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Gay, bisexual and other men who have sex with men (GBM) are at greatest risk of HIV infection in New Zealand, accounting for 2,329 HIV diagnoses from 1985 to the end of 2014,1 and roughly 80% of the locally transmitted HIV epidemic.2 Almost all HIV transmission between GBM occurs through anal intercourse without a condom, hence health promotion efforts have sought to maximise and sustain condom use in this population.3 Trends in condom uptake among GBM in New Zealand have largely been high and stable,4,5 however in 2011 this dropped slightly among casual partners, and in 2014 the highest ever annual number of locally acquired HIV infections among GBM was diagnosed.1Public health consequently needs a better understanding of current patterns in non-condom use. Although the fraction of HIV infection events attributable to casual as opposed to regular sexual partnering is unknown, GBM having casual sex are likely to change partners more frequently than those with regular partners, increasing the probability of encountering a sexual partner with undiagnosed HIV in the highly infectious early acute phase of infection. Individuals are also less likely to be aware of their casual partners sexual and HIV testing histories. Identifying predictors of unprotected casual anal intercourse therefore helps HIV prevention agencies, such as the New Zealand AIDS Foundation, target and place condom social marketing.Previous New Zealand research in 1996 found that GBM on lower incomes, who were not gay-community affiliated, or who had fewer sexual partners were more likely to never use condoms with casual partners.6 An analysis of our own behavioural surveillance data among younger GBM aged under 30 between 2006-2011 found that condom use was lower among Pacific GBM and those with less education. Alternatively, condom use was higher among GBM recruited from community venues, who had tested HIV-negative, had a modest number of recent sexual partners, did not have sex with women, or who used condoms with any regular male partners.7The aim of this study was to investigate factors predicting recent non-condom use with casual sex partners using a large and diverse sample of GBM recruited from community and Internet settings in 2014.MethodsData collectionWe analysed data collected from the 2014 round of the Gay Auckland Periodic Sex Survey (GAPSS) and Gay Online Sex Survey (GOSS), an established behavioural surveillance system consistent with WHO/UNAIDS Guidelines.8 GAPSS participants were recruited in Auckland by trained recruitment staff during one week in February, 2014, from a gay community fair day and subsequently at all gay bars (four) and sex-on-site venues (five) in that city. Eligibility criteria were being male, aged at least 16 years, having had sex with a man in the past five years, and had not already participated in GAPSS or GOSS that year. Questionnaires were voluntary, anonymous and self-completed on site. Secure return boxes ensured privacy. Following GAPSS, the same questionnaire was used for the Internet-based nationwide GOSS over the next month that accessed participants through banners on New Zealand Internet dating sites and apps. These included NZDating.com, Manhunt, Grindr, JackD, Hornet and Growlr. Detailed methods are provided elsewhere.9 Ethics approval was received from the University of Auckland Human Participant Ethics Committee (#010738) and surveys were funded by the Ministry of Health.QuestionnaireParticipants were asked the number, type (casual or regular) and nature of current regular relationships ( Boyfriend/long-term lover/life partner/civil union partner/husband , hereafter BF ; or fuckbuddy/friend I have sex with , hereafter FB ) in the previous six months. Casual partners were defined as men they had had sex with no more than three times over this period, and regular partners men they had sex with four or more times. If participants had engaged in anal intercourse with a casual and/or a current regular partner they were asked the sexual position (receptive, insertive), and for each position the frequency of condom use on a five point scale (always, almost always, about half the time, very rarely, never). The questionnaire contained socio-demographic items and items about sexual partnering, HIV and STI testing, frequency of exposure to condom social marketing, and attitudes to HIV, condoms and safe sex.AnalysisThe main outcome was infrequent condom use ( never , very rarely or half the time ) for any anal intercourse role; frequent use being at least almost always or always used a condom. The denominator is respondents reporting at least one episode of anal intercourse with a casual partner in the previous six months. Chi-squared tests explored the association of condom use with demographic characteristics, sexual partnering, health screening, social marketing exposure and attitudes. This informed the multivariate logistic regression models of factors independently associated with infrequent condom use. Due to potential collinearity between safe sex attitudes and social marketing on condom use, we developed three models: (1) containing attitudes and socio-demographic variables; (2) containing social marketing and socio-demographic variables; (3) containing both attitudes and social marketing variables. Statistical analyses and data management were carried out using Stata v.12.1 on non-missing data.ResultsThe 2014 surveys attracted 3,141 respondents, of whom 1,912 had engaged in anal intercourse with a casual partner in the previous six months and reported on their condom use. Of these, just under three-quarters (72.8%) reported frequent condom use, and just over a quarter (27.2%) infrequent condom use. The latter equated to 16.7% of all GAPSS/GOSS respondents.In univariate analyses, infrequent condom use varied significantly by recruitment site, ethnicity and education status (Table 1), condom use at first intercourse, HIV testing and STI history (Table 2), condom social marketing exposure (Table 3) and attitudes to HIV, condoms and safe sex (Table 4).Table 1: Infrequent condom use by socio-demographic characteristics Socio-demographic characteristics Number Reported infrequent condom use (n,%) X2 p-value Total 1,912 518 27.2 Recruitment site Offline: community event 485 106 21.9 * Offline: bars 51 6 11.8 Offline: sex-on-site venue 125 13 10.4 Online dating site 1,244 393 31.6 Age group 16-29 819 227 27.7 Ns 30-44 553 141 25.5 45+ 488 139 28.5 Ethnicity European 1,370 371 27.1 * Mori 173 66 38.2 Pacific 56 21 37.5 Asian 198 40 20.2 Other 72 11 15.3 Highest education qualification Less than tertiary degree 998 332 33.3 * Tertiary degree or higher 863 175 20.3 Free time spent with other gay men None 76 18 23.7 Ns A little 655 178 27.2 Some 590 154 26.1 A lot 510 143 28.0 Sexual identity Gay or homosexual 1,535 432 28.1 Ns Bisexual or other 365 83 22.7 * p<0.001. Ns=not statistically significantTable 2: Infrequent condom use by behaviours and HIV screening Behaviours and screening Number Reported infrequent condom use (n,%) X2 p-value Condom used at first anal intercourse with a male No 730 277 38.0 * Yes 1,132 232 20.5 Number of male sexual partners in last 6 months One 146 41 28.1 Ns 2-5 795 204 25.7 6-10 436 112 25.7 11-20 269 72 26.8 21-50 188 64 34.0 >50 52 20 38.5 Partnering and protective behaviours in last 6 months Casual only or no current regular partner 986 253 25.7 * Current BF and no anal intercourse with him 61 14 23.0 Current BF and frequent condom use with him 109 5 4.6 Current BF and infrequent condom use with him 238 98 41.2 Current FB and no anal intercourse with him 73 15 20.6 Current FB and frequent condom use with him 226 6 2.7 Current FB and infrequent condom use with him 171 116 67.8 HIV testing history Last tested HIV-negative 1,329 334 25.1 * Diagnosed HIV-positive 108 51 47.2 Untested or no result 412 122 29.6 STI diagnosed in last 12 months No 1,539 384 25.0 * Yes 290 108 37.2 * p<0.001. Ns=not statistically significant. BF=boyfriend-type regular partner. FB=friend with benefit-type regular partnerTable 3: Infrequent condom use by condom social marketing exposure Condom social marketing exposure Number Reported infrequent condom use (n,%) X2 p-value Frequency of seeing condom promotion in last 12 months Very frequently 829 187 22.6 * Often 515 139 27.0 Occasionally 333 107 32.1 Rarely 165 60 36.4 Never 39 18 46.2 Number of places recalled seen condoms promoted in last 12 months\u2020 None 89 40 44.9 * 1 466 152 32.6 2 260 73 28.1 3 325 76 23.4 4 267 69 25.8 5 287 52 18.1 6 178 45 25.3 * p<0.001. \u2020 Options included promos at gay events , billboards or bus-stop adverts , condom packs , promos online or on a mobile app , posters , material at saunas or cruise clubs . Table 4: Infrequent condom use by attitudes to condoms, HIV and safe sex Attitude Number Reported infrequent condom use (n,%) X2 p-value HIV/AIDS is a less serious threat than it used to be because of new treatments Agree/strongly agree 632 217 34.3 \u2020 Disagree/strongly disagree 1,244 291 23.4 Condoms are OK as part of sex Agree/strongly agree 1,796 449 25.0 \u2020 Disagree/strongly disagree 86 63 73.3 If he doesnt want to use condoms I wont bother using them Agree/strongly agree 404 270 66.8 \u2020 Disagree/strongly disagree 1,470 238 16.2 We all have a shared responsibility to protect other gay and bisexual men by using condoms for anal sex Agree/strongly agree 1,766 434 24.6 \u2020 Disagree/strongly disagree 105 73 69.5 I dont like wearing condoms because they reduce sensitivity Agree/strongly agree 793 345 43.5 \u2020 Disagree/strongly disagree 1,070 165 15.4 Its no-one elses business whether or not I use condoms Agree/strongly agree 602 270 44.9 \u2020 Disagree/strongly disagree 1,257 240 19.1 I would sometimes rather risk HIV transmission than use a condom during anal sex Agree/strongly agree 241 148 61.4 \u2020 Disagree/strongly disagree 1,612 360 22.3 The sex I have is always as safe as I want it to be Agree/strongly agree 1,594 375 23.5 \u2020 Disagree/strongly disagree 262 130 49.6 I would never be willing to use condoms for anal sex Agree/strongly agree 111 62 55.9 \u2020 Disagree/strongly disagree 1,743 445 25.5 A man who knows he has HIV would tell me he was positive before we had sex Agree/strongly agree 757 227 30.0 * Disagree/strongly disagree 1,092 281 25.7 *P<0.05. \u2020 p<0.001.Three separate models were then developed to investigate the relationship between condom social marketing exposure, attitudes to condoms, and other potential independent predictors. In the first model, six attitude items remained associated with infrequent condom use after controlling for respondent socio-demographic characteristics (Table 5; two were omitted as they obviously indicated non-condom use: I would never be willing to use condoms for anal sex and I would sometimes rather risk HIV transmission than use a condom during anal sex ). The most strongly predictive was agreement that if he doesnt want to use condoms I wont bother using them (AOR 6.8, 95%CI 5.0-9.1).Table 5: Attitudes independently associated with infrequent condom use with casual partners*\u2020c Attitude Adjusted odds ratio (95% CI) p-value for variable Condoms are OK as part of sex Agree/strongly agree (ref) 1 Disagree/strongly disagree 3.7 (2.0-7.0) <0.001 If he doesnt want to use condoms I wont bother using them Agree/strongly agree 6.8 (5.0-9.1) <0.001 Disagree/strongly disagree (ref) 1 We all have a shared responsibility to protect other gay and bisexual men by using condoms for anal sex Agree/strongly agree (ref) 1 Disagree/strongly disagree 4.2 (2.3-7.7) <0.001 I dont like wearing condoms because they reduce sensitivity Agree/strongly agree 2.6 (2.0-3.4) <0.001 Disagree/strongly disagree (ref) 1 Its no-one elses business whether or not I use condoms Agree/strongly agree 2.0 (1.5-2.7) <0.001 Disagree/strongly disagree (ref) 1 The sex I have is always as safe as I want it to be Agree/strongly agree (ref) 1 Disagree/strongly disagree 3.4 (2.4-4.8) <0.001 * Two attitude statements were omitted from the model because they would obviously be correlated to condom use, including I would never be willing to use condoms for anal sex and I would sometimes rather risk HIV transmission than use a condom during anal sex .\u2020 Socio-demographic variables included in the model were recruitment site, age group, ethnic group, education and sexual identity. In the second model, twelve non-attitude variables were entered into a multivariate logistic regression, including socio-demographic (recruitment site, age group, ethnicity, education, sexual identity), behavioural (condom use at first anal intercourse, number of partners, recent partnering history, anal intercourse modality), condom social marketing exposure (frequency recalling condom social marketing, number of different condom social marketing avenues recalled) and HIV testing variables. The model found infrequent condom use with a casual partner was independently predicted by being recruited from Internet dating sites, being of Pacific ethnicity, having 20 or more male sexual partners in the last six months, using condoms infrequently with a current BF or FB, or being diag

