Report No. 8 June 1999
Stephanie Knox, Paul Van de Ven, Garrett Prestage, June
Crawford and Susan Kippax
National Centre in HIV Social Research, University of New
South Wales
National Centre in HIV Social Research
The University of New South Wales
This report produced for and with the assistance of the AIDS/Infectious Diseases Branch, NSW Health Department
All data in this report are provisional and subject to
future revision.
© 1999 by National Centre in HIV Social Research
ISSN 1325-3883
The Sydney Gay Community Periodic Survey is a joint project of the National Centre in HIV Social Research (the University of New South Wales), the National Centre in HIV Epidemiology and Clinical Research (the University of New South Wales), the AIDS Council of NSW and PLWHA (NSW) Inc.
This report may not be copied without the express permission of the copyright holder.
Anal intercourse, protection and sero-concordance
Testing, treatments and drug use
This report summarises data from the Sydney Gay Community Periodic Surveys conducted from February 1997 to February 1999. Men recruited at Fair Day in February 1997, 1998 and 1999 are reported separately from the samples recruited at gay venues and clinics. Respondents who were also participants in the Sydney Men and Sexual Health (SMASH) Study were excluded from the analysis to keep the Periodic Survey independent of SMASH. There are no new data for SMASH in the period July to December 1998 and therefore figures for SMASH will not be included in this report.
The median age of the men was 34 years (range from 14&emdash;79). Ninety per cent identified as gay. The majority (61&emdash;73 per cent) lived in inner or eastern Sydney. Around 90 per cent reported sex with one or more regular or casual male partners in the six months prior to interview. A greater proportion of Fair Day men (around 50 per cent) were in a regular relationship of more than six months compared with men surveyed at clinics and venues (30 per cent). Around 80 per cent had engaged in any anal intercourse with a male partner and between 49&emdash;61 per cent had practised oral sex with ejaculation. Few men (5&emdash;12 per cent) had had sexual contact with women in the previous six months. There had been a high rate of uptake of new antiretroviral treatments among HIV-positive men with some evidence that this may have reached a plateau at around 70&emdash;75 per cent. The use of marijuana, amyl and 'party' drugs was common among these men, each used by around 40&emdash;54 per cent of men. Injection of drugs was more common among men surveyed at clinics and venues (7&emdash;10 per cent) compared with Fair Day men (around 4 per cent).
This Sydney Gay Community Surveillance Report summarises data from the Sydney Gay Community Periodic Surveys. The data provide snapshots of sexual practices and other health factors in Sydney gay community, to assist with planning and monitoring of HIV prevention, care and support.
Sydney Gay Community Periodic Survey
The Periodic Survey is a cross-sectional survey of
homosexually active men in Sydney. It uses a short
self-administered questionnaire that takes about ten minutes
to complete. The Periodic Survey has been undertaken in
February and August of each year since February 1996.
Respondents are recruited at various sites, including two
sexual health clinics and a number of gay community venues
(gyms, social clubs and sex-on-premises venues) in inner and
outer Sydney. (Wherever possible, the same venues have been
used for each survey.) In February, men are also recruited
at the annual Gay and Lesbian Mardi Gras Fair Day. Fair Day
is attended by about 40 000 people; it is held in an
inner-city park, with community information booths, market
stalls, stage musical performances, a dog show, etc. So that
the February figures shown here are roughly comparable with
the August figures, the respondents from Fair Day have been
separated from the men surveyed at clinics and other gay
community venues and the figures for the two samples Fair
Day and Venues are reported separately. The body of the
report contains tables for the period February 1997 to
February 1999. An appendix at the end of the report contains
graphs that show trends over time since February 1996.
There are no new data for the Sydney Men and Sexual Health Study (SMASH) in the period July to December 1998 and therefore figures for SMASH will not be included in this report. The previous Report (No 7) contains the SMASH data until the end of 1998. Interviewing of SMASH men will recommence in 1999 and it is planned to include updated SMASH figures in future reports. Data on men responding to the Periodic Survey who indicated that they were part of the SMASH cohort have been excluded so that the figures reported here for the Periodic survey are independent of SMASH.
