Increase in HIV sexual risk behaviour in homosexual men in Scotland, 1996–2002: prevention failure?

<b>Objective</b>: To investigate trends in homosexual men’s sexual risk behaviour for HIV infection in Scotland. <b>Methods</b>: Cross sectional surveys in 1996, 1999, and 2002 were carried out in "gay" bars in Glasgow and Edinburgh, Scotland. 6508 men—2276 (79% response rate) in 1996, 2498 (78%) in 1999, and 1734 (62%) in 2002. <b>Results</b>: In 1996, 10.7% of men surveyed and in 1999, 11.2% reported unprotected anal intercourse (UAI) with casual partners, compared with 18.6% in 2002 (p<0.001). There was also a significant increase in men reporting that they "knew" their casual partners’ HIV status, despite no increase in HIV testing among men who reported UAI with casual partners. In 2002, increases in UAI with more than one partner, in UAI with casual partners and in reporting seroconcordance remained significant after adjusting for confounding factors including HIV testing status and demographic characteristics. <b>Conclusions</b>: High risk sexual behaviour among homosexual men in Scotland increased between 1999 and 2002. Men showed increased confidence of shared antibody status, despite no increase in HIV testing, or evidence of discussion of HIV status. Explanations for this must include consideration of a cultural shift in the perception of HIV and "prevention failure" on the part of governments and health agencies