Background Recent evidence suggests that the majority of HIV transmissions
among men who have sex with men (MSM) occur between steady partners. We sought
to determine factors associated with HIV transmission risks in steady
partnerships. Methods Data is from the German cross-sectional 2013 Gay Men and
AIDS survey. The study population was HIV-negative or untested men reporting a
steady partnership and at least one non-steady anal sex partner in the
previous year. Bivariate and multivariate logistic regression was used to
determine which of several independent variables best predicted both
unprotected anal intercourse (UAI) with a non-steady partner and lack of HIV
testing in the past year (high-risk outcome group). Results The study
population consisted of 1731 men. Among individuals in the outcome group (n =
271), 67 % reported UAI with a non-steady partner of unknown status and 9 %
reported UAI with a non-steady HIV-positive partner in the past 12 months; 55
% considered themselves to be at low risk for HIV acquisition. In multivariate
analyses (n = 1304), participants were statistically more likely to belong to
the outcome group if they reported UAI with their steady partner in the past
year (OR = 2.21), did not know their steady partner’s HIV status (OR = 1.98),
or agreed that condoms were disruptive during sex (OR = 3.82 (strongly agree),
OR = 2.19 (agree)). Participants were less likely to belong to the outcome
group if they were out to their primary doctor (OR = 0.54), were well-educated
about post-exposure prophylaxis (OR = 0.46), had sought information on HIV in
the past year and kept condoms in an accessible place (OR = 0.20), or believed
that insisting on condoms would lead partners to assume they were HIV-negative
(OR = 0.20). Participants in the outcome group were more likely to say they
would use HIV home tests (OR = 1.58) or pre-exposure prophylaxis (OR = 2.11).
Conclusions Based on our results, we reflect on HIV prevention measures that
should be improved in order to better target behaviors that may lead to HIV
transmission between MSM in steady relationships. In particular, we highlight
the need for multifaceted interventions focusing not only on members of the
at-risk community themselves, but on communities as a whole
