Approximately a third of Australian gay men report having unprotected anal sex with a partner assumed to be of a different HIV status during group sex sessions, according to a study published in the February edition of Sexually Transmitted Infections. Engaging in unprotected sex during group sex was associated with increased levels of testing for HIV and other sexually transmitted infections. Moreover, gay men who told their doctors about their group sex behaviour had more tests for sexually transmitted infections than men who did not disclose such behaviour. The investigators suggest that encouraging an honest and trusting relationship between gay men and their healthcare providers would ensure that men receive appropriate testing and care.
Overall, 90% of gay men in Australia have had an HIV test and it is estimated that approximately two-thirds have annual tests.
Group sex among gay men has been associated with a risk of HIV and other sexually transmitted infections. Investigators therefore wished to establish a better understanding of recent HIV and sexual health testing amongst gay men engaging in group sex.
The study involved 436 men. Most (80%) were recruited online. The men provided details of their most recent group sex encounter, including the number of men present at this encounter and the sexual behaviour they had engaged in. The men then provided details of what sexual health tests they had had since their last group sex encounter and were asked if they had discussed having had group sex with the doctor who provided their sexual health care.
Participants had a mean age of 40 years (range, 18-67) and the majority (57%) had a university education.
An HIV test was reported by 90% of men, in accordance with general levels of HIV screening for Australian gay men. Just over two-thirds (67%) of men reported that they were HIV-negative, the remaining 23% saying they were HIV-positive.
Over a quarter (29%) of men said there had been three men present at their last group sex encounter (a threesome), with 51% saying there had been four or more men present. The majority of men (63%) said that they knew at least some of the men with whom they had had group sex.
Unprotected anal sex during group sex was reported by 145 men (33%). The majority of men said that they had had unprotected sex with a non-regular partner whom they assumed had a different HIV status to their own.
Half the men reported having had a sexual health test within a month of their last group sex encounter.
Factors associated with seeking such tests included: engaging in unprotected anal sex with a non-regular partner (p = 0.008); at least four other men being present at the group sex session (p = 0.014); having previously met any of these men (p = 0.006); and having less than a university education (p = 0.019).
The investigators then restricted their analysis to men who reported being HIV-negative or of unknown HIV status. Only having unprotected sex with a non-regular partner (p = 0.001) and there being at least four men present at the group sex encounter (p = 0.035) were significantly associated with seeking a test for HIV or other sexually transmitted infections.
Approximately half (52%) the men said that they had discussed having had group sex with their doctor, with 17% saying they did so frequently.
Discussing such behaviour with healthcare providers was associated with a greater level of testing for sexually transmitted infections. Men who did not tell their doctor that they had engaged in group sex had a mean of 2.58 such tests, compared to a mean of 3.52 tests for men who had discussed engaging in group sex, and a mean of 4.05 tests for men who frequently discussed their group sex behaviour with their doctor.
Of the 342 men who said that they were HIV-negative or of unknown HIV status, 94 (28%) said that they had had an HIV test since the last time they had engaged in group sex. Men who had had unprotected anal sex with a non-regular partner were more likely to have had an HIV test than men who had not engaged in this high-risk behaviour (p
The investigators also conducted in-depth interviews with 16 men about their testing behaviour.
One man (who reported being HIV-negative) expressed the belief that as he tested for infections every three months, and had not been diagnosed with any infections, he felt reassured that he had not put himself at risk. However, he also indicated that he had engaged in unprotected anal sex with men during group sex and that he did not know the HIV status of these men. He told the investigators: “I just don’t think it is that risky to have unprotected sex, for the insertive partner…And I get tested regularly, and I haven’t caught anything yet.”
It was also clear that some men felt uncomfortable discussing group sex behaviour with a healthcare provider. One man told the investigators that his doctor did not understand his need to be tested for sexually transmitted infections every three months. He told the investigators: “My doctor tries to get me to test every six months, and so I alternate his visit with a visit to the Sexual Health Clinic, and that makes me seem like a bit less of a slut”.
“Our findings confirm that gay men who engage in group sex are at a high risk of transmission and infection with HIV and other STIs and that consideration of potential risks figure highly in their decisions about testing”, write the investigators. They add, “one possible factor for improving the quality of this testing is the relationship between such men and their doctors. Promoting an open, non-judgemental and trusting relationship with doctors with whom they can feel safe discussing all aspects of their sexual behaviour may lead to improved testing decisions.”
Prestage GP et al. Testing for HIV and sexually transmissible infections within a mainly online sample of gay men who engage in group sex. Sex Transm Infect 85: 70-74, 2009.