Correlates of Unprotected Anal Sex at Last Sexual Episode: Analysis from a Surveillance Study of Men who have Sex with Men in Montreal

Abstract

Recent increases in rates of unprotected anal sex (UAS) among men who have sex with men (MSM) signal the need to continually refine our understanding of factors associated with risky sexual behavior. Data were collected using a questionnaire eliciting information about the last sexual episode (LSE) with another man in the past 6 months. Logistic regression was used to identify both event-level and background correlates of UAS at LSE. 965 participants who reported having sex with a partner with whom they were not in a couple relationship at LSE were studied. Several event-level variables were significantly associated with UAS after adjusting for background factors, including finding the partner at LSE sexually attractive and using alcohol or cocaine at LSE. Our findings parallel the results of other HIV prevention studies which have highlighted the importance of interpersonal factors that influence risk-taking at the moment of a sexual act among MSM.

A Review of the Literature on Event-Level Substance Use and Sexual Risk Behavior Among Men Who Have Sex with Men

“…Drumright and colleagues conducted a systematic review of substances limited to specific ''club drugs'' [23]. Since that 2006 review, a considerable number of event-level studies [10,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] have been published on a full range of MSM substance use. Another systematic review [24] focused on MSM over 50 years of age, and only two event-level studies were included.…”

Pervasive Heavy Alcohol Use and Correlates of Increasing Levels of Binge Drinking among Men Who Have Sex with Men, San Francisco, 2011

“…3,17 These event-level assessments of alcohol use provide the most precise temporal link between these two behaviors and provide stronger evidence for causality. 2,17 Binge drinking and other patterns of heavy alcohol use are independently associated with a variety of high-risk behaviors in MSM, including unprotected anal sex, multiple partners, and having HIV-serodiscordant partners, [18][19][20][21][22][23][24][25][26][27][28] a link also observed among Black, Native American, and older MSM. [29][30][31] Binge drinking and heavy alcohol consumption are major causes of incident HIV infections in MSM.…”

A systematic review of HIV testing among Canadian populations

“…1 Not surprisingly, several studies were conducted that described the testing patterns within gay, bisexual, and other MSM. [13][14][15][16]18 Among MSM in Canada, the high rates of ever having been tested (83%) are comparable to the rates in other resource-rich countries. For both the United States and Australia, the percentage of MSM ever tested was 90% and for Scotland, 80%.…”

“…There were five studies of MSM that included numerator and denominator information on the proportion who had "ever tested"; this yielded a pooled prevalence of 83.0% (95% CI 79.0-87.5). [13][14][15][16][17][18] In a sensitivity analysis, the proportion who had ever tested differed by 1% when studies with small sample sizes (<250) were excluded from the analysis.…”

“…18 With regards to recent testing, 63.1%-75.2% of total participants were tested in the previous two years and approximately 58.0%-59.3% were tested in the previous year (Table 3). [13][14][15][16][17] …”