The men covered a broad age range with a median around the mid-30s. Between 61 and 74 per cent lived in the inner and eastern suburbs of Sydney, near the gay precincts of Oxford Street, Darlinghurst, and King Street, Newtown (Table 1). A slightly greater proportion of the Fair Day men lived in the inner and eastern suburbs compared with men surveyed at venues and clinics.
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Feb 1997 |
Aug 1997 |
Feb 1998 |
Aug 1998 |
Feb 1999 |
Feb 1997 |
Feb 1998 |
Feb 1999 |
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Sample size |
457 |
898 |
872 |
669 |
789 |
971 |
994 |
1256 |
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Age Range Median |
15-79 34 |
18-71 34 |
17-76 34 |
16-69 34 |
14-74 35 |
17-71 34 |
16-75 32 |
17-74 33 |
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Suburban region (%) Inner/Eastern Northern Southern Western Other |
65.2 10.9 3.7 9.4 10.7 |
61.2 8.0 5.9 13.4 11.5 |
69.5 5.6 4.9 9.4 10.6 |
70.3 7.2 4.2 9.4 9.0 |
67.0 7.4 4.1 9.3 12.3 |
71.1 11.7 3.0 5.5 8.8 |
73.1 10.1 3.8 5.3 7.6 |
70.6 9.2 5.1 5.5 9.6 |
Most of the men in the samples identified as gay or homosexual. A smaller proportion of men surveyed at Fair Day identified as bisexual, heterosexual or otherwise, compared with men surveyed at venues and clinics (Table 2).
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Feb 1997 |
Aug 1997 |
Feb 1998 |
Aug 1998 |
Feb 1999 |
Feb 1997 |
Feb 1998 |
Feb 1999 |
|
Sample size |
457 |
898 |
872 |
669 |
789 |
971 |
994 |
1256 |
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Sexual identity (%) Gay Bisexual Heterosexual Other |
87.0 9.9 1.3 1.8 |
89.4 7.4 1.0 2.1 |
88.7 8.8 1.3 1.3 |
89.0 8.6 0.9 1.5 |
88.3 8.8 1.0 1.9 |
94.7 3.3 0.6 1.4 |
94.2 3.5 1.0 1.2 |
92.6 4.4 1.7 1.4 |
|
Missing data (n) |
(3) |
(9) |
(7) |
(5) |
(5) |
(9) |
(3) |
(4) |
Most of the men in the samples were engaging in sex with men at the time of interview (Table 3). There were distinct differences between Fair Day men and men recruited at other venues. Men surveyed at clinics and venues had had more sexual partners than men surveyed at Fair Day; men surveyed at Fair Day were more likely to be in a regular relationship and less likely to be having sex with casual partners.
regular relationships and number of casual partners (%)
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Feb 1997 |
Aug 1997 |
Feb 1998 |
Aug 1998 |
Feb 1999 |
Feb 1997 |
Feb 1998 |
Feb 1999 |
|
Sample size |
457 |
898 |
872 |
669 |
789 |
971 |
994 |
1256 |
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‘Current’ relationships with men Casual only One regular partner onlya Regular plus casualb Currently celibate Other |
31.5 17.0 37.6 13.2 0.7 |
28.1 19.8 39.3 12.6 0.1 |
29.9 19.4 41.2 9.5 0 |
32.1 17.3 39.4 9.4 1.7 |
30.6 20.1 37.4 11.8 0.1 |
19.2 34.4 33.9 11.0 1.6 |
17.3 36.0 34.5 12.0 0.1 |
16.8 43.2 29.1 10.8 0.1 |
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Missing data (n) |
(10) |
(31) |
(27) |
(22) |
(8) |
(22) |
(14) |
(12) |
|
Length of current regular relationship(s) More than 6 months Less than 6 months |
36.7 10.7 |
38.0 11.0 |
36.0 10.8 |
37.6 10.3 |
39.2 9.6 |
47.3 13.6 |
51.4 11.0 |
53.0 12.9 |
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Number of men had sex with past 6 mths None One 2-10 men 11-50 men More than 50 men |
6.0 12.6 45.0 28.5 7.9 |
5.2 15.2 44.5 27.5 7.7 |
4.8 15.1 40.9 31.1 8.1 |
5.1 11.1 44.7 30.3 8.7 |
6.0 15.8 44.2 27.7 6.4 |
6.3 28.4 41.7 19.2 4.4 |
5.5 28.7 43.3 17.5 5.0 |
6.1 33.0 41.4 15.6 3.8 |
(b) Includes 'Regular, and both my partner and I have casual partners', 'Regular, and I have casual partners' and 'Several regular'.
