Paul VAN DE VEN Patrick RAWSTORNE June CRAWFORD Susan KIPPAX

Transcription

1 Paul VAN DE VEN Patrick RAWSTORNE June CRAWFORD Susan KIPPAX

2 Paul VAN DE VEN Patrick RAWSTORNE June CRAWFORD Susan KIPPAX Monograph 2/2001 National Centre in HIV Social Resaerch Faculty of Arts and Social Sciences The University of New South Wales

3 Copies of this monograph or any other publications from this project may be obtained by contacting : National Centre in HIV Social Research Level 2, Webster Building The University of New South Wales Sydney NSW 2052 AUSTRALIA Telephone (61 2) Fax (61 2) nchsr@unsw.edu.au National Centre in HIV Social Research 2001 ISBN Paul Van De Yen National Centre in HIV Social Research The University of New South Wales Patrick Rawstorne National Centre in HIV Social Research The University of New South Wales June Crawford National Centre in HIV Social Research The University of New South Wales Susan Klppax National Centre in HIV Social Research The University of New South Wales

4 CONTENTS List of Tables Acknowledgements INTRODUCTION METHOD Questionnaire Procedure Sample Data analysis and presentation Scales DEMOGRAPHIC VARIABLES Age Country of birth Education Labour force status Occupation State Area of residence Living situation MILIEU VARIABLES Sexual identity Gay identity disclosure Contact with the HIV epidemic Social engagement with gay community Gay community attachment HIV status Recency of HIV testing SEXUAL RELATIONSHIPS AND SEXUAL PRACTICES Number of sexual partners Sexual relationships with men Sexual practices Sex with female partners Condom use with female partners Anal intercourse with women CONDOM USE Types of male sexual partners Regular partners Regional differences Agreements Casual partners Regional differences Beats, saunas, sex clubs Attitudes toward condoms Avoidance and expectations DRUG USE HIV OPTIMISM CONCLUSIONS REFERENCES APPENDIX ii iii

5 LIST OF TABLES Table 1 : Age bands Table 2: Country of birth Table 3: Education level Table 4 : Labour force status Table 5: Occupation Table 6 : State of residence Table 7: Area of residence Table 8: Living situation Table 9 : Sexual identity Table 10 : Gay identity disclosure Table 11 : Contact with the HIV epidemic Table 12: Social engagement with gay community Table 13: Gay community attachment Table 14 : HIV status 13 Table 15: HIV status by gay community attachment Table 16: Men without HIV test results by age category Table 17 : Time of most recent HIV test Table 18 : Time of most recent HIV test by gay community attachment Table 19: Number of male and female sexual partners in previous six months Table 20 : Number of male sexual partners in previous six months by gay community attachment Table 21 : Number of female partners in previous six months by gay community attachment Table 22 : Current sexual relationships with men Table 23 : Current sexual relationships with men by gay community attachment Table 24 : Sexual practices with regular partners 'in the previous six months' by gay community attachment: includes only those men with regular partners Table 25 : Sexual practices with casual partners 'in the previous six months' by gay community attachment: includes only those men with casual partners Table 26: Sexual practices ('occasionally' or 'often') with regular or casual male partners in past six months 20 Table 27 : Female sexual partners in the previous six months Table 28: Condom use with female partners in the six previous months Table 29 : Anal intercourse with women Table 30 : Types of male sexual partners in the six months prior to the survey Table 31 : Anal intercourse with regular partners Table 32 : Anal intercourse with regular partners by gay community attachment Table 33 : Anal intercourse with regular partners by HIV serostatus Table 34 : Anal intercourse with regular partners by State-2000 data Table 35 : Anal intercourse with regular partners by area of residence-2000 data Table 36 : Type of agreement with regular partner about anal sex within the relationship Table 37 : Type of agreement with regular partner about sexual interactions with casual partners Table 38 : Anal intercourse with casual partners Table 39 : Anal intercourse with casual partners by gay community attachment Table 40 : Anal intercourse with casual partners by HIV serostatus Table 41 : Anal intercourse with casual partners by State-2000 data Table 42 : Anal intercourse with casual partners by area of residence-2000 data Table 43 : Unprotected anal intercourse with casual partners (UAIC) in the six months prior to the survey among men who reported having sex at a Beat, Sauna or Sex club Table 44 : Attitudes toward Condoms scale, total sample and by gay community attachment Table 45 : Extent to which men reported avoiding having sex with people they think have HIV, by gay community attachment and HIV serostatus Table 46 : Expectations that an HIV positive man would disclose his status prior to sex, by gay community attachment and HIV serostatus Table 47 : Drug use in the six months prior to the survey Table 48 : Drug use in the six months prior to the survey by gay community attachment Table 49 : Injecting drug use, ever Table 50 : HIV Optimism scale scores, by HIV serostatus and unprotected anal intercourse with casual (UAIC) and regular (UAIR) partners-2000 data II

