Trends in harm reduction practices among men who have anal intercourse [AI] with casual male partners, Switzerland 2007-2009
S. Lociciro, A. Jeannin, B. Spencer, F. Dubois-Arber
University Hospital Center and University of Lausanne, Institute of Social and Preventive Medicine, Epalinges, Switzerland
Background: This observational study focuses on explicit harm reduction practices – defined as serosorting (SS), strategic positioning (SP) and withdrawal before ejaculation (WBE) – in MSM living in Switzerland who had AI with casual partners without using a condom. The aims were first to study trends between 2007 and 2009 concerning the frequency of harm reduction practices, and secondly the demographic, lifestyle, and health-related factors associated with these practices.
Methods: Cross-sectional surveys conducted as part of the Swiss HIV behavioral surveillance system, using an anonymous self-administered questionnaire in a self-selected sample of MSM (N2007=2953 and N2009=1929). Logistic regression was used to estimate adjusted odds ratios (aOR) of factors associated with SS, SP and WBE.
Results: Except for WBE (47% vs. 35%), the frequency of the different practices remained stable between 2007/2009 (SS: 38% vs. 39%; SP: 25% vs. 26%).WBE was significantly higher in respondents more than 35 years old (aOR2009=3.54).In 2007 and 2009, SS was less frequently used by respondents who regularly frequent sex-on-premises venues (aOR2007=0.39; aOR2009=0.23) and who had AI with partners of different or unknown HIV status (aOR2007=0.14; aOR2009=0.18). Frequent use of Internet for sexual encounters (aOR2007=2.32) and having had an HIV-test in the past 12 months aOR2007=1.81) were associated with SS in 2007, but no longer so in 2009. SP was noticeably less frequently used by those infected by HIV (aOR2007=0.13; aOR2009=0.20). AI with partners of different or unknown HIV status (aOR2007=3.57) was associated with SP in 2007, but no longer in 2009.
Conclusions: Harm reduction practices are prevalent among MSM who reported AI with casual partners. Some significant associations between practices and personal characteristics remained constant (such as HIV-status for SP) but many changed within the period studied. Qualitative studies are needed to further explore these practices and their importance in terms of individual risk management.