Study Links Group Sex to Increased HIV Risk

Researchers in Australia studying sexuality and HIV transmission risk have coined the term "sexual adventurism." Activities such as engaging in group sex, having a high number of sex partners and attending sex saunas are all considered "aspects of sexual adventurism."

These Australian researchers have been monitoring the health of HIV negative gay men to find clues as to what beliefs and behaviours may have placed some of these men at high risk for HIV infection. Their preliminary data suggested that men who engaged in group sex were significantly more likely to have unprotected intercourse. Past research has found that some men who engaged in group sex devalued the possibility of HIV risk in favour of an "emphasis on sexual pleasure and excitement."

Because there has been relatively little research on gay men, group sex and HIV risk, and based on their preliminary research, Australian researchers undertook a large survey of more than 700 men who engaged in group sex. Subsequently, 16 of the men were extensively interviewed about their sex lives. The researchers found that a substantial proportion of men who engaged in group sex had unprotected anal intercourse. Clues as to why this behaviour might have happened appear later in this CATIE News report.

Study Details

The research team performed its survey in 2007 and 2008 and later analysed data from 746 men who completed the surveys in a variety of ways -- via the Internet, in person privately, at organized sex parties or saunas. Their average profile was as follows:

• age -- 40 years (ranging from 17 to 72 years)
• 58% had completed some university education
• 84% self-identified as gay
• 90% indicated that they had been tested for HIV and 71% of these people reported that they were HIV negative

Results

About 60% of the men in this study disclosed that they had participated in group sex within the past month. According to the researchers, 33% of the men revealed that they "usually engaged in group sex at least monthly."

What Constitutes Group Sex?

About 33% of the men indicated that for them group sex involved only two other men. Astonishingly, nearly 30% of men said that for them "group sex involved more than five other men."

Most of the men in this survey, about 80%, reported that they engaged in anal intercourse. In about one-third of such encounters, condoms were not used.

According to the researchers, some men only had unprotected anal intercourse with casual partners "they believed to be of the same HIV status as themselves."

Serodiscordance

The researchers found that "few HIV negative men engaged in unprotected anal intercourse with any HIV positive partners." However, there were also these findings:

• Among 144 HIV positive men, 24% disclosed that they had been the insertive partner during unprotected anal intercourse with a partner who was not HIV positive.
• Among 526 HIV negative men, 9% reported being anally penetrated without a condom by a man who they did not know to be HIV negative.

Influencing Risk

The research team stated that there were factors that helped to facilitate unprotected anal intercourse among men in this study, as follows:

• not having a clear intention to use condoms
• not being HIV negative -- that is, being HIV positive or not knowing one's infection status
• having at least five men at a group sex session
• engaging in group sex at least every month

Flawed Assumptions and Dangerous Consequences

Another finding from this study revealed that men who did not know their own HIV status were somewhat more likely to report unprotected anal sex with partners they believed to be HIV negative. The study authors suggest that the conclusions men made about their sex partner's HIV status were based on "assumption" -- perhaps their appearance or other features.

Pleasure and Danger

The Australian team notes that most of the men surveyed appeared to be "well informed about HIV transmission." Indeed, they add that these men are not "engaging in risk behaviour due to a lack of safer-sex information." Rather, the sexual behaviour of these men appears to be directly organized around their desire and pleasures rather than prioritizing HIV risk reduction. This may be due to misunderstandings and misperceptions of the risk and danger of basing decisions about a sex partner's HIV status on his appearance.

Sexual culture among gay men in Australia is probably similar to that of gay men in Canada and other high-income countries. Certainly, the Australian data underscore the need to reach gay men who engage in group sex if only because the large number of men they have sex with heightens the potential for the spread of HIV and other sexually transmitted infections.

The Australian analysis, suggesting that some men organize their sexual behaviour by prioritizing desire and pleasure over HIV risk reduction, may stimulate research teams in other countries to investigate this issue. In doing so, a better understanding of the motivation for and the context of risk behaviours may emerge. Such an understanding can help guide and enhance HIV prevention programs.

Reference

1. Prestage GP, Hudson J, Down I, et al. Gay men who engage in group sex are at increased risk of HIV infection and onward transmission. AIDS and Behavior. 2009 Aug;13(4):724-30.