Across Europe, 58% of gay and other men who have sex with
men (MSM) report at least one incident of unprotected anal intercourse in the past
year, according to results from the European MSM Internet
Survey (EMIS) released last month. Whereas 39% of men had had unprotected sex
with a steady partner, 26% had done so with a casual partner.
Younger and less educated men reported higher rates of
unprotected sex with a steady partner whose HIV status was either unknown or
thought to be different from the respondent’s. In relation to casual partners, these factors were not relevant.
The EMIS project involved an internet-based
questionnaire, that was made available in 25 languages across Europe in 2010,
recruiting around 180,000 participants. Because the survey used the same
recruitment methods, questions and definitions of risky behaviour with
respondents across Europe, the data it produces on different countries are
comparable.
In the previous year, 58% of respondents had had sex with a
steady partner (and sometimes more than one). Also, 67% had had sex with a
casual partner – half of them had five or fewer partners in the past year, 19%
had between six and ten, and 30% had more than ten partners.
Among those who had a steady partner:
- 67% had unprotected anal intercourse, at least
once.
- 23% consistently used condoms.
- 10% did not have anal intercourse.
Among those with a casual partner:
- 39% had unprotected anal intercourse, at least
once.
- 44% consistently used condoms.
- 17% did not have anal intercourse.
Expressed as a proportion of the whole sample, 39% of
European MSM had unprotected anal intercourse with a steady partner, and 26% with
a casual partner, in the previous twelve months.
The survey also asked some detailed questions about the most
recent casual partner that men had met. Looking at this measure, rates of
unprotected sex are lower than when considering all partners in the previous
year.
- 19% had unprotected anal intercourse.
- 42% used condoms.
- 39% did not have anal intercourse.
On that occasion, around two-thirds of men did not discuss
their HIV status with this partner. Amongst those who had unprotected sex, 47%
of men with diagnosed HIV and 42% of other men discussed their HIV status.
Returning to the data on unprotected anal intercourse in the
past year, the survey also gathered information on the HIV status of the
respondent and his partners, as some unprotected sex is likely to be between
men who believe they have the same HIV status. However, if the respondent did
not know his own HIV status or that of his partner, of if he knew that his
partner’s HIV status was different, the investigators describe the sex as ‘non-concordant’.
They found that 22% of men with a steady partner had had
non-concordant unprotected anal intercourse, and 25% of those who had had
casual partnerships had done so.
Moreover, they looked at whether certain demographic factors
were associated with increased rates of non-concordant sex, as outlined below.
These differences were statistically significant.
|
Steady partners
|
Casual partners
|
Younger men (25 or less)
|
More likely to report it (AOR 1.53)
|
No association
|
Men with less education
|
More likely to report it (AOR 1.42)
|
No association
|
Men living in larger cities
|
Less likely to report it (AOR 0.76)
|
No association
|
Men with diagnosed HIV
|
No association
|
More likely to report it (AOR 3.03)
|
Country of residence
|
Relevant
|
Relevant
|
In terms of country of residence, the authors say that there
appears to be a west-east divide in rates of risky sex.
The countries with the highest rates of non-concordant
unprotected anal intercourse with a steady partner were Turkey, Bosnia &
Herzegovina, Lithuania, Romania, Slovakia, Latvia, Croatia, Moldova, Ukraine
and Cyprus.
Those living in the following countries were the least likely to report this behaviour with a steady partner – France, Luxembourg,
Switzerland, Belgium, Denmark, the Netherlands, Sweden, Austria, the United
Kingdom and Germany.
In part this reflects high testing rates in these
countries, although there are exceptions – Spain and Portugal have extremely
high testing rates, but rates of risky sex closer to the European average.
And while the data on casual partners are similar in many
ways, there are some intriguing differences. The UK, Sweden and Denmark recorded
relatively high rates of non-concordant unprotected anal intercourse with
casual partners, whereas their scores with steady partners were more
encouraging. While Slovenia and Greece had some of the lowest rates of
non-concordant sex with casual partners, their scores in relation to steady
partners were much closer to the average.