Generational analysis of trends in unprotected sex in France among men who have sex with men: The major role of context-driven evolving patterns

<div><p>Objective</p><p>Using a generational approach, this study analyses how unprotected anal intercourse has evolved since 1991 in France across different generations of men who have sex with men (MSM) whose sexual lives began at different periods in the history of the HIV epidemic.</p><p>Design</p><p>Data were collected from 18–59 year-old respondents to the French Gay Press surveys <i>Enquêtes Presse Gay</i>, conducted repeatedly between 1991 and 2011 (N = 32,196) using self-administered questionnaires distributed in gay magazines and over the internet.</p><p>Methods</p><p>Trends in unprotected anal intercourse (i.e. condomless anal sex) with casual partners of unknown or different HIV serostatus (hereafter “UAId” in this manuscript) were studied. Responses were analysed according to year and then reorganised for age-cohort analyses by generation, based on the year respondents turned 18.</p><p>Results</p><p>UAId rates fell from 1991 to 1997, and then rose from 13.4% in 1997 to 25.5% in 2011 among seronegative respondents, and from 24.8% to 63.3%, respectively, among seropositive respondents. Both in seropositive and seronegative respondents, UAId increased over time for all generations, indicative of a strong period effect.</p><p>Conclusion</p><p>Analyses of data from several generations of MSM who started their sexual lives at different time points in the HIV epidemic, revealed very similar trends in UAId between generations, among both seropositive and seronegative respondents. This strong period effect suggests that sexual behaviours in MSM are influenced more by contextual than generational factors. The fact that prevention practices are simultaneously observed in different generations and that there are most likely underlying prevention norms among MSM, suggests that PrEP could become widely accepted by all generations of MSM exposed to the risk of HIV.</p></div

Percentage of participants reporting more than 10 male partners in the previous 12 months.

<p>Surveys in 1991–2011, respondents aged 18–59. Reading: 22.5% of the respondents from the 1996–1999 generation reported more than 10 male partners in the previous 12 months when their mean age was 18.6 years (i.e., when they were surveyed in 1997). Lines are drawn only when the generation is composed of at least 30 respondents.</p

Median age at first sexual intercourse with a man.

<p>Surveys in 1995–2011, respondents aged 18–59. Reading: Respondents aged 25–29 surveyed in 1995 had turned 18 in 1986 on average and had a median age at first intercourse with a man equal to 17.8. Lines are drawn only when the generation is composed of at least 30 respondents.</p

Percentage of participants reporting (a) masturbation, (b) oral sex, and (c) anal intercourse as frequent practices.

<p>Surveys in 1985–2011, respondents aged 18–59. Reading: 61.5% of the respondents from the 1996–1999 generation reported frequent anal intercourse when their mean aged was 18.6 years (i.e., when they were surveyed in 1997).Lines are drawn only when the generation is composed of at least 30 respondents.</p

Social and demographic characteristics, HIV status and UAI in the previous 12 months with casual partners, among respondents to the Gay Press surveys.

<p>Social and demographic characteristics, HIV status and UAI in the previous 12 months with casual partners, among respondents to the Gay Press surveys.</p

Trends in the percentage of respondents reporting at least one episode of UAId, as a function of HIV serostatus, in the Gay Press surveys from 1991 to 2011.

<p>UAId: unprotected anal intercourse in the 12 months before the survey with a casual partner of unknown or different HIV serostatus.</p

Socio-demographic characteristics of the respondents in the Gay Press surveys.

<p>Respondents aged 18–59.</p><p>^a Standard deviation</p><p>^b ≤100000 and >100000 confounded</p><p>Socio-demographic characteristics of the respondents in the Gay Press surveys.</p

Longitudinal changes from 1997 to 2011 in the percentage of respondents who reported at least one episode of UAId. (A) seronegative respondents; (B) seropositive respondents.

<p>The dotted curves link the points obtained during the same survey year. UAId: unprotected anal intercourse in the 12 months before the survey with a casual partner of unknown or different HIV serostatus. Looking at Fig 2 we see that the generation of HIV seronegative MSM who turned 18 between 1984 and 1987 is represented by the green curve in Fig 2A. When responding to the 1997 Gay Press survey this generation's mean age was 29.6 years, and 13.2% reported having UAId at least once during the previous year. When this generation responded to the 2000 survey, the mean age was 32.5 years, and 16.0% reported having UAId at least once during the previous year. In 2004 and 2011, with mean ages of 36.5 years and 43.5 years, respectively, 18.3% and 24.0% of the seronegative MSM from this generation who responded to the surveys, reported having UAId at least once during the preceding year. Similarly, in Fig 2B, the green curve represents the generation of seropositive MSM that turned 18 years old between 1984 and 1987. This generation's mean age when they responded to the 1997 Gay Press survey was 29.9 years, and 21.3% reported having UAId at least once during the previous year. This generation’s mean age when they responded to the 2000 survey was 32.7 years, and 37.3% reported having UAId at least once during the previous year. In 2004 and 2011, with mean ages of 36.6 years and 43.5 years, respectively, 48.0% and 58.8% of the seropositive MSM this generation reported at least one episode of UAId during the preceding year.</p

Percentages of respondents reporting that their first sexual intercourse was with a male partner, adjusted for age, and corresponding fit curve.

<p>Surveys in 1995–2011, respondents aged 18–59.</p