Age at First Anal Sex and HIV/STI Vulnerability Among Gay Men in Australia

The authors introduced their report by stating that gay men continue to experience "a disproportionate burden of HIV." The researchers set out to determine whether there is a link between age at first anal intercourse (AFAI) and gay men's vulnerability to HIV and STIs, as well as tendencies to participate in higher-risk sexual behavior.

A nationwide, cross-sectional online survey polled 845 Australian gay men born between 1944 and 1993. A total of 822 men reported having had anal intercourse. The median AFAI ranged from 35 years for men born between 1944 and 1953 to 18 years for men born between 1984 and 1993. Among those who had experienced anal sex, the results showed HIV-positive men were on average "significantly younger" at first anal intercourse (18.5 years) compared to HIV-negative men (21.3 years) (p<0.001). In addition, men with a history of other STIs also were "significantly younger."

The authors highlighted the association between AFAI and recent higher-risk sexual behavior. AFAI was generally lower among men who reported more than 10 sex partners in the past year (P<0.001), participated in group sex (p<0.001), had receptive anal intercourse (p=0.008), or were under the influence of drugs or alcohol during their most recent sexual encounter (p=0.06).

The team concluded that the survey revealed "strong links between [AFAI] and future sexual health and behavior." Among participants, "those who became HIV-positive, engaged in higher risk sexual behavior and reported other poorer sexual health outcomes tended to have had their first anal intercourse at a younger age than other men."

Given that the median age of sexual debut continues to decline, "clinicians and other health service providers, as well as researchers, need to pay particular attention to gay men's earliest sexual experiences," the authors wrote. "In particular, men who report having anal intercourse at a young age are likely to be at heightened HIV vulnerability and therefore require additional education and support for ensuring a healthier sex life. Further education around safer sex practices that specifically targets gay-identified youth may also be required to ensure their sexual debut does not lead to poorer sexual health outcomes."

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