Rates of sexually transmitted infections, including HIV, are rising among men who have sex with men. Sexual health research, however, is lacking.
According to data from the US Centers for Disease Control and Prevention, three-quarters of syphilis cases, 22 percent of gonorrhea cases, and two-thirds of HIV diagnoses in the US occur in men who have sex with men.
A recent study identifies multiple sexual behaviors significantly associated with prevalent sexually transmitted infections, including HIV.
“People participate in a wide range of sexual behaviors—however, public health research has mainly focused almost exclusively on anal intercourse as the singular sexual behavior of interest among men who have sex with men,” says Cara E. Rice, a postdoctoral fellow at The Methodology Center at Penn State.
“Standard prevention messages are largely about avoiding risky anal sex. Yet many men engage in other sexual practices, and the associations between those practices and sexually transmitted infections have not been comprehensively characterized.”
Rice notes that some men, for example, abstain from anal intercourse and engage in other sexual activities because they perceive those practices to be less risky. However, the current study shows that this is not necessarily the case.
At the clinic
In order to increase understanding of the range of sexual behaviors practiced by men who have sex with men and associations with prevalent HIV and STI, Rice and colleagues surveyed 235 men who went to a sexually transmitted disease clinic for care and reported having sex with another man in the past year. The researchers report their results in the Journal of Sexual Medicine.
In the sample, 35 percent of the participants tested positive for an STI on the day of the study, and 17 percent had HIV. Men who participated in anal stimulation with a fist or hand in the last three months were nearly five times as likely to be positive for HIV as those who did not report these behaviors. Those who reported enema use had nearly four times the prevalence of HIV as those who did not report recent enema use.
Those who reported fisting, enema use, or use of penetrative sex toys were significantly more likely to have chlamydia, gonorrhea, or syphilis at the time of the study than those who did not report those practices.
Better research, better messages
“Public health practitioners need a more nuanced understanding of the behaviors their patients are engaging in,” says Rice. “And patients deserve more robust, evidence-based messages about the associations between specific practices and the prevalence of infections.”
As far as the researchers are aware, this is one of the first studies to take a comprehensive look at a wide range of sexual behaviors practiced by men who have sex with men and the associations between these behaviors and the prevalence of HIV and STI.
Rice points out that much more research is needed in this area, including further analysis of sexual behavior and STI and HIV occurrence that also looks at drug use, number of sexual partners, and context of and intent behind specific behaviors. Prospective studies are also needed to definitively link behaviors and risk of HIV and STI.
Additional researchers from Penn State, Ohio State University, and Columbus Public Health contributed to the study. The Ohio State University Center for Clinical and Translational Science and the National Institute on Drug Abuse supported this work.
Source: Penn State