Abstract

Introduction: Universal condom use in casual sex is unlikely. We explored whether gay men lower the risk of HIV transmission during unprotected anal intercourse with casual partners (UAIC) by disclosing HIV serostatus and engaging in lower risk practices such as strategic positioning and/or withdrawal.

Methods: We used data from the annual cross-sectional Sydney Gay Community Periodic Survey. A short self-administered questionnaire collects information about HIV serostatus of the respondents, sexual practices with other men and other HIV-relevant behaviours. We present the prevalence of and time trends in disclosure of serostatus and the use of strategic positioning and withdrawal with casual partners.

Results: In 2006, 2568 men reported having had a casual partner in the 6 months before the survey. Disclosure was higher among men engaging in UAIC (68.4%) compared to those who always used condoms (49.7%). This relationship was more apparent amongst HIV-positive than negative men, of whom 83.5% and 63.9%, respectively, reported any disclosure. Over time, HIV-positive and negative men have increasingly reported disclosing to 'all' of their casual partners (p < 0.01). HIV-positive men were less likely to report insertive-only positioning during UAIC (8.9%) compared to HIV-negative men (39.2%), with no changes emerging since over time. Significant increases were also noted in the proportion of HIV-positive men reporting withdrawal during insertive-UAIC (p < 0.001) and HIV-negative men reporting withdrawal during receptive-UAIC (p < 0.001).

Conclusion: In the context of UAIC, gay men appear to be employing a range of risk-reduction strategies. Increasing levels of disclosure and/or practices such as strategic positioning and withdrawal demonstrate the complexity of gay men's construction of, and engagement with, risk associated with HIV transmission. A more thorough understanding of these practices is essential for ongoing education and prevention.