Nearly one third of men recruited at venues and clinics were having only casual sex, and nearly 40 per cent were engaging in sex with both regular and casual partners. Forty-five per cent of the men in each Fair Day sample and over a third of the men in the venues and clinic samples were in, or had recently had, a regular relationship lasting over six months. Around 10 per cent of each sample were in or had had a relationship of less than six months.
casual partners in the previous six months (%)
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Feb 1997 |
Aug 1997 |
Feb 1998 |
Aug 1998 |
Feb 1999 |
Feb 1997 |
Feb 1998 |
Feb 1999 |
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Sample size |
457 |
898 |
872 |
669 |
789 |
971 |
994 |
1256 |
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Any anal intercourse |
81.6 |
83.3 |
84.5 |
82.1 |
81.4 |
81.5 |
82.8 |
78.8 |
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Anal intercourse with regular partners No regular partner None with regular partner 100% protected Any unprotected |
44.6 5.7 24.5 25.2 |
39.2 8.2 27.6 24.9 |
44.8 4.4 25.7 25.0 |
42.5 5.4 24.4 27.8 |
41.6 7.4 25.7 25.3 |
33.1 8.4 25.8 32.6 |
30.5 7.7 26.9 34.9 |
28.7 10.7 26.2 34.4 |
|
Anal intercourse with casual partners No casual partners None with casual partner 100% protected Any unprotected |
17.5 20.1 41.1 21.2 |
22.7 19.2 37.5 20.6 |
20.6 17.6 40.8 21.1 |
18.4 19.4 42.2 20.0 |
24.0 17.6 38.9 19.5 |
35.7 17.9 34.3 12.0 |
33.4 20.9 33.8 11.9 |
41.8 16.2 30.8 11.2 |
Around 80 per cent of the men in all samples had engaged in anal intercourse in the six months prior to survey. Of the men surveyed at venues and clinics around 50 per cent had anal intercourse with a regular partner and around 60 per cent with a casual partner. Sixty per cent of Fair Day men had had anal intercourse with a regular partner and around 45 per cent per with a casual partner (Table 4). These differences in anal intercourse with casual and regular partners reflect the differences in relationship status between Fair Day men and men surveyed at other venues, there were no significant differences in overall levels of anal intercourse either across locations or over time.
Around one in four men surveyed at venues and clinics had had unprotected anal intercourse with a regular partner in the six months prior to survey. One in three men surveyed at Fair Day had had unprotected anal intercourse with a regular partner. The higher proportion of men at Fair Day in a regular relationship may partly explain the difference between the samples in unprotected anal intercourse with regular partners. Among men with regular partners 48- 50 per cent of Fair Day men and 43- 45 per cent of men at other venues had unprotected anal intercourse with their regular partner. There has been no significant change in levels of unprotected anal intercourse with regular partners since February 1997 (see also Figure 2, page 13).
Around 20 per cent of men surveyed at clinics and venues had had unprotected anal intercourse with a casual partner, while around 12 per cent of men at Fair Day had done so. The higher rate of unprotected anal intercourse with casual partners among men recruited at venues again reflects the higher rates of casual relationships among these men. There was a significant increase in unprotected anal intercourse between February 1996 and February 1997 among men at venues and clinics (p<.05). (See Figure 2 page 13.) However since February 1997, rates of unprotected anal intercourse with casual partners have remained stable with no further upward trend.