6 ACKNOWLEDGEMENTS FUNDING: Commonwealth Department of Health and Aged Care CONSULTATIVE COMMITTEE MEMBERS: Clive Aspin (NCHSR), Paul Lehmann and Roger Nixon (DHAC), Garrett Prestage (NCHECR), Russell Westacott (AFAO/NAPWA) QUESTIONNAIRE DISTRIBUTION: The late Gerry Hercus of Champions Video of Australia who generously distributed the questionnaires without charge. DATA CODING: Limin Mao (NCHSR) DATA ENTRY: janice Bull (Bull Consulting) LAYOUT & DESIGN: judi Rainbow (NCHSR) PARTICIPANTS: The 1832 men who completed and returned a questionnaire and thereby allowed us to document some of the intimate details of their lives. lll

7 Executive Summary The key findings of the 2000 Male Out Survey are presented in dot point form in the Conclusions section of this report. Introduction An integral part of Australia's response to the HIV/AIDS epidemic has been a program of behavioural and epidemiological research for the purpose of informing, implementing and evaluating education and prevention programs. The first Project Male Call survey of homosexually active men', conducted in 1992 within the context of evaluation of the first National HIV/AIDS Strategy, was part of that behavioural research program (Kippax et al., 1994). Following the evaluation of the second National HIV/AIDS Strategy (Feachem, 1996), the then Commonwealth Department of Heath and Family Services commissioned the National Centre in HIV Social Research to provide an update to and a comparison with the 1992 survey. That survey was known as Male Call 96 (Crawford et al., 1998). At this stage of the HIV/AIDS epidemic in Australia, the vast majority of cases of AIDS, people infected with HIV and new transmissions of HIV continue to be found among homosexually active men. In Australia, data on new HIV infections have been reported since In the period from 1 january 1995 to 30 September 2000, 82 per cent of new diagnoses of HIV infection were attributed to 'male homosexual/bisexual contact' or 'male homosexua l/bisexua l contact and injecting drug use' (National Centre in HIV Epidemiology & Clinical Research, 2001 ). Against this background, large national surveys such as Project Male Call in 1992 and Male Call 96 are important. To be of use to evaluators, policy makers and educators, such surveys must be conducted, analysed and reported with appropriate academic rigour. It is important to obtain information from a wide variety of homosexually active men, including men who also have sex with women. A large sample, which contains men from a wide spectrum of society-in terms of age, social class, geographic area, and degree of gay community attachment-is needed in order to provide a credible snapshot of sexual practice among homosexually active men at a particular point in time. ' The 'term homosexually active men' is used to include all men who have sex with men; from time to time we use the term 'gay and homosexually active men' to emphasise that both gay-identified men and those not so identified are included. Facts & Figures : 2000 Mole Out Survey

8 This is an important juncture in the HIV epidemic, as Australia moves into a phase of direct involvement in HIV vaccine trials. In terms of documenting gay men's sexual and other behaviours, policy makers and educators across Australia are well-served by various studies which are in place or about to start. The Positive Health (ph) Cohort Study in Sydney and Melbourne (Prestage et al., 2000), and the national HIV Futures surveys (Grierson et al., 2000), provide detailed information on the lives of HIV positive people. The forthcoming Health in Men (HIM) open cohort study of HIV negative men in Sydney will provide rich data in the context of HIV vaccine initiatives. In addition, Gay Community Periodic Surveys are now conducted in Sydney (Prestage et al., 1999), Melbourne (Aspin et al., 2000a), Queensland (Aspin et al., 2000b), Perth (Van de Yen et al., 1999), Adelaide (Van de Yen et al., 2000b) and Canberra (Aspin et al., 2001 ). These periodic surveys provide regular and timely data based on large samples of gay men in Australia's principal cities. Since Project Male Call in 1992 and Male Call 96, there is one important group of homosexually active men about which there are few new data. This is the group of men who have sex with men but who at the same time are not gay community attached, often do not identify as gay, are likely to have sex with women as well as men and are likely to live outside the larger cities with recognisable gay communities. Very few of these sorts of men are ever recruited into cohort studies or into periodic surveys conducted largely within gay communities. It remains important to document these men's sexual and other behaviours at this point in the epidemic. To this end, we initiated the 2000 Male Out Survey as part of the four-year cycle of national surveys of Australian homosexually active men. In both Project Male Call (n=2583) and the Male Call 96 survey (n=3039), large numbers of men were recruited through leaflets inserted in the direct marketing campaigns of a mail-order pornographic video distributor. This distributor has an extensive mailing list which covers every part of Australia. Of the 534 and 588 men, respectively, recruited into Project Male Call and Male Call 96 through this strategy, approximately 47% of the men were defined as non gay community attached. This strategy had been shown to be an effective and cost efficient way of recruiting such men. With the cooperation of the mail-order pornographic video distributor, the same recruitment strategy was adapted for the 2000 Male Out Survey. The method involved a self-complete questionnaire along the lines of those used successfully in the Gay Community Periodic Surveys which we conduct in collaboration with the National Centre in HIV Epidemiology and Clinical Research. The questionnaires were distributed with the pornographic video catalogues and returned to the National Centre in HIV Social Research via a reply-paid service. 2 Van de Ven, Rawstorne, Crawford & Kippax

