Background: Practising unprotected anal intercourse (UAI) with high numbers of partners is associated with increased risk for acquiring and transmitting HIV and other sexually transmitted infections. Our aim was to describe factors associated with UAI with multiple partners in a large sample of MSM from 38 European countries recruited for an online survey in 2010. Methods: Data are from the European Men-Who-Have-Sex-With-Men Internet Survey (EMIS). The analysis was restricted to men who reported any anal sex with a non-steady partner in the past 12 months, and who were either never diagnosed with HIV, or who had been diagnosed with HIV more than 12 months ago, reported a detectable viral load and did not exclusively serosort (n = 91,477). Multivariable logistic regression was used to compare men reporting UAI with four or more (4+) non-steady partners to two comparison groups: a) no UAI with non-steady partners, and b) UAI with 1-3 non-steady partners. Results: Overall, 9.6 % of the study population reported UAI with 4+ partners in the past 12 months. In both models, factors consistently associated with this behaviour were: having been diagnosed with HIV, lower educational levels, use of nitrite inhalants, drugs associated with sex and parties, or erectile dysfunction drugs in the past 4 weeks, using sex-on-site venues in the past 4 weeks, buying or selling sex in the past 12 months, having experienced physical violence due to sexual attraction to men in the past 12 months, reporting sexual happiness, being out to all or almost all of one's acquaintances, and knowing that ART reduces HIV transmissibility. Conclusions: Effective antiretroviral treatment drastically reduces HIV transmission for men diagnosed with HIV, irrespective of partner numbers. Apart from reducing partner numbers or increasing condom use no other recommendations are currently in place to reduce the risk of HIV acquisition and onward transmission for HIV-negative men practicing UAI with multiple partners. A range of factors were identified as associated with UAI with four or more partners which allow the strengthening and targeting of prevention strategies to reduce HIV transmission risks resulting from condomless anal intercourse with multiple partners.
Bibliographical noteFunding Information:
We begin by thanking all of the men who took part in EMIS 2010. We also thank the more than 235 websites who placed the EMIS banner, and particularly to those who sent individual messages to their users: PlanetRomeo, Manhunt, Qruiser, Qguys and Gaydar. We also thank all NGOs who promoted the survey. This research was made possible by The EMIS Network. EMIS associated partners: D.E.: GTZ, Robert Koch Institute; E.S.: Centre de Estudis Epidemiolo`gics sobre les ITS i SIDA de Catalunya (CEEISCat); I.T.: Regional Centre for Health Promotion Veneto; N.L.: University College Maastricht; UK: Sigma Research, London School of Hygiene & Tropical Medicine. EMIS Collaborating Partners: A.T.: Aids-Hilfe Wien; BE: Institute of Tropical Medicine, Facult?s Universitaires Saint-Louis, Ex Aequo, Sensoa, Arc-en-ciel Wallonie; B.G.: National Centre of Infectious and Parasitic Diseases, Queer Bulgaria Foundation; B.Y.: Vstrecha; C.H.: Institut universitaire de medicine sociale et preventive, Aids-Hilfe Schweiz; C.Y.: Research Unit in Behaviour & Social Issues; C.Z.: Charles University (Institute of Sexology), Ceska spolecnost AIDS pomoc; D.E.: Berlin Social Science Research Center (WZB), Deutsche AIDS-Hilfe; Federal Centre for Health Education (BZgA); D.K.: Statens Serum Institut, Department of Epidemiology, STOP AIDS; ES: National Centre of Epidemiology, stopsida, Ministry of Health, Social Policy and Equality; E.E.: National Institute for Health Development; FI: University of Tampere (Nursing Science), HIVsaatio/Aidstukikeskus; FR: Institut de veille sanitaire (InVS), AIDeS, Act Up Paris, Sida Info Service, Le Kiosque, The Warning; G.R.: Positive Voice; H.R.: University of Zagreb (Humanities and Social Sciences); H.U.: Hungarian Civil Liberties Union (TASZ), H?tt?r; I.E.: Gay Men?s Health Service, Health Services Executive; I.T. University of Bologna, Arcigay, Instituto Superiore di Sanit?; L.T.: Center for Communicable Diseases and AIDS; L.V.: The Infectiology Center of Latvia; Mozaika; M.D.: GenderDoc-M; M.K.: Equality for Gays and Lesbians (EGAL); N.L.: schorer; N.O.: Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health; P.L.: National AIDS Centre, Lambda Warszawa; P.T.: GAT Portugal, University of Porto (Medical School), Institute of Hygiene and Tropical Medicine; R.O.: PSI Romania RS: Safe Pulse of Youth; RU: PSI Russia, LaSky; SE: Malm? University, Riksforbundet for homosexuellas, bisexuellas och transpersoners rattigheter (RFSL); S.I.: National Institute of Public Health, Legebitra, ?KUC-Magnus, DIH; S.K.: OZ Odyseus; T.R.: Turkish Public Health Association, KAOS-GL, Istanbul LGBTT, Siyah Pembe Ucgen Izmir; U.A.: Gay Alliance, Nash Mir, LiGA Nikolaev; UK: City University, London, CHAPS (Terrence Higgins Trust); E.U.: ILGA-Europe,AidsAction Europe, European AIDS Treatment Group, PlanetRomeo, Manhunt & Manhunt Cares. EMIS Advisory Partners: Executive Agency for Health and Consumers (EAHC), European Centre for Disease Prevention and Control (ECDC),WHO-Europe. EMIS was funded by grants from the Executive Agency for Health and Consumers (EU Health Programme 2008?2013); Centre d''Estudis Epidemiol?gics sobre les ITS HIV/SIDA de Catalunya (CEEISCat); Terrence Higgins Trust for the CHAPS partnership; Regione de Veneto; Robert Koch Institute; Maastricht University; German Ministry of Health; Finnish Ministry of Health; Norwegian Institute of Public Health; and the Swedish Board of Health and Welfare. S.C.K. was supported by a Fulbright grant from the German-American Fulbright Commission. Finally, we would like to thank Matthias an der Heiden for advice regarding the statistical analysis.
© 2016 Kramer et al.
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