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Feb 1997 |
Aug 1997 |
Feb 1998 |
Aug 1998 |
Feb 1999 |
Feb 1997 |
Feb 1998 |
Feb 1999 |
|
Sample size |
457 |
898 |
872 |
669 |
789 |
971 |
994 |
1256 |
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No regular partner |
44.6 |
39.2 |
44.8 |
42.5 |
41.6 |
33.1 |
30.5 |
28.7 |
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Concordant positive |
6.8 |
5.7 |
4.5 |
4.0 |
3.5 |
4.4 |
1.7 |
1.6 |
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Concordant negative |
19.3 |
20.7 |
17.7 |
18.1 |
22.8 |
33.4 |
33.9 |
33.7 |
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Known discordant |
7.9 |
8.2 |
9.1 |
5.8 |
7.2 |
5.9 |
6.5 |
7.4 |
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Concordance unknown |
8.9 |
7.3 |
8.3 |
7.5 |
7.1 |
10.4 |
13.8 |
12.0 |
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Missing data one or both |
13.1 |
18.8 |
15.7 |
22.1 |
17.7 |
12.9 |
13.6 |
16.6 |
Between 3.5 and 7 per cent of the men surveyed at clinics and venues were in regular relationships where both men were HIV-seropositive ('concordant positive', Table 5) and this proportion has declined since February 1997. Fewer Fair Day men (1.5 to 4 per cent) were in concordant positive relationships, possibly reflecting the smaller proportion of seropositive men at Fair Day (see Figure 6, page 15). Between 6 and 9 per cent of men were in serodiscordant regular relationships, with no differences across location or over time. One in three Fair Day men were in a 'concordant negative' relationship compared with about 20 per cent of men surveyed at venues and clinics. A greater proportion of Fair Day men were in relationships where the serostatus of one or both partners was unknown (10- 14 per cent) compared with men surveyed at venues and clinics (5 to 8 per cent, Table 5). A large minority of men (13 to 19 per cent) did not fully answer the questions on which these data are based.
in the previous six months (%)
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> Transfer interrupted!IGN=top WIDTH="10%">
Feb 1997 |
Aug 1997 |
Feb 1998 |
Aug 1998 |
Feb 1999 |
Feb 1997 |
Feb 1998 |
Feb 1999 |
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Sample size |
457 |
898 |
872 |
669 |
789 |
971 |
994 |
1256 |
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Practised withdrawal Any (casual or regular) With regular partners With casual partners |
28.4 16.6 17.9 |
29.7 17.6 17.9 |
31.3 17.7 18.8 |
32.4 20.8 18.4 |
30.0 19.0 17.2 |
29.4 21.5 11.2 |
29.5 24 9.8 |
31.1 25.4 9.6 |
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Practised withdrawal onlya |
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Any (casual or regular) With regular partners With casual partners |
15.7 7.0 9.6 |
16.3 8.1 10.2 |
16.3 7.5 10.4 |
19.0 10.0 10.8 |
18.8 10.5 11.0 |
14.1 9.1 6.9 |
12.7 9.1 5.2 |
16.7 12.7 5.4 |
Around 30 per cent of the men in each sample practised withdrawal (as insertive or receptive partner). As many of these men also have unprotected sex with ejaculation, especially with regular partners, it is unlikely that withdrawal is a protective strategy for all these men although it may be for a minority. The proportion of those men who have had unprotected anal intercourse with either casual or regular partners only without ejaculation, 'true withdrawers', is much lower. Around 12 to 20 per cent of the men practised unprotected withdrawal but not intercourse with ejaculation.
