships were independently associated with risky sexual behaviour. Of all participants with SP, 775/907 (85.4%) negotiated with their main partner the possibility of sex outside of the contact. Length of steady relationship correlated with the number of concurrent CP.
Conclusions: Risky sexual behaviour was associated with lesser negotiation skills, difficulties in condom-use and a risk-taking profile. Health educators should encourage MSM with SP to perform HIV testing before UAI and to improve their negotiation skills during the contact, as it may not be monogamous. The internet can be used as a bi-directional instrument to collect information from MSM and to convey health messages from and to the gay community.