9 ... ~. Me--- t _: h : o... i d /.._,. : Project Male Call in 1992 and Male Call 96 recruited homosexually active men through a variety of sources which included advertisements in gay and mainstream media, pamphlets and posters, and pornographic video catalogues. For the 2000 Male Out Survey, only pornographic video catalogues were used. QUESTIONNAIRE A copy of the questionnaire is provided in the Appendix. The interview schedules for Project Male Call in 1992 and Male Call 96 contained approximately 150 questions, many requesting detailed responses to a large number of items. It is not feasible to ask so many questions in such detail in a self-complete instrument. Hence, the 2000 Male Out questionnaire contained only 62 relatively short questions. Areas covered in the questionnaire included: sexual identity and disclosure; sexual relationships with men and with women; sexual practices with men; agreements with regular male partners; sexual intercourse with women; gay community attachment; HIV testing; contact with the HIV epidemic; attitudes toward condoms; HIV optimism; drug use; demographic characteristics. PROCEDURE Questionnaires were distributed through the two pornographic video catalogues used for recruitment into Project Male Call in 1992 and Male Call 96. A questionnaire was distributed with 120,000 'straight' catalogues (which contained a very small selection of homosexual and bisexual products at the end of the catalogue) in August Likewise, 15,000 questionnaires were distributed with a 'gay' catalogue in September As previously, only men who had had sex with another man in the past five years were eligible. Participation was voluntary and anonymous, and men returned questionnaires to the National Centre in HIV Social Research via a reply-paid service. SAMPLE Within a month or two of the distribution, 1832 completed questionnaires were returned. A small number of incomplete questionnaires-as well as those which contained obscenities only, typically homophobic-were discarded. Facts & Figures : 2000 Mole Out Survey 3

10 Naturally, there is no way of determining response rate. No doubt, most of questionnaires were delivered to people ineligible to participate in the survey. It must be said, however, that the overall response was very pleasing and far exceeded our initial expectations of 700 participants. This estimate was based on frequency of recruitment through this strategy into the 1992 and 1996 Male Call surveys as well as simplified method (i.e. short self-complete questionnaire to be completed at any time versus lengthy telephone interview at designated times). Unlike for Project Male Call in 1992 and Male Call 96, no competing recruitment strategies were employed. When asked where they heard about these previous surveys, men may have nominated one of the other strategies even though they may have at some time also received a leaflet through a pornographic video catalogue. This is a likely explanation for the greater proportion of gay identified and gay community attached men who participated in the current survey (see below). DATAANALYSISANDPRESENTATION In this report, the 2000 Male Out Survey data are presented and compared (wherever possible) with comparable data from Project Male Call (1992) and Male Call 96, i.e. with earlier data from those participants who were recruited through brochures distributed with pornographic video catalogues (n=534 and 588, respectively). The data are presented for the sample as a whole. As well, the findings are (where relevant) broken down by HIV serostatus, by locality, and most importantly by degree of gay community attachment, gay community attached (GCA) versus non-gay community attached (NGCA). In 2000, these gay community attachment binary categories were derived from the total scale score for Community Attachment (or Social Engagement as it is sometimes referred to) that, itself, was calculated from the sum of the scores on the two items measuring the amount of free time spent with gay men and number of gay friends (see questions 33 and 34, Appendix). Scores on the scale range from 0 to 6, with a score of 2 or greater used as the indicator of gay community attachment. In 1992 and 1996 this scale was calculated with the addition of variables that measured where the respondent went with gay male friends (gay bars, discos, parties, pool/beach, meetings/organisations). This latter information was not asked of respondents in 2000 and its omission has made very little difference to the scale score. For example, there is a strong correlation between the previously calculated measure (including social places) and the newly calculated measure (omitting social places), r 10, = 0.86, p < The data are presented mainly as counts and frequencies. For these mostly categorical variables, l tests of association were used to examine statistical significances. F- and t-tests were used to determine statistical significances among scale means. As with other large datasets, analysis of the 2000 Male Out Survey data will continue and new findings may necessitate some reinterpretation of those reported here. 4 Van de Ven, Rawstorne, Crawford & Kippax

11 SCALES The Attitudes toward Condoms scale was formed, as in previous years, from three items (see Question 39, Appendix): I can't be bothered using condoms all the time because they are a nuisance; Condoms reduce sensitivity; Condoms can be fun and erotic. Items were coded so that high scores on the scale indicate a positive attitude to condoms. Scores on this scale range from 3 to 12. Coefficient alpha in the Male Call 96 sample was.52 and in 2000 was.66. The HIV Optimism scale was based on three items (see Question 48, Appendix) from a larger 12-item scale (Van de Ven et al., 2000a) which forms the basis of the International Collaboration on HIV Optimism with research partners in Australia, Canada, England, France, the Netherlands and Scotland. Items were coded so that high scores on the scale reflect a greater degree of optimism in light of the changed HIV therapeutic environment which began around Scores on this scale range from 4 to 12. Coefficient alpha in this sample was.85. ' Facts & Figures : 2000 Male Out Survey 5