in the previous six months (%)
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Feb 1997 |
Aug 1997 |
Feb 1998 |
Aug 1998 |
Feb 1999 |
Feb 1997 |
Feb 1998 |
Feb 1999 |
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Sample size |
457 |
898 |
872 |
669 |
789 |
971 |
994 |
1256 |
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Oral&emdash;genital sex Any (casual or regular) Regular partners Casual partners |
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87.1 54.8 66.4 |
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87.3 67.4 49.3 |
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Oral&emdash;genital sex with ejaculation |
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Any (casual or regular) Regular partners Casual partners |
53.8 31.9 37.9 |
54.3 34.3 34.3 |
56 33.9 36.1 |
58.4 35.4 38.3 |
46 27.6 28.1 |
60.0 44 28.4 |
60.2 44.5 29.0 |
49.2 37.8 19.9 |
Table 8. Sex with women in the previous six months
(%)
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Feb 1997 |
Aug 1997 |
Feb 1998 |
Aug 1998 |
Feb 1999 |
Feb 1997 |
Feb 1998 |
Feb 1999 |
|
Sample size |
457 |
898 |
872 |
669 |
789 |
971 |
994 |
1256 |
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Any sexual contact |
11.6 |
8.9 |
9.2 |
11.1 |
7.7 |
5.4 |
6.2 |
5.0 |
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Number of women None One More than one |
87.9 5.9 6.2 |
90.4 5.7 4.0 |
90.2 5.4 4.4 |
88.4 7.5 4.1 |
92.1 5.2 2.7 |
94.3 3.6 2.1 |
93.4 4.6 2.0 |
94.9 2.6 2.5 |
The questions around oral sex were revised in February 1999 to include oral sex both with and without ejaculation. In February 1999, 87 per cent of men engaged in oral&emdash;genital sex with regular or casual partners in the six months prior to the survey. More than half the men reported oral sex with ejaculation. There appears to be a decrease in oral sex with ejaculation in February 1999, however this may be an artefact of the change in the questions and may not indicate any real change in practice. Compared with men surveyed at venues and clinics, a larger proportion of Fair Day men reported oral sex with ejaculation with regular partners and a smaller proportion with casual partners (Table 7).
Few men had had any sexual contact with women in the six months prior to survey. A greater proportion of men surveyed at venues and clinics had had any sexual contact with women in this period compared with Fair Day men (Table 8).
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Feb 1997 |
Aug 1997 |
Feb 1998 |
Aug 1998 |
Feb 1999 |
Feb 1997 |
Feb 1998 |
Feb 1999 |
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Sample size |
457 |
898 |
872 |
669 |
789 |
971 |
994 |
1256 |
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HIV test last 12 months |
64.8 |
67.0 |
62.4 |
61.7 |
62.7 |
56.3 |
57.8 |
58.8 |
|
HIV Serostatus Negative Positive Unknown |
63.0 27.6 7.2 |
62.5 25.4 6.8 |
63.1 24.3 9.7 |
64.0 20.3 10.8 |
70.3 19.4 9.5 |
75.4 12.2 10.8 |
76.0 10.8 11.1 |
76.5 10.0 12.0 |
Table 10. HIV-Positive men's use of treatments
(%)
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Feb 1997 |
Aug 1997 |
Feb 1998 |
Aug 1998 |
Feb 1999 |
Feb 1997 |
Feb 1998 |
Feb 1999 |
|
Sample size |
|
228 |
212 |
136 |
153 |
|
107 |
126 |
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Combination therapy |
|
69.7 |
66.5 |
72.8 |
74.5 |
|
72.0 |
69.0 |
Between 61 and 67 per cent of men recruited at venues and clinics and 56- 58 per cent of men at Fair Day had had a test for HIV infection in the previous 12 months. Around 65 per cent of men at venues and clinics and around 75 per cent of men at Fair Day reported being HIV seronegative. At venues and clinics, 20- 25 per cent of men reported being HIV-positive, a higher proportion than Fair Day where 10&emdash;12 per cent of men reported being HIV-positive. Around 7- 12 per cent of men did not know their serostatus (Table 9). (Because of missing data the totals for HIV status in do not add to 100 percent.)
Information on HIV-positive men's use of antiretroviral treatments has been collected in the Periodic Survey since February 1998 (Table 10). The smaller sample size of HIV-positive men means that a small change in numbers translates to a large apparent change in percentage and hence these results should be interpreted with caution. More than two thirds of HIV-positive men were on 'combination therapy' (using three or more antiretroviral drugs). Uptake of combination therapy has increased among men surveyed at venues and clinics but not among Fair Day men, where the rate appears to have stabilised at around 70 per cent.