Summary

Abstract

Aim

To identify predictors of non-condom use among gay and bisexual men (GBM) in New Zealand with casual male partners.

Method

We analysed anonymous self-completed data from GBM who participated in the community-based Gay Auckland Periodic Sex Survey (GAPSS) and Internet-based Gay Online Sex Survey (GOSS), undertaken in 2014. Infrequent condom use was defined as not using condoms always or almost always during anal intercourse in the prior six months.

Results

Of the 1,912 GBM reporting anal intercourse with a casual partner, 27.2% reported infrequent condom use. Being recruited from Internet dating sites, Pacific ethnicity, having over 20 recent male partners, infrequent condom use with a current regular partner, or being HIV-positive were independently predictive of infrequent condom use. Conversely, being older, having a tertiary degree, using a condom at first anal intercourse, being exclusively receptive with a casual partner/s, and seeing condoms promoted through multiple channels predicted frequent condom use. Attitudes to condoms and safe sex were strongly predictive of actual condom use.

Conclusion

Social marketing should target the modifiable predictors of condom use, such as attitudes to safe sex. Interventions also need to engage successfully with GBM reporting non-modifiable traits such as HIV-positive GBM.

Author Information

Peter J W Saxton, Director, Gay Mens Sexual Health research group, Department of Social and Community Health, University of Auckland, Auckland; Nigel P Dickson, Director, AIDS Epidemiology Group, Department of Preventive and Social Medicine, University of Otago, Dunedin; Anthony J Hughes, Scientific Director, New Zealand AIDS Foundation, Auckland; Adrian H Ludlam, Research Assistant, Gay Mens Sexual Health research group, Department of Social and Community Health, University of Auckland, Auckland.

Acknowledgements

We would like to thank all participants, community venues and websites involved in the study. The GAPSS and GOSS projects are a collaboration between the Gay Mens Sexual Health research group, the AIDS Epidemiology Group and the New Zealand AIDS Foundation. The Ministry of Health funded the 2014 study and the NZAF Fellowship assisted with analysis.

Correspondence

Dr Peter Saxton, Department of Social and Community Health, University of Auckland, Private Bag 92109, Auckland.