12 AGE The men were aged between 16 and 82 (median = 38 years). As shown in Table 1, there were fewer men in the and age bands, and more in the and > 50 age bands, than in previous surveys. Table 1 : Age bands n % n % n % < > NR TOTAL P<.001 NR = No response (Note: Non response was greater in 2000 than in previous years, as was expected with a self-complete questionnaire rather than a telephone interview.) COUNTRY OF BIRTH As shown in Table 2, and consistent with previous surveys, most of the men were born in Australia or New Zealand. The 2000 Male Out Survey recruited a smaller proportion of men born in the UK or Ireland and a greater proportion of men born in an Asian country, reflecting general population trends. Table 2: Country of birth n % n % n % Australia I NZ Non-indigenous Aboriginal or Torres Strait Islander USA/Canada UK I Ireland Other Europe Asia Central or Sth. America Africa Oceania NR TOTAL p <.001 NR = No response 6 Van de Ven, Rawstorne, Crawford & Kippax

13 EDUCATION As in other surveys of homosexually active men, there was an over-representation of men with post-secondary qualifications (see Table 3). This was more marked in 2000 than in previous years. Table 3: Education level n % n % n % Primary only Intermediate School Certificate HSC or equivalent Diploma I Trade Tertiary NR TOTAL p<.001 NR =No response LABOUR FORCE STATUS As shown in Table 4, the majority of the men were in some form of full-time employment, although less so in 2000 than in previous years. Part-time employment has remained fairly steady. Unemployed status has declined over the years whereas receipt of other social security benefits has gradually increased. Table 4: Labour force status n % n % n % Wage-salary I Self-employed I Employer Full-time employment Part-time employment Unemployed Student Social security Other I NR TOTAL p<.001 NR = No response Facts & Figures : 2000 Male Out Survey 7

14 OCCUPATION As in previous surveys of homosexually active men, there was an over-representation of men in managerial and professional roles (see Table 5). The 2000 survey attracted a smaller proportion of tradesmen and labourers and a greater proportion of men in clerical and sales/service positions than previous surveys. TableS: Occupation n o/o n o/o n o/o Manager Professional Paraprofessional Trade Clerical Sales I service Machinist Labourer NA/NR TOTAL p <.001 NA = Not Applicable, NR = No response STATE As anticipated, the 2000 survey recruited men roughly in proportion to the overall size of the population of the States (see Table 6). The recruitment strategy utilising questionnaires sent out with pornographic video catalogues is effective at attracting participants from the States with a smaller population base. Whereas the small numbers preclude detailed analyses on a State-by-State basis, it is important that men from all parts of Australia are represented in this national snapshot. Table 6: State of residence n o/o n o/o n o/o ACT NSW VIC OLD WA SA TAS NT NR TOTAL p<.01 NR =No response 8 Van de Ven, Rawstorne, Crawford & Kippax

15 AREA OF RESIDENCE Table 7 presents data based on Question 60 (see Appendix) which was not included in previous surveys. Consistent with Australia's urbanised population, and gay and homosexually active men's tendency to migrate to urban areas, most of the participants lived in capital or major cities. Table 7: Area of residence 2000 n % Capital city Major regional centre Smaller city I town Rural/ remote area NR TOTAL NR = No response LIVING SITUATION The most common living arrangement remained for the men to live alone (see Table 8). Other categories were reasonably consistent over time with the exception of living with a female sexual partner (much smaller proportion in 2000) and living with a male sexual partner (much greater proportion in 2000). These differences are largely reflective of the more strongly gay-identified sample recruited in 2000 (as discussed below). Table 8: Living situation n % n % n % Alone Female sexual partner Male sexual partner Parents I relatives Friends (incl. sex ptnr) Friends (excl. sex ptnr) Other NR TOTAL p <.001 NR = No response Facts & Figures : 2000 Male Out Survey 9

