Between January 1, and October 31, 1987, 420 homosexual men who participated in a cohort study of infection with the human immunodeficiency virus (HIV) completed a questionnaire that examined their sexual practices during the previous six months. Of the subjects, 205 (48.8%) men were HIV-seropositive and 215 (51.2%) men were HIV-seronegative. Although there was an appreciable level of condom usage in both groups, 13.5% of the HIV-seronegative men had engaged in unprotected receptive anal intercourse and 6.3% of the HIV-seropositive men had engaged in unprotected insertive anal intercourse. Condom breakage was reported on approximately 6% of occasions by a minority of subjects. Among subjects who were in a relationship with a regular male sexual partner, the most commonly reported sexual practices were deep kissing, mutual masturbation and receptive oral intercourse without ejaculation. No HIV-seronegative man engaged in unprotected receptive and/or insertive anal intercourse, receptive oral intercourse with ejaculation or receptive and/or insertive "fisting" with a regular partner who was HIV-seropositive. No HIV-seropositive man engaged in unprotected insertive anal intercourse to ejaculation with an HIV-seronegative partner, although they did so with partners who were HIV-seropositive or of unknown status. On multivariate analyses the subject's antibody status was found to be associated with receptive anal intercourse with a condom (P = 0.007) and mutual masturbation (P = 0.001), with HIV-seronegative men being more likely to practise either; no significant independent effect was associated with the partner's antibody status. These findings provide important information on the types and levels of sexual practices in a group of homosexual men after the recognition of the acquired immunodeficiency syndrome in this country.
PIP: Sexual practices and condom usage in a cohort of homosexual and bisexual men in Sydney, Australia were investigated in 1987. Of the 420 subjects, 205 (48.8%) were HIV seropositive, and 215 (51.2%) were HIV seronegative based on and confirmed by enzyme-linked immunosorbent assay. The questionnaire examined drug abuse, history of illnesses, presence of physical symptoms, and related life style factors such as sexual behavior and practices with the regular male sexual partner in the preceding 6 months. Partners were grouped by HIV or unknown status. The following practices defined sexual activity: deep kissing, insertive oroanal intercourse, receptive oroanal intercourse, unprotected receptive anal intercourse with ejaculation; receptive anal intercourse with a condom, receptive anal intercourse with withdrawal, unprotected insertive anal intercourse with ejaculation, insertive anal intercourse with a condom, receptive oral intercourse with ejaculation, receptive oral intercourse without ejaculation, receptive fisting, insertive fisting, mutual masturbation, and the use of sex toys. Analysis was based on Student's t test, Wilcoxon's rank sum test, and Fisher's exact test. Multiple stepwise logistic regression models were tested with the subject's response for a sexual activity against his partner's antibody status and subject's antibody status and response for each of the sexual practices. The results for age were a mean of 39.4 years for those HIV seronegative and 37.3 years for those HIV seropositive. For number of sexual partners, seronegative subjects had a median of 4 and seropositive subjects a median of 3. In the overview of anal intercourse, seropositive subjects had practiced significantly more receptive anal intercourse at least once in 6 months, and for seronegative subjects, more insertive anal intercourse. Condom use was appreciable in both groups. However, 13.5% of seronegative men engaged in unprotected receptive anal intercourse vs. 6.3% of seropositive men. Condom breakage was reported as 5.1% on occasions of receptive anal intercourse and 7.3% of insertive anal intercourse. Seropositive men had 5.4% breakage in receptive and 4.6% in insertive anal intercourse. Subjects' sexual practices with a regular male sexual partner by HIV status are analyzed separately. The most commonly reported practices of seronegative or positive men with 1 partner were deep kissing, mutual masturbation, and receptive oral intercourse without ejaculation. Seronegative men were more likely to engage in receptive anal intercourse with a condom and mutual masturbation. The implications are that seronegative men are at risk because of sexual practices, but neither condom usage nor partner selection is based on HIV status. Condom usage and withdrawal were used by a great number of subjects. Safer practices appear to have been used prior to screening availability.