Correspondence Email

p.saxton@auckland.ac.nz

Competing Interests

Nil

- - AIDS - New Zealand. Issue 74. Dunedin: AIDS Epidemiology Group, University of Otago, 2015. Saxton PJ, Dickson NP, McAllister SM, et al. Increase in HIV diagnoses among men who have sex with men in New Zealand from a stable low period. Sex Health. 2011;8:311-8. Hughes A. Effective strategies for HIV prevention in gay men: The next decade. Paper presented at Three Decades of HIV in New Zealand HIV Clinical Update, 8th May 2015. https://www.eiseverywhere.com/file_uploads/5b565af98d2382f05749dfc076065f47_TonyHughes.pdf Saxton PJ, Dickson NP, Hughes AJ. Location-based HIV behavioural surveillance among MSM in Auckland, New Zealand 2002-2011: condom use stable and more HIV testing. Sex Transm Infect. 2014;90:133-8. Saxton PJ, Dickson NP, Hughes AJ. Trends in web-based HIV behavioural surveillance among gay and bisexual men in New Zealand: complementing location-based surveillance. AIDS Care. 2015;27:762-6. Reid A, Hughes A, Worth H, et al. Male Call Waea Mai, Tane Ma Report Four: Casual sex between men. Auckland: New Zealand AIDS Foundation, 1997. Lachowsky N, Saxton P, Hughes A, et al. Frequent condom use with casual partners varies by sexual position among younger gay and bisexual men in New Zealand: national behavioural surveillance 2006-2011. Sex Health, 2015; Online first http://dx.doi.org/10.1071/SH14220. UNAIDS/WHO. Second generation HIV Surveillance for HIV: the next decade. Geneva: UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance; 2000. Saxton P, Dickson N, Hughes A, Ludlam A. Gay Auckland Periodic Sex Survey (GAPSS) and Gay mens Online Sex Survey (GOSS): Basic frequency tables 2002-2014. Auckland: The University of Auckland, 2014. https://www.fmhs.auckland.ac.nz/assets/fmhs/soph/sch/gmsh/docs/BFReport_34LoRes.pdf Hughes A, Saxton P. Geographic micro-clustering of homosexual men: Implications for research and social policy. Soc Pol J New Zealand. 2006; 28:158-178. de Wit J, Mao L, Adam P, Treloar C. HIV/AIDS, hepatitis and sexually transmissible infections in Australia: Annual report of trends in behaviour 2014 (Monograph 7/2014). Sydney: Centre for Social Research in Health, UNSW Australia, 2014. Finlayson T, Binh L, Smith A, et al. HIV Risk, Prevention, and Testing Behaviors Among Men Who Have Sex With Men: National HIV Behavioral Surveillance System, 21 U.S. Cities, United States, 2008. MMWR. 2011; 60(SS14);1-34. Williamson L, Dodds J, Mercey D, Hart G, et al. Sexual risk behaviour and knowledge of HIV status among community samples of gay men in the UK. AIDS. 2008; 22:1063-1070. Truong H, Kellogg T, Klausner J, et al. Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting?. Sex Transm Infect. 2006; 82:461-466. Crawford J, Rodden P, Kippax S, Van de Ven P. Negotiated safety and other agreements between men in relationships: risk practice redefined. Int J STD AIDS. 2001; 12: 164-170. Grulich A, de Visser R, Badcock P, et al. Homosexual experience and recent homosexual encounters: the Second Australian Study of Health and Relationships. Sex Health. 2014; 11:439-450. Lucassen M, Clark T, Moselen E, et al. Youth12 The Health and Wellbeing of Secondary School Students in New Zealand: Results for Young People Attracted to the Same Sex or Both Sexes. Auckland: The University of Auckland, 2014. Rich J. HIV prevention among gay and bisexual men. Paper presented at Three Decades of HIV in New Zealand HIV Clinical Update, 8th May 2015. http://player.vimeo.com/external/130713756.sd.mp4?s=eea703ddb3ed5aa75178674d7dace69a&profile_id=112 Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011; 365:493-505. The INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015; 373:795-807. McCormack S, Dunn D. Pragmatic Open-Label Randomised Trial of Preexposure Prophylaxis: The PROUD Study. 2015 Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, USA, abstract 22LB, 2015. Molina JM, Capitant C, Charreau I, et al. On Demand PrEP With Oral TDF-FTC in MSM: Results of the ANRS Ipergay Trial. 2015 Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, USA, abstract 23LB, 2015. Kippax S. Biomedical prevention: rhetoric and reality. HIV Australia. 2015; 13:8-11. https://www.afao.org.au/library/hiv-australia/volume-13/vol-13-number-2-horizons/biomedical-prevention-rhetoric-and-reality National AIDS Trust. HIV prevention in Englands high prevalence local authorities 2013/14 and 2014/15: Examining spending on primary HIV prevention and additional HIV testing. London: National AIDS Trust, 2015. http://www.nat.org.uk/media/Files/Publications/Prevention_Report_2015-1.pdf Ludlam A, Saxton P, Dickson N, Hughes A. Attitudes towards safe sex among men who have sex with men in New Zealand: Findings from the GAPSS and GOSS surveys 2002-2011. Research brief to the Ministry of Health. Dunedin: AIDS Epidemiology Group, University of Otago, 2012. https://www.fmhs.auckland.ac.nz/assets/fmhs/soph/sch/gmsh/docs/gapss-goss-attitudes-research-brief.pdf Lachowsky NJ, Dewey CE, Dickson NP, et al. Habitual condom use across partner type and sexual position among younger gay and bisexual men: findings from New Zealand HIV behavioural surveillance 2006-2011. Sex Transm Infect. 2015; 91:445-450 Coughlan E, Young H, Parkes C, et al. A novel response to an outbreak of infectious syphilis in Christchurch, New Zealand. Sex Health. 2015; 12:170-3. The Institute of Environmental Science and Research Ltd. Enhanced Surveillance of Infectious Syphilis in New Zealand Sexual Health Clinics - 2013. Porirua: ESR, 2014. Basu I, Bromhead C, Balm M, et al. Lymphogranuloma venereum in men who have sex with men: evidence of local transmission in New Zealand. N Z Med J. 2015;128:25-9. Public Health England. Sexually transmitted infections and chlamydia screening in England, 2014. Health Protection Report. 2015; 9:22. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/437433/hpr2215_STI_NCSP_v6.pdf - -