16 M.,,_. b. I I. 1 e/~> u. _ v a"' r11a/ /} :e::./s : _, '! h y '.. -,. - ' ----~ SEXUAL IDENTITY There w ere significant differences in terms of the sexual identification of the men in the samples over time, and it will be important to take these variations into account in interpreting the findings. As show n in Table 9, a smaller proportion of the men in the 2000 sample identified as heterosexual or bisexual, and a correspondingly greater proportion identifi ed as gay. Separate analyses revealed, in line with expectations, an association between sexual identity and gay community attachment. GCA men identified more strongly as gay or homosexual than their NGCA counterparts. Table 9: Sexual identity n % n 0 /o n % Straight I Heterosexual Bisexual Gay Homosexual Other NR TOTAL p<.01 N R = No response GAY IDENTITY DISCLOSURE As in previous years, relatively few men had told no-one that they were sexually attracted to men (see Table 10). Most commonly, the men had disclosed to gay friends, straight friends and workmates. As always, mothers were a more suitable person for disclosure than fathers, yet fully half these men's mothers and nearly two-thirds of their fathers had not been told. The relatively greater degree of disclosure in 2000 than in previous years was attributable to the greater proportion of gay identified men in the latest survey. Separate analyses revealed, not unexpectedly, an association between gay identity disclosure and gay community attachment. In 2000, for example, less than four per cent of GCA men had told no one of their sexual attraction to men compared to almost 23 per cent of their NGCA counterparts. 10 Van de Ven, Rawstorne, Crawford & Kippax

17 Table 10: Gay identity disclosure (n=534) (n=588) (n=1832) Who has been told" n % n % n % No-one Mother Father Children Female ptnr I ex-ptnr Other relatives Gay friends Straight friends Workmates Neighbours Other Categories are not mutually exclusive CONTACT WITH THE HIV EPIDEMIC Both indicators of contact with the HIV epidemic-knowing people with HIV/AIDS and having personally known people who died following AIDS-show a significant increase in 2000 over the previous surveys (see Table 11 ). Again, this is largely attributable to the greater proportion of gay identified and gay community attached men in the latest sample. (Separate analyses revealed that GCA men were more likely to know people with HIV/AIDS, and to have personally known people who died following AIDS, than their NGCA counterparts.) Interestingly, however, a fairly large percentage of the men know no HIV positive people and have never personally known anyone who died from AIDS providing evidence that for a sizeable proportion of the homosexually active male population the HIV epidemic has not been as closely experienced as it has been for others. Table11: Contact with the HIV epidemic n % n % n % Knows how many people with HIV/AIDS None One Two or more NR TOTAL p<.001 Knows anyone who has died from AIDS Yes No NR TOTAL p<.001 NR = No response Facts & Figures: 2000 Mole Out Survey 11

18 SOCIAL ENGAGEMENT WITH GAY COMMUNITY Commensurate with the greater degree of gay identification in 2000 compared with previous years, there was an upturn in two indicators of social en gagement in gay community. As show n in Table 12, the participants in 2000 were more likely to have spent 'some'/'a lot' of free time with gay men than their counterparts in previous surveys. Correspondingly, and on the whole, the men recruited in 2000 tended to have more gay friends than the men recruited in previous years. Table 12: Social engagement with gay community Free time spent with gay men n % n % n % None A little Some A lot NR TOTAL p<.001 Friends who are gay men None A few Some Most All NR TOTAL p <.001 NR = No response GAY COMMUNITY ATTACHMENT For Project Male Call in 1992 and for Male Call 96, approximately half the men in the samples were classified as gay community attached (see Table 13). For the 2000 Male Out Survey there was a significant increase in the proportion of gay community attached men with almost two-thirds so classified. As discussed above, this would be largely attributable to the absence of competing recruitment strategies. In previous surveys some men in close proximity to gay communities would have been recruited through a range of strategies deployed in such communities before they may have come across the leaflets distributed with pornographic video catalogues. Nonetheless, the current survey attracted 651 non gay community attached men which greatly exceeded expectations. This finding, importantly, highlights the utility and cost effectiveness of the pornographic video catalogue recruitment strategy in reaching these otherwise hard-to-reach homosexually active men. 12 Van de Ven, Rawstorne, Crawford & Kippax

19 Table 13: Gay community attachment n % n % n % Gay community attached (GCA) Non gay community attached (NGCA) TOTAL p <.001 HIVSTATUS The men recruited in 2000 were significantly more likely to know their HIV status than those who participated in the previous years (see Table 14). Hence, a greater proportion reported being either HIV negative or HIV positive. In all, only 86 men reported positive H IV serostatus. The proportion of men without HIV test results (22%) is approximately double that for men who participate in Gay Community Periodic Surveys conducted in the major capital cities of Australia (Van de Ven et al., 2000c). Table 14: HIV status n % n % n % No test/ No result/ NR HIV negative HIV positive TOTAL p <.001 NR =No response Knowledge of HIV status varied by degree of gay community attachment, as shown in Table 15. Non gay community attached men were approximately twice as likely as their gay community attached counterparts to be without HIV test results. Among the gay community attached men there were no significant differences in HIV status over time. Among the non gay community attached men there was a trend over the years toward a smaller proportion without H IV test results. Of the 86 HIV positive participants in the 2000 Male Out Survey, 75 were gay community attached men and 11 were non gay community attached men. Facts & Figures : 2000 Mole Out Survey 13

