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Trends in risk-taking and risk reduction among German MSM. Results of follow-up surveys “Gay Men and AIDS” 1991-2007
Axel J. Schmidt1, Michael Bochow1
Objectives: To calculate esti­mates for group level trends among German men who have sex with men (MSM) regarding parameters related to HIV epidemiology: frequency of anal intercourse, consistency in condom use, risk-taking, numbers of sex partners, incident bacterial STIs, and HIV-testing behaviour.
Methods: Data derived from six large cross-sectional national follow-up surveys among MSM, conduc­ted 1991-2007. Questionnaires were circulated with German magazines for gay men; in 2003/2007, online recruitment was added. 23,878 anonymously self-administered questionnaires were analyzed in multiple regression models for five subgroups.
Results: With the normalization of AIDS, restriction of anal intercourse to primary partnerships has lost its relevance as a risk avoidance strategy for MSM. Other traditional risk reduction strategies among MSM in Germany showed a high degree of time stability: Between 1991 and 2007, condom use in anal intercourse has been relatively stable; numbers of sex partners have been rather constant. No positive trends in the use of Nitrite inhalants were seen, party drugs were increasingly used by a minority of gay men during the 1990s. The syphilis epidemic seen after 1999 among German gay men is well reflected in the survey data. No evidence was found for a concurrent rise in urethral gonorrhoea. The proportion of MSM with a recent HIV test has been continuously increasing.
Conclusions: We found no evidence for increasing 'carelessness' or 'prevention fatigue'. However, given the increasing proportions of MSM who frequently engage in anal inter­course with casual partners, a rise in HIV incidence is likely; especially if accompanied by a syphilis epidemic.
Time trend analyses of these large behavioural follow-up surveys suggest that the rise in new HIV diagnoses among MSM in Germany may partially reflect an increased uptake of HIV-testing, rather than new infections due to the erosion of condom use or increased numbers of sex partners.
Datei SOEDAK_09_OSB2.pdf