Group Sex Events Among Cisgender Men Who Have Sex With Men: Cross-Sectional and Longitudinal Survey Study to Explore Participation and Risk-Taking Behaviors

Abstract

BackgroundGroup sex events (GSEs) are common among cisgender men who have sex with men (MSM), pose a unique risk profile for HIV and sexually transmitted disease (STD) transmission, and may be on the rise, in part because of Web-based networking platforms. However, collecting data on GSEs can be challenging, and many gaps exist in our knowledge about GSE participation among MSM.ObjectiveThe objective of this study was to develop survey questions addressing aggregate and partner-specific group sex behaviors to measure prevalence of GSEs and associated risks in persons participating in Project Diagnostic Evaluation To Expand Critical Testing Technologies (DETECT), including MSM seeking HIV and STD testing at a public clinic in Seattle, Washington.MethodsWe developed a computer self-assisted survey that included questions about participant demographics, sexual history, and risk behaviors, including group sex, as a part of Project DETECT, a Centers for Disease Control and Prevention–funded study evaluating point-of-care HIV tests. Aggregate and partner-specific questions asked about participation in all GSEs, threesomes, and four-or-more-somes including questions about number and HIV status of sex partners and condom use during the events. To evaluate question performance, we assessed the discrepancies in reporting between the aggregate and partner-specific questions, quantified question refusal rates, and calculated the additional time required to answer the GSE questions. Information about network density (number of partnerships of overlapping duration) was estimated and compared for MSM who did and did not report GSEs.ResultsAmong 841 visits by 690 MSM who were asked any group sex survey question, participation in a GSE of any type in the past 3 months was reported at 293 visits (293/841, 34.8%). We found that 9.0% (76/841) of MSM in the sample reported ≥1 four-or-more-some in the partner-specific questions but did not report in the aggregate. The proportion of refusals on any given aggregate GSE-related question ranged from 0% (0/273) to 10.6% (15/141) (median 2.6%) and partner-specific questions ranged from 0% (0/143) to 22% (5/23) (median 3.0%), with questions about four-or-more-somes having the highest proportions of refusals. Completing the aggregate group sex questions added 1 to 2 minutes and the partner-specific questions added an additional 2 to 4 minutes per partner to the total survey length. As expected, the partner-specific GSE questions documented higher density of sexual networks that was not captured by asking about total partner counts and overlap of specific partnerships.ConclusionsWe found that the Project DETECT survey was able to obtain nuanced information about GSEs. The question skip patterns and consistency checks were effective, and survey fatigue was minimal. More research is needed on GSEs, and our survey represents a promising data collection tool to help fill gaps in knowledge about the subject.

Sexual Activities and Changes in Condom Use in Group Sex Events Among Female Sex Workers in Melbourne, Australia

“…Group sex, a sex event that involves more than two participants, has been considered a high-risk activity for the acquisition of HIV and other sexually transmitted infections (STIs) due to a greater number of partners affected by condomless sex ( 1 ). Previous studies have estimated about 27.2–34.8% of gay, bisexual and other men who have sex with men (MSM) had participated in at least one group sex event in the past 3 months ( 2 , 3 ). An exploratory study by Turek et al ( 4 ) reported 49% of 51 female sex workers (FSWs) had participated in at least one group sex event in the past 3 months.…”

“…There are few studies investigating group sex among FSWs. While most group sex studies have focused on MSM, other at-risk populations such as heterosexuals and FSWs have been understudied ( 2 , 3 ). Additionally, previous studies have predominantly examined the association between group sex participation and HIV/STI acquisition with few data on the details of sexual activities during the group sex event such as the size of the group sex event (i.e., the number of participants) and the sexual activities involved during group sex.…”

Sexual activities and condom use among heterosexual men and women engaged in mixed-gender group sex events in Melbourne, Australia

“…Most studies investigating group sex focus on MSM, where the proportion of engaging in group sex within the past 3 months is estimated to be 27-35%. 4,5 However, there have been very limited group sex studies among other at-risk populations, such as heterosexuals. [4][5][6] A cross-sectional survey by Constantinou et al (2021) reported that 5% of 698 heterosexual men and women in Melbourne had participated in at least one group sex event within the past 3 months and found that heterosexuals who participated in group sex were over six times more likely to test positive for chlamydia, gonorrhoea or syphilis.…”

“…4,5 However, there have been very limited group sex studies among other at-risk populations, such as heterosexuals. [4][5][6] A cross-sectional survey by Constantinou et al (2021) reported that 5% of 698 heterosexual men and women in Melbourne had participated in at least one group sex event within the past 3 months and found that heterosexuals who participated in group sex were over six times more likely to test positive for chlamydia, gonorrhoea or syphilis. 6 Furthermore, previous studies investigating mixed-gender group sex events have not studied the number of people involved in each group sex event, the sexual activities involved in group sex events and the practice of changing condoms between partners during group sex in details.…”

“…6 Furthermore, previous studies investigating mixed-gender group sex events have not studied the number of people involved in each group sex event, the sexual activities involved in group sex events and the practice of changing condoms between partners during group sex in details. 4,5 Most studies report condom use in group sex as a binary variable (yes/no) and it is unclear whether participants change condoms for each partner. 4,7 To our knowledge, there has been only one study investigating whether MSM have changed condoms between partners during group sex 4 and there are no quantitative studies among the heterosexual population.…”