20 Table 15: HIV status by gay community attachment GCA 1 NGCA 2 n=288 n=305 n=1181 n=246 n=283 n=651 % % % % % % No test I No result I NR HIV negative HIV positive TOTAL NR = No response 1 ns, 2 p<.05 Having HIV test results is a factor of age (see Table 16). In 2000, as in 1996, younger (<25 years) and older (50+ years) men were less likely to have HIV results than men aged between 25 and 49 years. Also shown in Table 16, younger (<25 years) and older (50+ years) men were significantly less likely in 2000 to have HIV test results than in previous years. The reverse trend applied to men in the and age brackets, with these men significantly more likely to have HIV results at this time. Table 16: Men without HIV test results by age category n % n % n % Trend p < Note: HIV positive men excluded. RECENCY OF HIV TESTING As noted above-and shown in Table 17-a smaller proportion of the non HIV positive participants in 2000 were without HIV test results. Nonetheless, there was a marked downward trend in recency of HIV testing. For example, the proportion of men who had had an HIV test in the last yea r declined from approximately 56% in 1992, to approximately 51% in 1996, to approximately 45% in Van de Ven, Rawstorne, Crawford & Kippax

21 Table 17: Time of most recent HIV test n % n % n % < 1 week weeks months months years years > 4 years NR I Not tested TOTAL p <.001 Note: HIV positive men excluded. NR = No response Although gay community attached men were more likely as a group to have HIV test results, the significant downward trend in recency of HIV testing applied to gay community attached and non gay community attached men alike (see Table 18). Among gay community attached men, the proportion who had had an HIV test in the last year declined from approximately 66% in 1992, to approximately 64% in 1996, to approximately 51 % in Among non gay community attached men, the proportion who had had an HIV test in the last year declined from approximately 44% in 1992, to approximately 38% in 1996, to approximately 34% in Table 18: Time of most recent HIV test by gay community attachment GCA 1 NGCA 2 n=277 n=288 n=1106 n=245 n=282 n=640 % % % % % % < 1 week weeks months months years years > 4 years NRI Not tested TOTAL Note: HIV positive men excluded. NR =No response 1 p<.001, 2 p<.001 Facts & Figures : 2000 Male Out Survey 15

22 Se" x./ u. a/-- I r/ei l;a, t: ~l o; ;n s : h, l p --,s.._,_,,.../,,,.:... J...-/; j '.../ :... d.: ' ',..,../ : :...) :. : ~....,. /.../ and se xual practices NUMBER OF SEXUAL PARTNERS Most commonly, the men had between two and 10 male sexual partners in the six months prior to the 2000 Male Out Survey, consistent with previous years (see Table 19). In 2000, a smaller proportion of the men had a single partner and a greater proportion than in previous surveys were at the extremities with no male sexual partners or with more than 50. (Note: There were slight changes in 2000 to the wording of the items on which this finding was based which may have attributed somewhat to this difference.) Reflective of the greater degree of gay identification and gay community attachment in 2000, a much larger proportion of the men recruited in 2000 had no female sexual partners (over 80 per cent). Table 19: Number of male and female sexual partners in previous six months Male partners n % n % n % None > NR TOTAL p<.001 Female partners None > NR TOTAL p<.001 NR = No response There were changes over time in number of male sexual partners in the previous six months for both gay community attached and non gay community attached men (see Table 20). For both groups, a greater proportion of the 2000 participants had no male partners compared with previous surveys. Not unexpectedly, and consistent with the earlier data, gay community attached men were more likely to have male sexual partners per se and more likely to have a greater number of partners. 16 Van de Ven, Rawstorne, Crawford & Kippax

23 Table20: Number of male sexual partners in previous six months by gay community attachment GCA 1 NGCA 2 n=288 n=305 n=1181 n=246 n=283 n=651 o/o o/o o/o 0 /o o/o o/o None > NR TOTAL NR = No response 1 p <.001' 2 p <.001 As shown in Table 21, there were significant changes over time in number of female sexual partners in the previous six months for both gay community attached and non gay community attached men. The trend among both categories of men in the 2000 Male Out Survey was toward no female sexual partners at all, although non gay community attached men were much more likely to have had any female sexual partners in the previous six months. Interestingly, the sharp drop in the proportion of men with greater than 10 female partners was applicable to gay community attached men and non gay community attached men alike. Further findings about sex with female partners are presented at the end of this section (see Tables 27-29). Table 21 : Number of female partners in previous six months by gay community attachment GCA 1 NGCA 2 n=288 n=305 n=1181 n=246 n=283 n=651 o/o o/o o/o o/o o/o o/o None > NR TOTAL NR =No response 1 p<.001, 2 P<.001 Facts & Figures : 2000 Male Out Survey 17

