We Do not Know Enough About the Behaviors of Men Who Have Sex With Men

We Do not Know Enough About the Behaviors of Men Who Have Sex With Men


BHM Edit Staff

Rates of sexually transmitted infections (STIs), including HIV, are on the rise among men who have sex with men. Too bad sexual health research isn’t following suit.

Data from the Centers for Disease Control and Prevention shows three-quarters of syphilis cases, 22 percent of gonorrhea cases, and two-thirds of HIV diagnoses in the United States 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,” said Cara E. Rice, a postdoctoral fellow at The Methodology Center at Penn State, “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. 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 points out that some men abstain from anal intercourse and engage in other sexual activities because they perceive those practices to be less risky. But the current study, one of the first look at the wide range of sexual behaviors of this population, shows this is not necessarily the case.

To better understand the range of sexual behaviors practiced by men who have sex with men and associations with prevalent HIV and STIs, 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.

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 test 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.

“Public health practitioners need a more nuanced understanding of the behaviors their patients are engaging in,” Rice said. “And patients deserve more robust, evidence-based messages about the associations between specific practices and the prevalence of infections.”

More research is needed in this area, Rice added, 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.