Cross-sectional study of sexual behaviour and health of gay and bisexual men in suburban Sydney, New South Wales, Australia: contrasts between sex venue and clinic attendees
Catriona Ooi![https://orcid.org/0000-0002-7214-2978](/media/client/orcid_16x16.png)
A Northern Sydney Local Health District Sexual Health Service, NSW, Australia.
B Northern Clinical School, Faculty of Health and Medicine, University of Sydney, NSW, Australia.
C Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
D Sydney Sexual Health Centre, Sydney, NSW, Australia.
E Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, Australia.
F Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, Australia.
G Corresponding author. Email: catriona.ooi@health.nsw.gov.au
Sexual Health 18(3) 248-253 https://doi.org/10.1071/SH20196
Submitted: 5 November 2020 Accepted: 6 April 2021 Published: 20 May 2021
Abstract
Background: In Australia, men-who-have-sex-with-men (MSM) have higher rates of sexually transmissible infections (STIs) and HIV compared with heterosexual men. We compared demographics, behaviour and HIV/STI prevalence for MSM attending a sex-on-premises-venue (SOPV) or the local sexual health clinic (SHC) to determine key differences. Methods: Men attending a SOPV during onsite HIV/STI screening from November 2015 for 12 months were compared with MSM attending a local SHC for screening. Each group completed a self-administered questionnaire and STI/HIV testing. Data analysis was performed using SPSS. Results: Compared with SHC participants (n = 108), SOPV participants (n = 84) had a higher median age (47 years [range, 22–88] vs 33 years [range, 19–71]; P < 0.001) and less likely to report previous HIV testing (73% vs 89%; P < 0.01), STI testing (60% vs 90%; P < 0.001) or be vaccinated for hepatitis A (32% vs 65%; P < 0.001) or hepatitis B (35% vs 73%; P < 0.001). SOPV participants were more likely to be married, widowed or have a long-term female partner (39% vs 7%; P < 0.001) and have a higher prevalence of urethral and rectal chlamydia (7% vs 1%; P = 0.02 and 8% vs 2%; P = 0.03, respectively). There was no significant difference between the groups for detection of syphilis (4% vs 9%), gonorrhoea (5% vs 9%) or HIV (1% vs 0%). Conclusion: MSM attending the SOPV had higher anogenital chlamydial prevalence compared with those attending the SHC. They reported higher rates of sex with female partners, which may facilitate STI/HIV transmission to heterosexual populations. Our findings have implications for HIV/STI service provision, contact tracing and local health promotion initiatives.
Keywords: health services, men who have sex with men (MSM), risk behaviours, screening, sex on premises venue (SOPV), sexual behaviours, sexuality, sexually transmissible infections (STIs).
References
[1] The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report 2019. Sydney: Kirby Institute, UNSW Sydney; 2019.[2] Templeton DJ, Read P, Varma R, Bourne C. Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence. Sex Health 2014; 11 217–29.
| Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence.Crossref | GoogleScholarGoogle Scholar | 24690473PubMed |
[3] Prestage G, Brown G, Keen P. Barriers to HIV testing among Australian gay men. Sex Health 2012; 9 453–8.
| Barriers to HIV testing among Australian gay men.Crossref | GoogleScholarGoogle Scholar | 23380195PubMed |
[4] Zablotska I, Holt M, de Wit J, McKechnie M, Mao L, Prestage G. Gay men who are not getting tested for HIV. AIDS Behav 2012; 16 1887–94.
| Gay men who are not getting tested for HIV.Crossref | GoogleScholarGoogle Scholar | 22538372PubMed |
[5] Barth KR, Cook RL, Downs JS, Switzer GE, Fischhoff B. Social stigma and negative consequences: factors that influence college students’ decisions to seek testing for sexually transmitted infections. J Am College Health 2002; 50 153–9.
| Social stigma and negative consequences: factors that influence college students’ decisions to seek testing for sexually transmitted infections.Crossref | GoogleScholarGoogle Scholar |
[6] Mimiaga MJ, Goldhammer H, Belanoff C, Tetu A, Mayer K. Men who have sex with men: perceptions about sexual risk, HIV and sexually transmitted disease testing, and provider communication. Sex Transm Dis 2007; 34 113–9.
| Men who have sex with men: perceptions about sexual risk, HIV and sexually transmitted disease testing, and provider communication.Crossref | GoogleScholarGoogle Scholar | 16810121PubMed |
[7] Denison HJ, Bromhead C, Grainger R, Dennison EM, Jutel A. Barriers to sexually transmitted infection testing in New Zealand: a qualitative study. Aust N Z J Public Health 2017; 41 432–7.
| Barriers to sexually transmitted infection testing in New Zealand: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 28664644PubMed |
[8] Pell C, Donohoe S, Conway D. Health care services for men who have sex with men in different Australian states and territories since the emergence of HIV. Sex Health 2008; 5 161–8.
| Health care services for men who have sex with men in different Australian states and territories since the emergence of HIV.Crossref | GoogleScholarGoogle Scholar | 18588781PubMed |
[9] Santella AJ, Schlub TE, Ooi C, Varma R, Holt M, Prestage G, et al Sexual behaviour and HIV prevention needs of men attending a suburban Sex on Premises Venue. Sex Health 2015; 12 383–9.
| Sexual behaviour and HIV prevention needs of men attending a suburban Sex on Premises Venue.Crossref | GoogleScholarGoogle Scholar | 26188482PubMed |
[10] Bingham TA, Secura GM, Behel SK, Bunch JG, Simon PA, MacKellar DA. HIV risk factors reported by two samples of male bathhouse attendees in Los Angeles, California, 2001–2002. Sex Transm Dis 2008; 35 631–6.