24 SEXUAL RELATIONSHIPS WITH MEN As shown in Table 22, there were significant changes over time in the men's 'current' sexual relationships with men. The most notable change was in the smaller proportion of men in the 2000 Male Out Survey having casual sex only at the time of the survey. The switch was towards a larger proportion of men who had a regular partner plus casual sex. Table 22: Current sexual relationships with men Type of relationship n o/o n o/o n o/o None Monogamous Regular plus casual Several regular Casual sex only TOTAL * 100 p<.001 Missing data (n=9) The change in relationship patterns-from casual sex only, to regular partner plus casual sex-applied to both gay community attached and non gay community attached men, although gay community attached men remained much more likely to be in a 'regular plus casual' relationship than their non gay community attached counterparts (see Table 23). Of note, non gay community attached men were three times as likely as gay community attached men to report no sexual relationships with men at the time of the 2000 survey. Table 23: Current sexual relationships with men by gay community attachment GCA 1 NGCA 2 n=288 n=305 n=1173* n=246 n=283 n=650** o/o o/o o/o o/o o;o o/o None Monogamous Regular plus casual Several regular Casual sex only TOTAL Missing data (n=8) Missing data (n=1) 1 p <.001, 2 p <.001 SEXUAL PRACTICES Table 24 shows trends for a range of oral and anal sexual practices with regular partners. Oral-genital sex with ejaculation became more commonly practised, particularly among gay community attached men. lnsertive and receptive anal intercourse, including the practice of withdrawal prior to ejaculation, also became more widely practised regardless of 18 Van de Ven, Rawstorn e, Crawford & Kippax

25 degree of gay community attachment. These trends should be examined in light of the greater proportion of gay identified men in the 2000 sample, although it is clear that many of the upward tendencies were evident in Table 24 : Sexual practices with regular partners 'in the previous six months' by gay community attachment: includes only those men with regular partners GCA NGCA (N= )" (N= )" n=149" n=184" n=893" n=81 n=107" n=409" % % % % % % lnsertive oral-genital, no ejaculation Receptive oral-genital, no ejaculation lnsertive oral-genital, with ejaculation Receptive oral-genital, with ejaculation lnsertive anal intercourse Receptive anal intercourse lnsertive anal, withdrawal Receptive anal, withdrawal Note: Sexual practice categories are not mutually exclusive a Fluctuations in N due to missing data Percentages in bold indicate that between 1992, 1996 and 2000 there was a significant trend p < Percentages in italics indicate that between 1992, 1996 and 2000 there was a significant trend p < 0.05 Interestingly, similar trends in oral and anal sexual practices were documented for casual partners (see Table 25). Oral-genital sex with ejaculation was more commonly reported, particularly among gay community attached men. lnsertive and receptive anal intercourse, including the practice of withdrawal prior to ejaculation, also became more prevalent among both gay and non gay community attached men. Again, these trends should be considered in light of the larger proportion of gay identified men in the 2000 sample, although it is clear that many of the upward tendencies were evident in Facts & Figures : 2000 Male Out Survey 19

26 Table 25: Sexual practices with casual partners 'in the previous six months' by gay community attachment: includes only those men with casual partners GCA (N= )" n =199" n=227" % % lnsertive oral-genital, no ejaculation Receptive oral-genital, no ejaculation lnsertive oral-genital, with ejaculation Receptive oral-genital, with ejaculation lnsertive anal intercourse Receptive anal intercourse lnsertive anal, withdrawal Receptive anal, withdrawal NGCA (N= )" n=838" n=152" n=189" % % % n=422" % Note: Sexual practice categories are not mutually exclusive a Fluctuations in N due to missing data Percentages in bold indicate that between 1992, 1996 and 2000 there was a significant trend p < Question 28 in the 2000 Male Out questionnaire (see Appendix) asked about a limited range of 'esoteric' sexual practices with regular or casual male partners. The resultant frequency data (see Table 26) were compared with those from previous surveys, where available. Rimming was more frequently reported, particularly since 1992 (p <.001 ), and likewise fisting (p <.001 ). Comparing the 2000 with the 1996 data, a larger proportion of men practised SM or B&D (p <.01 ). No doubt some of these changes were due to differences in the samples, especially the larger proportion of gay identified men in the 2000 sample. There were no significant changes over time in group sex, that which involved men only or otherwise. Table 26 : Sexual practices ('occasionally' or 'often') with regular or casual male partners in past six months (n=498) (n=549) (n=1753) n % n % n % Rimming Fisting SM or B&D* Group sex (men only)* Other group sex* Note: Categories are not mutually exclusive * Questions about these practices were not asked of respondents in Project Male Call in Van de Ven, Rawstorne, Crawford & Kippax

