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Serosorting and Strategic Positioning During Unprotected Anal Intercourse: Are Risk Reduction Strategies Being Employed by Gay and Bisexual Men in Scotland?

McDaid, Lisa M. PhD*; Hart, Graham J. PhD

doi: 10.1097/OLQ.0b013e31825a3a3c
Original Study

Background: Unprotected anal intercourse (UAI) remains the main risk factor for HIV among men who have sex with men (MSM), but risk varies by the sexual position adopted and the risk reduction strategies used. Here, we report on sexual position, and knowledge of partners' HIV status, during UAI to assess whether MSM in Scotland are using sexual risk reduction strategies.

Methods: Anonymous, self-complete questionnaires and Orasure oral fluid specimens (OraSure Technologies, Inc., Bethlehem, Pennsylvania, USA) were provided by 1277 MSM in commercial gay venues in Glasgow and Edinburgh, Scotland, United Kingdom (59.7% response rate). Overall, 488 MSM (39.7%) reported any UAI in the past 12 months; 318 reported on partner HIV status and sexual position and are included in these analyses.

Results: Being equally either the insertive or receptive partner during UAI was most commonly reported; 23.1% of HIV-negative MSM reported exclusive insertive UAI, whereas no MSM with diagnosed HIV reported exclusive receptive UAI. Five diagnosed HIV-positive MSM reported always knowing their partners' HIV status and only having HIV-positive partners (50.0% of HIV-positive MSM reporting UAI; 11.9% of the diagnosed HIV-positive sample); 160 HIV-negative MSM reported having had an HIV test (and therefore being aware of their HIV-negative status), always knowing their partners' status, and only having HIV-negative partners (52.8% of HIV-negative MSM reporting UAI; 13.7% of the total HIV-negative sample).

Conclusions: Behavior suggestive of serosorting and strategic positioning (among HIV-negative MSM) was evident in this sample, but inconsistent adoption of these and general versatility in sexual behavior suggest that they have a limited role.

From the *MRC/CSO Social and Public Health Sciences Unit, Glasgow, United Kingdom; and Faculty of Population Health Sciences, School of Life & Medical Sciences University College London, London, United Kingdom.

The authors thank the survey staff and fieldworkers in each city, the venue managers, their staff, and the men who agreed to participate in the survey.

L.M.M. devised the paper, conducted the analyses, and wrote the first draft. G.J.H. contributed to subsequent drafts, and both authors approved the final version of the manuscript.

The UK Medical Research Council funds Lisa McDaid and the Gay Men's Survey as part of the Sexual Health Programme (MC_US_A540_5TK60) at the MRC/CSO Social and Public Health Sciences Unit in Glasgow. Conflicts of Interest: none.

Correspondence: Lisa M. McDaid, MRC/CSO Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow, G12 8RZ, United Kingdom. E-mail:

Received for publication June 9, 2011, and accepted March 23, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association