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Gay, bisexual and other men who have sex with men (GBM) are at greatest risk of HIV infection in New Zealand, accounting for 2,329 HIV diagnoses from 1985 to the end of 2014,1 and roughly 80% of the locally transmitted HIV epidemic.2 Almost all HIV transmission between GBM occurs through anal intercourse without a condom, hence health promotion efforts have sought to maximise and sustain condom use in this population.3 Trends in condom uptake among GBM in New Zealand have largely been high and stable,4,5 however in 2011 this dropped slightly among casual partners, and in 2014 the highest ever annual number of locally acquired HIV infections among GBM was diagnosed.1Public health consequently needs a better understanding of current patterns in non-condom use. Although the fraction of HIV infection events attributable to casual as opposed to regular sexual partnering is unknown, GBM having casual sex are likely to change partners more frequently than those with regular partners, increasing the probability of encountering a sexual partner with undiagnosed HIV in the highly infectious early acute phase of infection. Individuals are also less likely to be aware of their casual partners sexual and HIV testing histories. Identifying predictors of unprotected casual anal intercourse therefore helps HIV prevention agencies, such as the New Zealand AIDS Foundation, target and place condom social marketing.Previous New Zealand research in 1996 found that GBM on lower incomes, who were not gay-community affiliated, or who had fewer sexual partners were more likely to never use condoms with casual partners.6 An analysis of our own behavioural surveillance data among younger GBM aged under 30 between 2006-2011 found that condom use was lower among Pacific GBM and those with less education. Alternatively, condom use was higher among GBM recruited from community venues, who had tested HIV-negative, had a modest number of recent sexual partners, did not have sex with women, or who used condoms with any regular male partners.7The aim of this study was to investigate factors predicting recent non-condom use with casual sex partners using a large and diverse sample of GBM recruited from community and Internet settings in 2014.MethodsData collectionWe analysed data collected from the 2014 round of the Gay Auckland Periodic Sex Survey (GAPSS) and Gay Online Sex Survey (GOSS), an established behavioural surveillance system consistent with WHO/UNAIDS Guidelines.8 GAPSS participants were recruited in Auckland by trained recruitment staff during one week in February, 2014, from a gay community fair day and subsequently at all gay bars (four) and sex-on-site venues (five) in that city. Eligibility criteria were being male, aged at least 16 years, having had sex with a man in the past five years, and had not already participated in GAPSS or GOSS that year. Questionnaires were voluntary, anonymous and self-completed on site. Secure return boxes ensured privacy. Following GAPSS, the same questionnaire was used for the Internet-based nationwide GOSS over the next month that accessed participants through banners on New Zealand Internet dating sites and apps. These included NZDating.com, Manhunt, Grindr, JackD, Hornet and Growlr. Detailed methods are provided elsewhere.9 Ethics approval was received from the University of Auckland Human Participant Ethics Committee (#010738) and surveys were funded by the Ministry of Health.QuestionnaireParticipants were asked the number, type (casual or regular) and nature of current regular relationships ( Boyfriend/long-term lover/life partner/civil union partner/husband , hereafter BF ; or fuckbuddy/friend I have sex with , hereafter FB ) in the previous six months. Casual partners were defined as men they had had sex with no more than three times over this period, and regular partners men they had sex with four or more times. If participants had engaged in anal intercourse with a casual and/or a current regular partner they were asked the sexual position (receptive, insertive), and for each position the frequency of condom use on a five point scale (always, almost always, about half the time, very rarely, never). The questionnaire contained socio-demographic items and items about sexual partnering, HIV and STI testing, frequency of exposure to condom social marketing, and attitudes to HIV, condoms and safe sex.AnalysisThe main outcome was infrequent condom use ( never , very rarely or half the time ) for any anal intercourse role; frequent use being at least almost always or always used a condom. The denominator is respondents reporting at least one episode of anal intercourse with a casual partner in the previous six months. Chi-squared tests explored the association of condom use with demographic characteristics, sexual partnering, health screening, social marketing exposure and attitudes. This informed the multivariate logistic regression models of factors independently associated with infrequent condom use. Due to potential collinearity between safe sex attitudes and social marketing on condom use, we developed three models: (1) containing attitudes and socio-demographic variables; (2) containing social marketing and socio-demographic variables; (3) containing both attitudes and social marketing variables. Statistical analyses and data management were carried out using Stata v.12.1 on non-missing data.ResultsThe 2014 surveys attracted 3,141 respondents, of whom 1,912 had engaged in anal intercourse with a casual partner in the previous six months and reported on their condom use. Of these, just under three-quarters (72.8%) reported frequent condom use, and just over a quarter (27.2%) infrequent condom use. The latter equated to 16.7% of all GAPSS/GOSS respondents.In univariate analyses, infrequent condom use varied significantly by recruitment site, ethnicity and education status (Table 1), condom use at first intercourse, HIV testing and STI history (Table 2), condom social marketing exposure (Table 3) and attitudes to HIV, condoms and safe sex (Table 4).Table 1: Infrequent condom use by socio-demographic characteristics Socio-demographic characteristics Number Reported infrequent condom use (n,%) X2 p-value Total 1,912 518 27.2 Recruitment site Offline: community event 485 106 21.9 * Offline: bars 51 6 11.8 Offline: sex-on-site venue 125 13 10.4 Online dating site 1,244 393 31.6 Age group 16-29 819 227 27.7 Ns 30-44 553 141 25.5 45+ 488 139 28.5 Ethnicity European 1,370 371 27.1 * Mori 173 66 38.2 Pacific 56 21 37.5 Asian 198 40 20.2 Other 72 11 15.3 Highest education qualification Less than tertiary degree 998 332 33.3 * Tertiary degree or higher 863 175 20.3 Free time spent with other gay men None 76 18 23.7 Ns A little 655 178 27.2 Some 590 154 26.1 A lot 510 143 28.0 Sexual identity Gay or homosexual 1,535 432 28.1 Ns Bisexual or other 365 83 22.7 * p<0.001. Ns=not statistically significantTable 2: Infrequent condom use by behaviours and HIV screening Behaviours and screening Number Reported infrequent condom use (n,%) X2 p-value Condom used at first anal intercourse with a male No 730 277 38.0 * Yes 1,132 232 20.5 Number of male sexual partners in last 6 months One 146 41 28.1 Ns 2-5 795 204 25.7 6-10 436 112 25.7 11-20 269 72 26.8 21-50 188 64 34.0 >50 52 20 38.5 Partnering and protective behaviours in last 6 months Casual only or no current regular partner 986 253 25.7 * Current BF and no anal intercourse with him 61 14 23.0 Current BF and frequent condom use with him 109 5 4.6 Current BF and infrequent condom use with him 238 98 41.2 Current FB and no anal intercourse with him 73 15 20.6 Current FB and frequent condom use with him 226 6 2.7 Current FB and infrequent condom use with him 171 116 67.8 HIV testing history Last tested HIV-negative 1,329 334 25.1 * Diagnosed HIV-positive 108 51 47.2 Untested or no result 412 122 29.6 STI diagnosed in last 12 months No 1,539 384 25.0 * Yes 290 108 37.2 * p<0.001. Ns=not statistically significant. BF=boyfriend-type regular partner. FB=friend with benefit-type regular partnerTable 3: Infrequent condom use by condom social marketing exposure Condom social marketing exposure Number Reported infrequent condom use (n,%) X2 p-value Frequency of seeing condom promotion in last 12 months Very frequently 829 187 22.6 * Often 515 139 27.0 Occasionally 333 107 32.1 Rarely 165 60 36.4 Never 39 18 46.2 Number of places recalled seen condoms promoted in last 12 months\u2020 None 89 40 44.9 * 1 466 152 32.6 2 260 73 28.1 3 325 76 23.4 4 267 69 25.8 5 287 52 18.1 6 178 45 25.3 * p<0.001. \u2020 Options included promos at gay events , billboards or bus-stop adverts , condom packs , promos online or on a mobile app , posters , material at saunas or cruise clubs . Table 4: Infrequent condom use by attitudes to condoms, HIV and safe sex Attitude Number Reported infrequent condom use (n,%) X2 p-value HIV/AIDS is a less serious threat than it used to be because of new treatments Agree/strongly agree 632 217 34.3 \u2020 Disagree/strongly disagree 1,244 291 23.4 Condoms are OK as part of sex Agree/strongly agree 1,796 449 25.0 \u2020 Disagree/strongly disagree 86 63 73.3 If he doesnt want to use condoms I wont bother using them Agree/strongly agree 404 270 66.8 \u2020 Disagree/strongly disagree 1,470 238 16.2 We all have a shared responsibility to protect other gay and bisexual men by using condoms for anal sex Agree/strongly agree 1,766 434 24.6 \u2020 Disagree/strongly disagree 105 73 69.5 I dont like wearing condoms because they reduce sensitivity Agree/strongly agree 793 345 43.5 \u2020 Disagree/strongly disagree 1,070 165 15.4 Its no-one elses business whether or not I use condoms Agree/strongly agree 602 270 44.9 \u2020 Disagree/strongly disagree 1,257 240 19.1 I would sometimes rather risk HIV transmission than use a condom during anal sex Agree/strongly agree 241 148 61.4 \u2020 Disagree/strongly disagree 1,612 360 22.3 The sex I have is always as safe as I want it to be Agree/strongly agree 1,594 375 23.5 \u2020 Disagree/strongly disagree 262 130 49.6 I would never be willing to use condoms for anal sex Agree/strongly agree 111 62 55.9 \u2020 Disagree/strongly disagree 1,743 445 25.5 A man who knows he has HIV would tell me he was positive before we had sex Agree/strongly agree 757 227 30.0 * Disagree/strongly disagree 1,092 281 25.7 *P<0.05. \u2020 p<0.001.Three separate models were then developed to investigate the relationship between condom social marketing exposure, attitudes to condoms, and other potential independent predictors. In the first model, six attitude items remained associated with infrequent condom use after controlling for respondent socio-demographic characteristics (Table 5; two were omitted as they obviously indicated non-condom use: I would never be willing to use condoms for anal sex and I would sometimes rather risk HIV transmission than use a condom during anal sex ). The most strongly predictive was agreement that if he doesnt want to use condoms I wont bother using them (AOR 6.8, 95%CI 5.0-9.1).Table 5: Attitudes independently associated with infrequent condom use with casual partners*\u2020c Attitude Adjusted odds ratio (95% CI) p-value for variable Condoms are OK as part of sex Agree/strongly agree (ref) 1 Disagree/strongly disagree 3.7 (2.0-7.0) <0.001 If he doesnt want to use condoms I wont bother using them Agree/strongly agree 6.8 (5.0-9.1) <0.001 Disagree/strongly disagree (ref) 1 We all have a shared responsibility to protect other gay and bisexual men by using condoms for anal sex Agree/strongly agree (ref) 1 Disagree/strongly disagree 4.2 (2.3-7.7) <0.001 I dont like wearing condoms because they reduce sensitivity Agree/strongly agree 2.6 (2.0-3.4) <0.001 Disagree/strongly disagree (ref) 1 Its no-one elses business whether or not I use condoms Agree/strongly agree 2.0 (1.5-2.7) <0.001 Disagree/strongly disagree (ref) 1 The sex I have is always as safe as I want it to be Agree/strongly agree (ref) 1 Disagree/strongly disagree 3.4 (2.4-4.8) <0.001 * Two attitude statements were omitted from the model because they would obviously be correlated to condom use, including I would never be willing to use condoms for anal sex and I would sometimes rather risk HIV transmission than use a condom during anal sex .\u2020 Socio-demographic variables included in the model were recruitment site, age group, ethnic group, education and sexual identity. In the second model, twelve non-attitude variables were entered into a multivariate logistic regression, including socio-demographic (recruitment site, age group, ethnicity, education, sexual identity), behavioural (condom use at first anal intercourse, number of partners, recent partnering history, anal intercourse modality), condom social marketing exposure (frequency recalling condom social marketing, number of different condom social marketing avenues recalled) and HIV testing variables. The model found infrequent condom use with a casual partner was independently predicted by being recruited from Internet dating sites, being of Pacific ethnicity, having 20 or more male sexual partners in the last six months, using condoms infrequently with a current BF or FB, or being diag

