Auto-evaluation of HIV transmission risk according to various sexual practices in a sample of MSM in Toulouse, France: evidence of spontaneous risk reduction strategies
Background: This research aims to determine how MSM evaluate HIV transmission risk and if they implement spontaneous risk reduction strategies.
Methods: Anonymous questionnaires, including an HIV transmission risk scale according to 29 sexual practices, have been proposed to 621 MSM in a cruising area and a gay sex club during summer 2005.
Results: In total, 420 completed questionnaires have been collected (68%). Median age is 36 years (19-72). These men identify as gay (76%) or bisexual (19%), and declare themselves single (60%) or in couple (28%). Some associate drug use with sexual activity: alcohol (37%), poppers (21%), cannabis (13%).
Most common practices such as anal or oral sex (AOS) are almost systematically rated; less common practices (eg. fist or urophilia) receive high ignorance rates (up to 30%). Respondents are generally coherent in their evaluation of risks: those who evaluate unprotected anal intercourse (UAI) with a maximum risk are also more cautious in their evaluation of other practices.
The analysis reveals two underlying logics of risk evaluation: one based on individual risk and one based on statistical risk. Each respondent applies either one according to each proposed practice. At a sample level, individual risk logic applies mainly to UAI and unprotected oral sex (UOS) with ejaculation, while statistical risk logic applies mainly to UOS without ejaculation. Some factors such as semen contact or encounters with multiple partners are associated with higher risk evaluation of unprotected AOS and some other factors such as positioning are not. In this sample, only alcohol or nitrite use are associated with lower risk evaluation of unprotected AOS.
Conclusions: In France, sexual risk strategies are not officially implemented through existing preventive information campaigns. Nonetheless, some procedures proposed as risk reduction messages are already part of risk evaluation process of unprotected sexual practices, but some other are not.
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