27 SEX WITH FEMALE PARTNERS Unlike Project Male Call in 1992 and Male Call 96, the 2000 Male Out Survey could include only a limited number of questions about sex with female partners (see Questions 35-38, Appendix). There were minor inconsistencies in the men's responses to these questions resulting in slight discrepancies in n in the following tables. As noted previously, most of the men recruited in 2000-a significantly greater proportion than in previous years-had had no sex with women in the six months prior to the survey (see Table 27). Of those who had in 2000, they were distributed fairly evenly among the three categories of female partnerships: regular only; casual only; regular plus casual. This was a departure from the previous surveys where 'regular female partner only' was much more common than other arrangements. This change was largely attributable to the greater proportion of gay community attached men in the 2000 sample, as evidenced by the separate finding that GCA men are much less likely to have regular female partners only (approximately three per cent) than NGCA men (approximately 13 per cent). Moreover, GCA men are much more likely to have no female sexual partners (approximately 88% ) than their NGCA counterparts (approximately 68%). Table 27: Female sexual partners in the previous six months n % n % n 0 /o No sex with women I NR Sex with regular female partner but no casual female sex Sex with casual female partner(s) but no sex with regular female partners Sex with regular and casual female partners TOTAL p <.001 CONDOM USE WITH FEMALE PARTNERS As in previous years, the men who had female partners were more likely to 'never' use condoms with regular than with casual female partners (see Table 28). However, over time there w as a significant upward trend the men 's reporting of 'sometimes'/'always' having used a condom with regular female partners. With casual female partners there was a significant trend in the opposite direction. Facts & Figures : 2000 Mole Out Survey 21

28 Table 28: Condom use with female partners in the six previous months Regular partners n % n % n % Never use condom with regular female partner Sometimes I always use condom with regular female partner TOTAL* p<.01 Casual partners Never use condom with casual female partner Sometimes I always use condom with casual female partner TOTAL* p<.01. Based on those men who had sex with female partners in the past 6 months and who also responded to Question 37. ANAL INTERCOURSE WITH WOMEN As shown in Table 29, there was a significant upward trend in the practice of anal intercourse with women, such that of the men who had female partners almost 58 per cent engaged in some anal intercourse with women. This finding cannot be attributed solely to the nature of the 2000 sample as the trend was an extension of a 'cultural' shift first noticed in Table 29 : Anal intercourse with women n % n % n o/o No anal intercourse Some anal intercourse TOTAL* p <.001. Based only on men who responded to Question Van de Ven, Rawstorne, Crawford & Kippax

29 C -o./ )n(:d/. o,..:m/[ use :... '....'. F,,...v" TYPES OF MALE SEXUAL PARTNERS As shown in Table 30, approximately 70 per cent of the men in the 2000 Male Out Survey reported sexual contact with regular male partners and approximately 70 per cent reported sexual contact with casual male partners, in the six months prior to the survey. There was a significant upward trend with respect to regular partners and a slight downward trend for casual partners. Caution needs to be exercised in interpreting these trends as some of the differences are no doubt due to variations in the samples, especially the larger proportion of gay identified men in the 2000 sample. Table 30 : Types of male sexual partners in the six months prior to the survey n 1992 {n=534) o/o n 1996 {n=588) o/o 2000 {n=1832) n 0 /o Any sexual contact with regular partners 1 Any sexual contact with casual partners Note: These categories are not mutually exclusive 1 p <.001, 2 p <.05 REGULAR PARTNERS In the overall sample, there was a significant change in sex with regular partners (see Table 31 ). A smaller proportion of the 2000 participants had no regular partners and a larger proportion had any unprotected anal intercourse with regular partners in the six months prior to the survey. The proportionate increase in any unprotected anal intercourse with regular partners remains if the trends are examined only among the men who had regular partners (see lower half of Table 31 ). Table 31: Anal intercourse with regular partners n o/o n o/o n o/o Total sample No regular partners No anal intercourse Always protected Any unprotected TOTAL p<.001 Men who had regular partners No anal intercourse Always protected Any unprotected TOTAL p<.001 Fa c ts & Figures: 2000 Male Out Survey 23

30 The increase in the proportion of men who reported any unprotected anal intercourse with regular partners applied to gay community attached and non gay community attached men alike (see Table 32). Whereas gay community attached men were more likely than their non gay community attached counterparts to have had regular partners and more likely to have had any unprotected anal intercourse with regular partners, both groups were more likely to have had any unprotected anal intercourse in 2000 than in previous years. Moreover, these upward trends remained when the analyses were based only on those men who had regular partners (see lower half of Table 32). Table 32: Anal intercourse with regular partners by gay community attachment GCA n % n % n % Total sample 1 No regular partners No anal intercourse Always protected Any unprotected TOTAL Men who had regular partners 2 No anal intercourse Always protected Any unprotected TOTAL NGCA Total sample 3 No regular partners No anal intercourse Always protected Any unprotected TOTAL Men who had regular partners 4 No anal intercourse Always protected Any unprotected TOTAL ,2,3,4 p <.001 Table 33 presents data on condom use with regular partners-among those men who had regular partners-stratified by H IV status. Among H IV negative men and those of unknown serostatus there was a significant upward trend in any instance of unprotected anal intercourse in the six months prior to each survey. There were too few HIV positive men in 1992/96 to determine statistically si gnificant change over time. 24 Van de Ven, Rawstorn e, Crawford & Kippax