Summary

Abstract

Aim

To identify predictors of non-condom use among gay and bisexual men (GBM) in New Zealand with casual male partners.

Method

We analysed anonymous self-completed data from GBM who participated in the community-based Gay Auckland Periodic Sex Survey (GAPSS) and Internet-based Gay Online Sex Survey (GOSS), undertaken in 2014. Infrequent condom use was defined as not using condoms always or almost always during anal intercourse in the prior six months.

Results

Of the 1,912 GBM reporting anal intercourse with a casual partner, 27.2% reported infrequent condom use. Being recruited from Internet dating sites, Pacific ethnicity, having over 20 recent male partners, infrequent condom use with a current regular partner, or being HIV-positive were independently predictive of infrequent condom use. Conversely, being older, having a tertiary degree, using a condom at first anal intercourse, being exclusively receptive with a casual partner/s, and seeing condoms promoted through multiple channels predicted frequent condom use. Attitudes to condoms and safe sex were strongly predictive of actual condom use.

Conclusion

Social marketing should target the modifiable predictors of condom use, such as attitudes to safe sex. Interventions also need to engage successfully with GBM reporting non-modifiable traits such as HIV-positive GBM.

Author Information

Peter J W Saxton, Director, Gay Mens Sexual Health research group, Department of Social and Community Health, University of Auckland, Auckland; Nigel P Dickson, Director, AIDS Epidemiology Group, Department of Preventive and Social Medicine, University of Otago, Dunedin; Anthony J Hughes, Scientific Director, New Zealand AIDS Foundation, Auckland; Adrian H Ludlam, Research Assistant, Gay Mens Sexual Health research group, Department of Social and Community Health, University of Auckland, Auckland.

Acknowledgements

We would like to thank all participants, community venues and websites involved in the study. The GAPSS and GOSS projects are a collaboration between the Gay Mens Sexual Health research group, the AIDS Epidemiology Group and the New Zealand AIDS Foundation. The Ministry of Health funded the 2014 study and the NZAF Fellowship assisted with analysis.

Correspondence

Dr Peter Saxton, Department of Social and Community Health, University of Auckland, Private Bag 92109, Auckland.

Correspondence Email

p.saxton@auckland.ac.nz

Competing Interests

Nil

- - AIDS - New Zealand. Issue 74. Dunedin: AIDS Epidemiology Group, University of Otago, 2015. Saxton PJ, Dickson NP, McAllister SM, et al. Increase in HIV diagnoses among men who have sex with men in New Zealand from a stable low period. Sex Health. 2011;8:311-8. Hughes A. Effective strategies for HIV prevention in gay men: The next decade. Paper presented at Three Decades of HIV in New Zealand HIV Clinical Update, 8th May 2015. https://www.eiseverywhere.com/file_uploads/5b565af98d2382f05749dfc076065f47_TonyHughes.pdf Saxton PJ, Dickson NP, Hughes AJ. Location-based HIV behavioural surveillance among MSM in Auckland, New Zealand 2002-2011: condom use stable and more HIV testing. Sex Transm Infect. 2014;90:133-8. Saxton PJ, Dickson NP, Hughes AJ. Trends in web-based HIV behavioural surveillance among gay and bisexual men in New Zealand: complementing location-based surveillance. AIDS Care. 2015;27:762-6. Reid A, Hughes A, Worth H, et al. Male Call Waea Mai, Tane Ma Report Four: Casual sex between men. Auckland: New Zealand AIDS Foundation, 1997. Lachowsky N, Saxton P, Hughes A, et al. Frequent condom use with casual partners varies by sexual position among younger gay and bisexual men in New Zealand: national behavioural surveillance 2006-2011. Sex Health, 2015; Online first http://dx.doi.org/10.1071/SH14220. UNAIDS/WHO. Second generation HIV Surveillance for HIV: the next decade. Geneva: UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance; 2000. Saxton P, Dickson N, Hughes A, Ludlam A. Gay Auckland Periodic Sex Survey (GAPSS) and Gay mens Online Sex Survey (GOSS): Basic frequency tables 2002-2014. Auckland: The University of Auckland, 2014. https://www.fmhs.auckland.ac.nz/assets/fmhs/soph/sch/gmsh/docs/BFReport_34LoRes.pdf Hughes A, Saxton P. Geographic micro-clustering of homosexual men: Implications for research and social policy. Soc Pol J New Zealand. 2006; 28:158-178. de Wit J, Mao L, Adam P, Treloar C. HIV/AIDS, hepatitis and sexually transmissible infections in Australia: Annual report of trends in behaviour 2014 (Monograph 7/2014). Sydney: Centre for Social Research in Health, UNSW Australia, 2014. Finlayson T, Binh L, Smith A, et al. HIV Risk, Prevention, and Testing Behaviors Among Men Who Have Sex With Men: National HIV Behavioral Surveillance System, 21 U.S. Cities, United States, 2008. MMWR. 2011; 60(SS14);1-34. Williamson L, Dodds J, Mercey D, Hart G, et al. Sexual risk behaviour and knowledge of HIV status among community samples of gay men in the UK. AIDS. 2008; 22:1063-1070. Truong H, Kellogg T, Klausner J, et al. Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting?. Sex Transm Infect. 2006; 82:461-466. Crawford J, Rodden P, Kippax S, Van de Ven P. Negotiated safety and other agreements between men in relationships: risk practice redefined. Int J STD AIDS. 2001; 12: 164-170. Grulich A, de Visser R, Badcock P, et al. Homosexual experience and recent homosexual encounters: the Second Australian Study of Health and Relationships. Sex Health. 2014; 11:439-450. Lucassen M, Clark T, Moselen E, et al. Youth12 The Health and Wellbeing of Secondary School Students in New Zealand: Results for Young People Attracted to the Same Sex or Both Sexes. Auckland: The University of Auckland, 2014. Rich J. HIV prevention among gay and bisexual men. Paper presented at Three Decades of HIV in New Zealand HIV Clinical Update, 8th May 2015. http://player.vimeo.com/external/130713756.sd.mp4?s=eea703ddb3ed5aa75178674d7dace69a&profile_id=112 Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011; 365:493-505. The INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015; 373:795-807. McCormack S, Dunn D. Pragmatic Open-Label Randomised Trial of Preexposure Prophylaxis: The PROUD Study. 2015 Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, USA, abstract 22LB, 2015. Molina JM, Capitant C, Charreau I, et al. On Demand PrEP With Oral TDF-FTC in MSM: Results of the ANRS Ipergay Trial. 2015 Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, USA, abstract 23LB, 2015. Kippax S. Biomedical prevention: rhetoric and reality. HIV Australia. 2015; 13:8-11. https://www.afao.org.au/library/hiv-australia/volume-13/vol-13-number-2-horizons/biomedical-prevention-rhetoric-and-reality National AIDS Trust. HIV prevention in Englands high prevalence local authorities 2013/14 and 2014/15: Examining spending on primary HIV prevention and additional HIV testing. London: National AIDS Trust, 2015. http://www.nat.org.uk/media/Files/Publications/Prevention_Report_2015-1.pdf Ludlam A, Saxton P, Dickson N, Hughes A. Attitudes towards safe sex among men who have sex with men in New Zealand: Findings from the GAPSS and GOSS surveys 2002-2011. Research brief to the Ministry of Health. Dunedin: AIDS Epidemiology Group, University of Otago, 2012. https://www.fmhs.auckland.ac.nz/assets/fmhs/soph/sch/gmsh/docs/gapss-goss-attitudes-research-brief.pdf Lachowsky NJ, Dewey CE, Dickson NP, et al. Habitual condom use across partner type and sexual position among younger gay and bisexual men: findings from New Zealand HIV behavioural surveillance 2006-2011. Sex Transm Infect. 2015; 91:445-450 Coughlan E, Young H, Parkes C, et al. A novel response to an outbreak of infectious syphilis in Christchurch, New Zealand. Sex Health. 2015; 12:170-3. The Institute of Environmental Science and Research Ltd. Enhanced Surveillance of Infectious Syphilis in New Zealand Sexual Health Clinics - 2013. Porirua: ESR, 2014. Basu I, Bromhead C, Balm M, et al. Lymphogranuloma venereum in men who have sex with men: evidence of local transmission in New Zealand. N Z Med J. 2015;128:25-9. Public Health England. Sexually transmitted infections and chlamydia screening in England, 2014. Health Protection Report. 2015; 9:22. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/437433/hpr2215_STI_NCSP_v6.pdf - -

