Gay and Bisexual Men's Sexual Partnerships and Variations in Risk Behaviour

Article excerpt

ABSTRACT: In epidemiological studies that focus on gay men's sexual risk behaviour the context in which it occurs is often ignored. Increasingly, knowledge of the type and nature of the partnerships is seen to be important when assessing sexual risk behaviour. For this study, gay and bisexual men were recruited through community groups, gay bars and bathhouses to complete a questionnaire on sexual practices with primary and casual same-sex partners. Partnerships were grouped as primary (16.2%, n = 110), casual (40.0%, n = 187) and both primary and casual (16.2%, n = 76). In these configurations 40.0%, 13.3% and 31.4% respectively reported at least one episode of unprotected sex in the previous three months. In the subgroup of men with both primary and casual partners a number varied their behaviour significantly with partner type. Most important, the pattern was for men to refrain from risky activities with their casual partners. However, for some men a reverse pattern of risk was reported. These findings emphasize that, for HIV education and prevention, there is a need to address the diversity of mens' relationships, to recognize the diversity of behaviour within relationships and to open discussion about the factors that influence condom use.

Key words: Gay men Bisexual men Sexual risk behavior Partnership characteristics

INTRODUCTION

Understanding the evolution of the HIV/AIDS epidemic among gay and bisexual men requires greater knowledge of their sexual risk-taking behaviour and changes they have made to their behaviour. In view of the fact that a substantial number of men continue to report high risk sex, a more in-depth understanding of the variation in behaviour and the broad determinants of that variation is essential (Haour-Knipe & Aggleton, 1998; International Summer Institute, 1997). Many examinations of individual and group determinants, have focussed on the biological and psychological aspects of risk behaviour (Misovich et al., 1997; Bastard and Cardia-Voneche, 1997a). Considerable emphasis has been placed on sociodemographic characteristics such as age, AIDS knowledge, substance use and peer group influences (Davies et al., 1992; Hays et al., 1997; Joseph et al., 1987a; Joseph et al., 1987b; Leigh & Stall, 1993). Understanding of these factors has led researchers to focus on the social interactions and the context of sexual encounters (Bastard et al., 1997; Boulton, 1994; Gold, 1993; Schellenberg & Linnebach, 1998; Shedden, 1998). Increasingly,. the role of relationship status as a determinant of sexual risk-taking is considered (Adam et al., 1998).

Over the past ten years, there has been extensive variation both in the terminology and operational definitions used to describe the sexual partnerships of gay and bisexual men (Misovich, Fisher, & Fisher, 1997). The literature refers both to type of partners and type of relationship. Reference has been made to regular and casual partnerships (Connell et al., 1989; Weatherburn et al., 1991), regular and nonregular partners (Fitzpatrick et al., 1990), steady and casual partners (Sasse et al., 1990 as cited by Pollack, 1994) and steady partners (i.e., those with lovers or intimate partners), friends (i.e., partners known well but who are not lovers or intimates) and casual or anonymous partners (McKirnan et al., 1995). Some of the early definitions included monogamous relationships, serial relationships, and relationship plus casual partners--where one or both of the partners in a relationship have casual sex; monogamous and non-monogamous relationships; exclusive, nonexclusive and both exclusive and non-exclusive; and monogamous versus non-exclusive or open (Connell et al., 1989; Fitzpatrick et al., 1990; Hickson et al., 1992; Weatherburn et al., 1991). A more detailed operational definition has been provided by Davies et al. (1993). This group described a regular partner as one with whom sex occurred more than once and where the second and subsequent meetings were not accidental and with whom there was an intention to have sex in the future. …