Sex while abroad appears to be contributing
to the ongoing epidemics of HIV and other sexually transmitted infections
(STIs) in European gay men, results of a large internet-based survey show.
Over a quarter of European gay men reporting sex with another man they met while
visiting another country engaged in unprotected anal intercourse. Respondents living with HIV were especially likely to report unprotected anal sex while
visiting another country.
These findings are especially significant
in light of epidemiological evidence showing European transmission networks of HIV, hepatitis C and Lymphogranuloma venereum (LGV).
Approximately 180,000 participants from 38 European
countries completed the European Men-Who-Have-Sex-with-Men Internet Survey
(EMIS) in 2010. This is the largest international study of men who have sex with men ever conducted.
The survey gathered a large amount of data on the
demographics, sexual behaviour and drug use of men who have sex with men. A
section of the survey was concerned with sex while visiting other countries.
Participants were asked “When did you last have sex
in a country outside the one you live in, with a man who does not also live in
[your country of residence]?”
Overall, 26.3% of men stated that they had had sex
abroad in the previous twelve months. The countries with the highest proportion
of participants reporting sex abroad tended to be in western Europe and Scandinavia, especially Luxembourg (57%), Switzerland (48%),
Malta (45%) and the Netherlands (44%).
Men living with HIV were almost twice as likely to
report sex abroad than HIV-negative and untested men (40 vs 24%; OR = 1.81).
Men aged over 25 years were also more likely to report sex abroad than younger
men (28 vs 16%), as were individuals with a higher level of education (32
vs 18%) and men living in larger cities (31 vs 20%).
The European countries in which respondents were
most likely to report having sex while abroad were Spain (18%) and Germany
(22%). Spain was visited most commonly by men from western European countries,
and Germany by men from eastern European countries.
Other countries where men commonly had sex while
abroad were France (7%), the UK (6%), Italy (4%) and the Netherlands (3%).
Sex while visiting non-European destinations was
also widely reported. Overall, 7% of respondents said they had had sex while
visiting the United States, 3% reported sex in Thailand and 2% in Brazil.
The most common way of meeting sexual partners while
abroad was the internet. A third of men reporting sex while abroad said they had
met their partners in this way.
“Potential sex partners can be contacted this way
before or during a trip abroad,” write the authors.
Saunas were also a common meeting place (14%), as
were gay discos or nightclubs.
Almost two-thirds (61%) of men reporting sex while
abroad said they had had anal sex. Higher rates of anal sex (71%) were reported
by men visiting Latin America and the Caribbean.
Men who had anal sex with a partner they had met
abroad were asked “On that occasion did you and that partner have anal
intercourse…without a condom?” A total of 26% of men who reported having sex
abroad in the previous twelve months said they had had unprotected anal sex.
Men from Malta (38%), the Netherlands (35%), the UK
(32%), Estonia (29%) and Sweden (29%) were especially likely to report
unprotected anal sex with a sexual partner they met while abroad.
Almost half (49%) of men living with HIV having sex
abroad reported unprotected anal sex compared to 21% of HIV-negative and
After controlling for factors such as country of
residence, age and education, the investigators found that men
living with HIV were 3.75 times more likely (CI, 3.47-4.04) to report unprotected anal sex with
partners met abroad than men who were HIV negative or of unknown HIV status.
Almost all the men (89%) reporting unprotected anal
sex while abroad also reported this behaviour with a casual partner in their
country of residence.
The most common countries where men had unprotected
anal sex while travelling abroad were the Netherlands (32%), Germany (29%) and
the United States (26%).
Data were also gathered on where men met partners
for unprotected sex. The most common venue (52%) was private sex parties,
followed by “backrooms” in a bar or club, or a sex party in a public venue
Overall, the findings suggest that HIV and many
STIs have international transmission networks. Men who have while abroad could be a target population for health education campaigns before
travelling - perhaps delivered via the internet - and sexual health screens and HIV testing on return.