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Gay, bisexual and other men who have sex with men (GBM) are at greatest risk of HIV infection in New Zealand, accounting for 2,329 HIV diagnoses from 1985 to the end of 2014,1 and roughly 80% of the locally transmitted HIV epidemic.2 Almost all HIV transmission between GBM occurs through anal intercourse without a condom, hence health promotion efforts have sought to maximise and sustain condom use in this population.3 Trends in condom uptake among GBM in New Zealand have largely been high and stable,4,5 however in 2011 this dropped slightly among casual partners, and in 2014 the highest ever annual number of locally acquired HIV infections among GBM was diagnosed.1Public health consequently needs a better understanding of current patterns in non-condom use. Although the fraction of HIV infection events attributable to casual as opposed to regular sexual partnering is unknown, GBM having casual sex are likely to change partners more frequently than those with regular partners, increasing the probability of encountering a sexual partner with undiagnosed HIV in the highly infectious early acute phase of infection. Individuals are also less likely to be aware of their casual partners sexual and HIV testing histories. Identifying predictors of unprotected casual anal intercourse therefore helps HIV prevention agencies, such as the New Zealand AIDS Foundation, target and place condom social marketing.Previous New Zealand research in 1996 found that GBM on lower incomes, who were not gay-community affiliated, or who had fewer sexual partners were more likely to never use condoms with casual partners.6 An analysis of our own behavioural surveillance data among younger GBM aged under 30 between 2006-2011 found that condom use was lower among Pacific GBM and those with less education. Alternatively, condom use was higher among GBM recruited from community venues, who had tested HIV-negative, had a modest number of recent sexual partners, did not have sex with women, or who used condoms with any regular male partners.7The aim of this study was to investigate factors predicting recent non-condom use with casual sex partners using a large and diverse sample of GBM recruited from community and Internet settings in 2014.MethodsData collectionWe analysed data collected from the 2014 round of the Gay Auckland Periodic Sex Survey (GAPSS) and Gay Online Sex Survey (GOSS), an established behavioural surveillance system consistent with WHO/UNAIDS Guidelines.8 GAPSS participants were recruited in Auckland by trained recruitment staff during one week in February, 2014, from a gay community fair day and subsequently at all gay bars (four) and sex-on-site venues (five) in that city. Eligibility criteria were being male, aged at least 16 years, having had sex with a man in the past five years, and had not already participated in GAPSS or GOSS that year. Questionnaires were voluntary, anonymous and self-completed on site. Secure return boxes ensured privacy. Following GAPSS, the same questionnaire was used for the Internet-based nationwide GOSS over the next month that accessed participants through banners on New Zealand Internet dating sites and apps. These included NZDating.com, Manhunt, Grindr, JackD, Hornet and Growlr. Detailed methods are provided elsewhere.9 Ethics approval was received from the University of Auckland Human Participant Ethics Committee (#010738) and surveys were funded by the Ministry of Health.QuestionnaireParticipants were asked the number, type (casual or regular) and nature of current regular relationships ( Boyfriend/long-term lover/life partner/civil union partner/husband , hereafter BF ; or fuckbuddy/friend I have sex with , hereafter FB ) in the previous six months. Casual partners were defined as men they had had sex with no more than three times over this period, and regular partners men they had sex with four or more times. If participants had engaged in anal intercourse with a casual and/or a current regular partner they were asked the sexual position (receptive, insertive), and for each position the frequency of condom use on a five point scale (always, almost always, about half the time, very rarely, never). The questionnaire contained socio-demographic items and items about sexual partnering, HIV and STI testing, frequency of exposure to condom social marketing, and attitudes to HIV, condoms and safe sex.AnalysisThe main outcome was infrequent condom use ( never , very rarely or half the time ) for any anal intercourse role; frequent use being at least almost always or always used a condom. The denominator is respondents reporting at least one episode of anal intercourse with a casual partner in the previous six months. Chi-squared tests explored the association of condom use with demographic characteristics, sexual partnering, health screening, social marketing exposure and attitudes. This informed the multivariate logistic regression models of factors independently associated with infrequent condom use. Due to potential collinearity between safe sex attitudes and social marketing on condom use, we developed three models: (1) containing attitudes and socio-demographic variables; (2) containing social marketing and socio-demographic variables; (3) containing both attitudes and social marketing variables. Statistical analyses and data management were carried out using Stata v.12.1 on non-missing data.ResultsThe 2014 surveys attracted 3,141 respondents, of whom 1,912 had engaged in anal intercourse with a casual partner in the previous six months and reported on their condom use. Of these, just under three-quarters (72.8%) reported frequent condom use, and just over a quarter (27.2%) infrequent condom use. The latter equated to 16.7% of all GAPSS/GOSS respondents.In univariate analyses, infrequent condom use varied significantly by recruitment site, ethnicity and education status (Table 1), condom use at first intercourse, HIV testing and STI history (Table 2), condom social marketing exposure (Table 3) and attitudes to HIV, condoms and safe sex (Table 4).Table 1: Infrequent condom use by socio-demographic characteristics Socio-demographic characteristics Number Reported infrequent condom use (n,%) X2 p-value Total 1,912 518 27.2 Recruitment site Offline: community event 485 106 21.9 * Offline: bars 51 6 11.8 Offline: sex-on-site venue 125 13 10.4 Online dating site 1,244 393 31.6 Age group 16-29 819 227 27.7 Ns 30-44 553 141 25.5 45+ 488 139 28.5 Ethnicity European 1,370 371 27.1 * Mori 173 66 38.2 Pacific 56 21 37.5 Asian 198 40 20.2 Other 72 11 15.3 Highest