| HIV risk factors reported by two samples of male bathhouse attendees in Los Angeles, California, 2001–2002.Crossref | GoogleScholarGoogle Scholar | 18545142PubMed |
[11] Binson D, Woods WJ, Pollack L, Paul J, Stall R, Catania JA. Differential HIV risk in bathhouses and public cruising areas. Differential HIV risk in bathhouses and public cruising areas. Am J Public Health 2001; 91 1482–6.
| Differential HIV risk in bathhouses and public cruising areas. Differential HIV risk in bathhouses and public cruising areas.Crossref | GoogleScholarGoogle Scholar | 11527785PubMed |
[12] Melendez-Torres GJ, Nye E, Bonell C. Is location of sex associated with sexual risk behaviour in men who have sex with men? Systematic review of within-subjects studies. AIDS Behav 2016; 20 1219–27.
| Is location of sex associated with sexual risk behaviour in men who have sex with men? Systematic review of within-subjects studies.Crossref | GoogleScholarGoogle Scholar | 25972073PubMed |
[13] Pastuszczak M, Bociaga-Jasik M, Sitko M, Wojas-Pelc A. HIV infection and sex in sex-on-premises venues are associated with a higher risk of syphilis reinfection among men who have sex with men. Postepy Dermatol Alergol 2018; 35 481–4.
| HIV infection and sex in sex-on-premises venues are associated with a higher risk of syphilis reinfection among men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 30429705PubMed |
[14] Wood M, Ellks R, Grobicki M. Outreach sexual infection screening and postal tests in men who have sex with men: are they comparable to clinic screening? Int J STD AIDS 2015; 26 428–31.
| Outreach sexual infection screening and postal tests in men who have sex with men: are they comparable to clinic screening?Crossref | GoogleScholarGoogle Scholar | 24912535PubMed |
[15] Zhao J, Chen L, Cai WD, Tan JG, Zheng CL, Cheng JQ, et al HIV infection and sexual behaviors among non-commercial men who have sex with men at different venues. Arch Sex Behav 2014; 43 801–9.
| HIV infection and sexual behaviors among non-commercial men who have sex with men at different venues.Crossref | GoogleScholarGoogle Scholar | 23982566PubMed |
[16] Bennett C, Knight V, Knox D, Gray J, Hartmann G, McNulty A. An alternative model of sexually transmissible infection testing in men attending a sex-on-premises venue in Sydney: a cross-sectional descriptive study. Sex Health 2016; 13 353–8.
| An alternative model of sexually transmissible infection testing in men attending a sex-on-premises venue in Sydney: a cross-sectional descriptive study.Crossref | GoogleScholarGoogle Scholar |
[17] Lister NA, Smith A, Tabrizi SN. Comprehensive clinical care on-site in men-only saunas: confidential STI/HIV screening outreach clinic. Int J STD AIDS 2005; 16 794–8.
| Comprehensive clinical care on-site in men-only saunas: confidential STI/HIV screening outreach clinic.Crossref | GoogleScholarGoogle Scholar | 16336760PubMed |
[18] Ooi C, Kong FYS, Lewis DA, Hocking JS. Prevalence of sexually transmissible infections and HIV in men attending sex-on-premises venues in Australia: a systematic review and meta-analysis of observational studies. Sex Health 2020; 17 135–48.
| Prevalence of sexually transmissible infections and HIV in men attending sex-on-premises venues in Australia: a systematic review and meta-analysis of observational studies.Crossref | GoogleScholarGoogle Scholar | 32228828PubMed |
[19] Chan D, Stewart M, Smith M, Price T, Lusk J, Ooi C, et al The rise of targeted HIV oral rapid testing in Australia. Med J Aust 2015; 202 251–4.
| The rise of targeted HIV oral rapid testing in Australia.Crossref | GoogleScholarGoogle Scholar | 25758695PubMed |
[20] Pilcher CD, Louie B, Facente S, Keating S, Hackett J, Vallari A, et al Performance of rapid point-of-care and laboratory tests for acute and established HIV infection in San Francisco. PLoS One 2013; 8 e80629
| Performance of rapid point-of-care and laboratory tests for acute and established HIV infection in San Francisco.Crossref | GoogleScholarGoogle Scholar | 24349007PubMed |
[21] Debattista J, Dwyer J, Anderson R, Rowling D, Patten J, Mortlock M. Screening for syphilis among men who have sex with men in various clinical settings. Sex Transm Infect 2004; 80 505–8.
| Screening for syphilis among men who have sex with men in various clinical settings.Crossref | GoogleScholarGoogle Scholar | 15572624PubMed |
[22] Marks G, Gardner LI, Rose CE, Zinski A, Moore RD, Holman S, et al Time above 1500 copies: a viral load measure for assessing transmission risk of HIV-positive patients in care. AIDS 2015; 29 947–54.
| Time above 1500 copies: a viral load measure for assessing transmission risk of HIV-positive patients in care.Crossref | GoogleScholarGoogle Scholar | 25768835PubMed |
[23] Bernstein KT, Liu KL, Begier EM, Koblin B, Karpati A, Murrill C. Same-sex attraction disclosure to health care providers among New York City men who have sex with men: implications for HIV testing approaches. Arch Intern Med 2008; 168 1458–64.
| Same-sex attraction disclosure to health care providers among New York City men who have sex with men: implications for HIV testing approaches.Crossref | GoogleScholarGoogle Scholar | 18625927PubMed |