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Feb 1997 |
Aug 1997 |
Feb 1998 |
Aug 1998 |
Feb 1999 |
Feb 1997 |
Feb 1998 |
Feb 1999 |
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Sample size |
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669 |
789 |
971 |
994 |
1256 |
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Marijuana |
|
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|
53.8 |
52.1 |
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|
43.8 |
|
Amyl |
|
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|
53.2 |
51.5 |
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42.0 |
|
Ecstasy/speed/LSD |
|
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39.8 |
44.7 |
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40.2 |
|
Injected drugs |
|
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10.0 |
7.4 |
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4.3 |
|
Injected speed |
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|
7.2 |
5.4 |
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3.0 |
|
Injected cocaine |
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1.9 |
2.2 |
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|
0.8 |
Since August 1998 men have been asked about drugs used for non-medicinal purposes in the six months prior to survey. Among men surveyed at clinics and venues more than half had used marijuana recently and more than half had used amyl nitrite, 40- 45 per cent had used party drugs and 7- 10 per cent had injected drugs. A smaller proportion of men at Fair Day had used marijuana (44 per cent) or amyl (42 per cent) or had injected drugs (4.3 per cent). The most common drug injected was speed (Table 11).
The similarities in men's sexual behaviour across a broad spectrum of locations in the Periodic Survey indicate that the men are representative of gay-community-attached men in Sydney. Readers involved in program development with other groups of homosexually active men should make their own judgments about the generalisability of these data to their constituencies.
Figure 1. Percentage of men reporting casual and regular relationships with men.
Figure 2. Percentage of men in each Periodic Survey sample having any unprotected anal intercourse
Figure 3. Percentage of men in each Periodic Survey sample practising withdrawal
Figure 4. Percentage of men in each Periodic Survey sample practising withdrawal but not unprotected anal intercourse with ejaculation
Figure 5 Percentage of men in each Periodic Survey sample who had undertaken a test for HIV antibodies in the previous 12 months
Figure 6 Percentage of men in each Periodic Survey sample who reported being HIV seropositive, HIV negative or who did not know their serostatus
More detailed analyses of data from the SMASH study and the Sydney Gay Community Periodic Survey can be found in other publications available from the National Centre in HIV Social Research.
Prestage, G, Noble, J, Kippax, S, Crawford, J, Baxter, D and Cooper, D (1995). Methods and sample in a study of homosexually active men in Sydney, Australia. Sydney: HIV AIDS and Society Publications.
Prestage, G, Kippax, S, Van de Ven, P, French, J, Richters, J, Campbell, D, Crawford, J, Grulich, A, Kinder, P and Kaldor, J (1996). Sydney Gay Community Periodic Survey February 1996: a demographic and behavioural profile of a cross-sectional sample of homosexually active men in Sydney, Australia. Sydney: HIV AIDS and Society Publications.
Kippax, S, Noble, J, Prestage, G, Campbell, D, Baxter, D and Cooper, D. (1997). Sexual negotiation in the AIDS era: negotiated safety revisited. AIDS 11: 191&emdash;7.
Knox, S, Van de Ven, P, Richters, J, Prestage, G, Crawford, J, & Kippax, S. (1998). Sydney Gay Community Surveillance Report: Update to June 1998 (Report No 7). Sydney: National Centre in HIV Social Research.
Van de Ven, P, Campbell, D, Kippax, S, Prestage, G, Crawford, J, Baxter, D and Cooper, D (1997). Factors associated with unprotected anal intercourse in gay men's casual partnerships in Sydney, Australia. AIDS Care 9: 637&emdash;49.
Van de Ven, P, Campbell, D, Kippax, S, Knox, S, Prestage, G, Crawford, J, Kinder, P, Cooper, D. (1998). Gay men who engage repeatedly in unprotected anal intercourse with casual partners: The Sydney Men and Sexual Health Study. International Journal of STD and AIDS 9: 336-340.