education qualification Less than tertiary degree 998 332 33.3 * Tertiary degree or higher 863 175 20.3 Free time spent with other gay men None 76 18 23.7 Ns A little 655 178 27.2 Some 590 154 26.1 A lot 510 143 28.0 Sexual identity Gay or homosexual 1,535 432 28.1 Ns Bisexual or other 365 83 22.7 * p<0.001. Ns=not statistically significantTable 2: Infrequent condom use by behaviours and HIV screening Behaviours and screening Number Reported infrequent condom use (n,%) X2 p-value Condom used at first anal intercourse with a male No 730 277 38.0 * Yes 1,132 232 20.5 Number of male sexual partners in last 6 months One 146 41 28.1 Ns 2-5 795 204 25.7 6-10 436 112 25.7 11-20 269 72 26.8 21-50 188 64 34.0 >50 52 20 38.5 Partnering and protective behaviours in last 6 months Casual only or no current regular partner 986 253 25.7 * Current BF and no anal intercourse with him 61 14 23.0 Current BF and frequent condom use with him 109 5 4.6 Current BF and infrequent condom use with him 238 98 41.2 Current FB and no anal intercourse with him 73 15 20.6 Current FB and frequent condom use with him 226 6 2.7 Current FB and infrequent condom use with him 171 116 67.8 HIV testing history Last tested HIV-negative 1,329 334 25.1 * Diagnosed HIV-positive 108 51 47.2 Untested or no result 412 122 29.6 STI diagnosed in last 12 months No 1,539 384 25.0 * Yes 290 108 37.2 * p<0.001. Ns=not statistically significant. BF=boyfriend-type regular partner. FB=friend with benefit-type regular partnerTable 3: Infrequent condom use by condom social marketing exposure Condom social marketing exposure Number Reported infrequent condom use (n,%) X2 p-value Frequency of seeing condom promotion in last 12 months Very frequently 829 187 22.6 * Often 515 139 27.0 Occasionally 333 107 32.1 Rarely 165 60 36.4 Never 39 18 46.2 Number of places recalled seen condoms promoted in last 12 months\u2020 None 89 40 44.9 * 1 466 152 32.6 2 260 73 28.1 3 325 76 23.4 4 267 69 25.8 5 287 52 18.1 6 178 45 25.3 * p<0.001. \u2020 Options included promos at gay events , billboards or bus-stop adverts , condom packs , promos online or on a mobile app , posters , material at saunas or cruise clubs . Table 4: Infrequent condom use by attitudes to condoms, HIV and safe sex Attitude Number Reported infrequent condom use (n,%) X2 p-value HIV/AIDS is a less serious threat than it used to be because of new treatments Agree/strongly agree 632 217 34.3 \u2020 Disagree/strongly disagree 1,244 291 23.4 Condoms are OK as part of sex Agree/strongly agree 1,796 449 25.0 \u2020 Disagree/strongly disagree 86 63 73.3 If he doesnt want to use condoms I wont bother using them Agree/strongly agree 404 270 66.8 \u2020 Disagree/strongly disagree 1,470 238 16.2 We all have a shared responsibility to protect other gay and bisexual men by using condoms for anal sex Agree/strongly agree 1,766 434 24.6 \u2020 Disagree/strongly disagree 105 73 69.5 I dont like wearing condoms because they reduce sensitivity Agree/strongly agree 793 345 43.5 \u2020 Disagree/strongly disagree 1,070 165 15.4 Its no-one elses business whether or not I use condoms Agree/strongly agree 602 270 44.9 \u2020 Disagree/strongly disagree 1,257 240 19.1 I would sometimes rather risk HIV transmission than use a condom during anal sex Agree/strongly agree 241 148 61.4 \u2020 Disagree/strongly disagree 1,612 360 22.3 The sex I have is always as safe as I want it to be Agree/strongly agree 1,594 375 23.5 \u2020 Disagree/strongly disagree 262 130 49.6 I would never be willing to use condoms for anal sex Agree/strongly agree 111 62 55.9 \u2020 Disagree/strongly disagree 1,743 445 25.5 A man who knows he has HIV would tell me he was positive before we had sex Agree/strongly agree 757 227 30.0 * Disagree/strongly disagree 1,092 281 25.7 *P<0.05. \u2020 p<0.001.Three separate models were then developed to investigate the relationship between condom social marketing exposure, attitudes to condoms, and other potential independent predictors. In the first model, six attitude items remained associated with infrequent condom use after controlling for respondent socio-demographic characteristics (Table 5; two were omitted as they obviously indicated non-condom use: I would never be willing to use condoms for anal sex and I would sometimes rather risk HIV transmission than use a condom during anal sex ). The most strongly predictive was agreement that if he doesnt want to use condoms I wont bother using them (AOR 6.8, 95%CI 5.0-9.1).Table 5: Attitudes independently associated with infrequent condom use with casual partners*\u2020c Attitude Adjusted odds ratio (95% CI) p-value for variable Condoms are OK as part of sex Agree/strongly agree (ref) 1 Disagree/strongly disagree 3.7 (2.0-7.0) <0.001 If he doesnt want to use condoms I wont bother using them Agree/strongly agree 6.8 (5.0-9.1) <0.001 Disagree/strongly disagree (ref) 1 We all have a shared responsibility to protect other gay and bisexual men by using condoms for anal sex Agree/strongly agree (ref) 1 Disagree/strongly disagree 4.2 (2.3-7.7) <0.001 I dont like wearing condoms because they reduce sensitivity Agree/strongly agree 2.6 (2.0-3.4) <0.001 Disagree/strongly disagree (ref) 1 Its no-one elses business whether or not I use condoms Agree/strongly agree 2.0 (1.5-2.7) <0.001 Disagree/strongly disagree (ref) 1 The sex I have is always as safe as I want it to be Agree/strongly agree (ref) 1 Disagree/strongly disagree 3.4 (2.4-4.8) <0.001 * Two attitude statements were omitted from the model because they would obviously be correlated to condom use, including I would never be willing to use condoms for anal sex and I would sometimes rather risk HIV transmission than use a condom during anal sex .\u2020 Socio-demographic variables included in the model were recruitment site, age group, ethnic group, education and sexual identity. In the second model, twelve non-attitude variables were entered into a multivariate logistic regression, including socio-demographic (recruitment site, age group, ethnicity, education, sexual identity), behavioural (condom use at first anal intercourse, number of partners, recent partnering history, anal intercourse modality), condom social marketing exposure (frequency recalling condom social marketing, number of different condom social marketing avenues recalled) and HIV testing variables. The model found infrequent condom use with a casual partner was independently predicted by being recruited from Internet dating sites, being of Pacific ethnicity, having 20 or more male sexual partners in the last six months, using condoms infrequently with a current BF or FB, or being diag

Summary

Abstract

Aim

To identify predictors of non-condom use among gay and bisexual men (GBM) in New Zealand with casual male partners.

Method

We analysed anonymous self-completed data from GBM who participated in the community-based Gay Auckland Periodic Sex Survey (GAPSS) and Internet-based Gay Online Sex Survey (GOSS), undertaken in 2014. Infrequent condom use was defined as not using condoms always or almost always during anal intercourse in the prior six months.

Results

Of the 1,912 GBM reporting anal intercourse with a casual partner, 27.2% reported infrequent condom use. Being recruited from Internet dating sites, Pacific ethnicity, having over 20 recent male partners, infrequent condom use with a current regular partner, or being HIV-positive were independently predictive of infrequent condom use. Conversely, being older, having a tertiary degree, using a condom at first anal intercourse, being exclusively receptive with a casual partner/s, and seeing condoms promoted through multiple channels predicted frequent condom use. Attitudes to condoms and safe sex were strongly predictive of actual condom use.

Conclusion

Social marketing should target the modifiable predictors of condom use, such as attitudes to safe sex. Interventions also need to engage successfully with GBM reporting non-modifiable traits such as HIV-positive GBM.

Author Information

Peter J W Saxton, Director, Gay Mens Sexual Health research group, Department of Social and Community Health, University of Auckland, Auckland; Nigel P Dickson, Director, AIDS Epidemiology Group, Department of Preventive and Social Medicine, University of Otago, Dunedin; Anthony J Hughes, Scientific Director, New Zealand AIDS Foundation, Auckland; Adrian H Ludlam, Research Assistant, Gay Mens Sexual Health research group, Department of Social and Community Health, University of Auckland, Auckland.

Acknowledgements

We would like to thank all participants, community venues and websites involved in the study. The GAPSS and GOSS projects are a collaboration between the Gay Mens Sexual Health research group, the AIDS Epidemiology Group and the New Zealand AIDS Foundation. The Ministry of Health funded the 2014 study and the NZAF Fellowship assisted with analysis.

Correspondence

Dr Peter Saxton, Department of Social and Community Health, University of Auckland, Private Bag 92109, Auckland.

Correspondence Email

p.saxton@auckland.ac.nz

Competing Interests

Nil

- - AIDS - New Zealand. Issue 74. Dunedin: AIDS Epidemiology Group, University of Otago, 2015. Saxton PJ, Dickson NP, McAllister SM, et al. Increase in HIV diagnoses among men who have sex with men in New Zealand from a stable low period. Sex Health. 2011;8:311-8. Hughes A. Effective strategies for HIV prevention in gay men: The next decade. Paper presented at Three Decades of HIV in New Zealand HIV Clinical Update, 8th May 2015. https://www.eiseverywhere.com/file_uploads/5b565af98d2382f05749dfc076065f47_TonyHughes.pdf Saxton PJ, Dickson NP, Hughes AJ. Location-based HIV behavioural surveillance among MSM in Auckland, New Zealand 2002-2011: condom use stable and more HIV testing. Sex Transm Infect. 2014;90:133-8. Saxton PJ, Dickson NP, Hughes AJ. Trends in web-based HIV behavioural surveillance among gay and bisexual men in New Zealand: complementing location-based surveillance. AIDS Care. 2015;27:762-6. Reid A, Hughes A, Worth H, et al. Male Call Waea Mai, Tane Ma Report Four: Casual sex between men. Auckland: New Zealand AIDS Foundation, 1997. Lachowsky N, Saxton P, Hughes A, et al. Frequent condom use with casual partners varies by sexual position among younger gay and bisexual men in New Zealand: national behavioural surveillance 2006-2011. Sex Health, 2015; Online first http://dx.doi.org/10.1071/SH14220. UNAIDS/WHO. Second generation HIV Surveillance for HIV: the next decade. Geneva: UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance; 2000. Saxton P, Dickson N, Hughes A, Ludlam A. Gay Auckland Periodic Sex Survey (GAPSS) and Gay mens Online Sex Survey (GOSS): Basic frequency tables 2002-2014. Auckland: The University of Auckland, 2014. https://www.fmhs.auckland.ac.nz/assets/fmhs/soph/sch/gmsh/docs/BFReport_34LoRes.pdf Hughes A, Saxton P. Geographic micro-clustering of homosexual men: Implications for research and social policy. Soc Pol J New Zealand. 2006; 28:158-178. de Wit J, Mao L, Adam P, Treloar C. HIV/AIDS, hepatitis and sexually transmissible infections in Australia: Annual report of trends in behaviour 2014 (Monograph 7/2014). Sydney: Centre for Social Research in Health, UNSW Australia, 2014. Finlayson T, Binh L, Smith A, et al. HIV Risk, Prevention, and Testing Behaviors Among Men Who Have Sex With Men: National HIV Behavioral Surveillance System, 21 U.S. Cities, United States, 2008. MMWR. 2011; 60(SS14);1-34. Williamson L, Dodds J, Mercey D, Hart G, et al. Sexual risk behaviour and knowledge of HIV status among community samples of gay men in the UK. AIDS. 2008; 22:1063-1070. Truong H, Kellogg T, Klausner J, et al. Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting?. Sex Transm Infect. 2006; 82:461-466. Crawford J, Rodden P, Kippax S, Van de Ven P. Negotiated safety and other agreements between men in relationships: risk practice redefined. Int J STD AIDS. 2001; 12: 164-170. Grulich A, de Visser R, Badcock P, et al. Homosexual experience and recent homosexual encounters: the Second Australian Study of Health and Relationships. Sex Health. 2014; 11:439-450. Lucassen M, Clark T, Moselen E, et al. Youth12 The Health and Wellbeing of Secondary School Students in New Zealand: Results for Young People Attracted to the Same Sex or Both Sexes. Auckland: The University of Auckland, 2014. Rich J. HIV prevention among gay and bisexual men. Paper presented at Three Decades of HIV in New Zealand HIV Clinical Update, 8th May 2015. http://player.vimeo.com/external/130713756.sd.mp4?s=eea703ddb3ed5aa75178674d7dace69a&profile_id=112 Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011; 365:493-505. The INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015; 373:795-807. McCormack S, Dunn D. Pragmatic Open-Label Randomised Trial of Preexposure Prophylaxis: The PROUD Study. 2015 Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, USA, abstract 22LB, 2015. Molina JM, Capitant C, Charreau I, et al. On Demand PrEP With Oral TDF-FTC in MSM: Results of the ANRS Ipergay Trial. 2015 Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, USA, abstract 23LB, 2015. Kippax S. Biomedical prevention: rhetoric and reality. HIV Australia. 2015; 13:8-11. https://www.afao.org.au/library/hiv-australia/volume-13/vol-13-number-2-horizons/biomedical-prevention-rhetoric-and-reality National AIDS Trust. HIV prevention in Englands high prevalence local authorities 2013/14 and 2014/15: Examining spending on primary HIV prevention and additional HIV testing. London: National AIDS Trust, 2015. http://www.nat.org.uk/media/Files/Publications/Prevention_Report_2015-1.pdf Ludlam A, Saxton P, Dickson N, Hughes A. Attitudes towards safe sex among men who have sex with men in New Zealand: Findings from the GAPSS and GOSS surveys 2002-2011. Research brief to the Ministry of Health. Dunedin: AIDS Epidemiology Group, University of Otago, 2012. https://www.fmhs.auckland.ac.nz/assets/fmhs/soph/sch/gmsh/docs/gapss-goss-attitudes-research-brief.pdf Lachowsky NJ, Dewey CE, Dickson NP, et al. Habitual condom use across partner type and sexual position among younger gay and bisexual men: findings from New Zealand HIV behavioural surveillance 2006-2011. Sex Transm Infect. 2015; 91:445-450 Coughlan E, Young H, Parkes C, et al. A novel response to an outbreak of infectious syphilis in Christchurch, New Zealand. Sex Health. 2015; 12:170-3. The Institute of Environmental Science and Research Ltd. Enhanced Surveillance of Infectious Syphilis in New Zealand Sexual Health Clinics - 2013. Porirua: ESR, 2014. Basu I, Bromhead C, Balm M, et al. Lymphogranuloma venereum in men who have sex with men: evidence of local transmission in New Zealand. N Z Med J. 2015;128:25-9. Public Health England. Sexually transmitted infections and chlamydia screening in England, 2014. Health Protection Report. 2015; 9:22. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/437433/hpr2215_STI_NCSP_v6.pdf - -

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