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Hughes getting in early 23.6 cp

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Hughes getting in early 23.6 cp

  1. 1. Getting in early: Condom use at first anal sex between males is associated with better current health outcomes Tony Hughes ¹ Peter Saxton ¹ ² Nigel Dickson ² Katrina Sharples ² ¹ Research, Analysis and Information Unit, New Zealand AIDS Foundation. ² Department of Preventive and Social Medicine, University of Otago, Dunedin. AIDS Impact Conference 1-4 July 2007 Marseille, France
  2. 2. <ul><li>NZ low prevalence of HIV diagnoses among MSM </li></ul><ul><li>Condom-centred programme for MSM from 1987 </li></ul><ul><ul><li>Normative </li></ul></ul><ul><ul><li>Reflex </li></ul></ul><ul><ul><li>Universal </li></ul></ul><ul><li>Has condom use for first anal sex changed over time? </li></ul><ul><li>Does condom use at first sex predict condom use at later sex? </li></ul>New Zealand
  3. 3. Behavioural surveillance studies <ul><li>Offline </li></ul><ul><ul><li>Gay Auckland Periodic Sex Survey (GAPSS) </li></ul></ul><ul><ul><li>Every 2 years (n=1228 in 2006) </li></ul></ul><ul><ul><li>Fair day, saunas/sex-on-site, bars </li></ul></ul><ul><ul><li>Response rate ~70% </li></ul></ul><ul><li>Online </li></ul><ul><ul><li>Gay men’s Online Sex Survey (GOSS) </li></ul></ul><ul><ul><li>Added in 2006 (n=2141 in 2006) </li></ul></ul><ul><ul><li>Internet dating sites </li></ul></ul><ul><li>Same questionnaire (total n=3369) </li></ul>
  4. 4. Questions on first anal sex <ul><li>Asked the year of first anal sex (92.5% had anal sex) </li></ul><ul><li>Whether condom used? (Y/N) </li></ul><ul><li>Modality of first anal sex? (I/R/Both) </li></ul>
  5. 5. Year of first anal sex n=2989
  6. 6. Year of first anal sex Pre-HAART Post-HAART 54.5% of sample 45.5% of sample n=2989
  7. 7. Key questions: <ul><li>Has condom use at first anal sex changed over time? </li></ul><ul><li>What is associated with non-condom use at first anal sex? </li></ul><ul><li>Whether non-condom use at first anal sex is related to current outcomes? </li></ul>
  8. 8. 1. Has condom use at first anal sex changed over time? AIDS identified % used condom at first anal sex HAART n=2834
  9. 9. 1. Has condom use at first anal sex changed over time? * p<0.001 * 25.5 28.8 33.1 48.1 70.8 81.9 93.5 No 74.5 71.2 66.9 51.9 29.2 18.1 6.5 Yes 2001-2005 (n=815) 1996-2000 (n=701) 1991-1995 (n=335) 1986-1990 (n=289) 1981-1985 (n=226) 1976-1980 (n=188) < 1976 (n=232) Condom used at first sex (%) Period during which first anal sex occurred
  10. 10. Next two parts of the analysis: <ul><li>What is associated with non-condom use at first sex </li></ul><ul><ul><li>( Pre-HAART 1981-1995 vs Post-HAART 1996-2005 ) </li></ul></ul><ul><li>Whether non-condom use at first sex is related to current outcomes </li></ul><ul><ul><li>( Pre-HAART 1981-1995 vs Post-HAART 1996-2005 ) </li></ul></ul>
  11. 11. Sample reduced to MSM for whom: <ul><li>First anal sex occurred between 1981 and 2005 (HIV era) </li></ul><ul><li>Age at first anal sex was ≥ 12yrs old </li></ul><ul><li>n=2266 </li></ul>
  12. 12. 2. What is associated with non-condom use at first sex? 24.6 48.8 Both receptive and insertive 23.2 42.9 Insertive only 0.036 29.8 0.505 46.1 Modality Receptive only 38.0 62.1 Other 34.8 54.2 Asian 36.8 66.7 Pacific 27.7 37.8 Maori 0.054 25.1 0.053 45.3 Ethnicity NZ European 25.3 42.6 Bisexual 0.668 27.1 0.421 46.7 Sexual identity Gay 24.8 41.4 40+ 21.6 38.9 35-39 17.9 34.6 30-34 20.8 36.7 25-29 28.5 44.2 20-24 26.4 43.9 16-19 0.006 35.4 <0.001 66.7 Age at first sex 12-15 X 2 p-value % X 2 p-value % Post-HAART Pre-HAART
  13. 13. 2. What is associated with non-condom use at first sex? 24.6 48.8 Both receptive and insertive 23.2 42.9 Insertive only 0.036 29.8 0.505 46.1 Modality Receptive only 38.0 62.1 Other 34.8 54.2 Asian 36.8 66.7 Pacific 27.7 37.8 Maori 0.054 25.1 0.053 45.3 Ethnicity NZ European 25.3 42.6 Bisexual 0.668 27.1 0.421 46.7 Sexual identity Gay 24.8 41.4 40+ 21.6 38.9 35-39 17.9 34.6 30-34 20.8 36.7 25-29 28.5 44.2 20-24 26.4 43.9 16-19 0.006 35.4 <0.001 66.7 Age at first sex 12-15 X 2 p-value % X 2 p-value % Post-HAART Pre-HAART
  14. 14. 3. Is non-condom use at first sex associated with non-condom use now? 1 Adjusted for age at first anal sex, ethnicity, identity, modality 3.7 (1.9-7.2) 2.8 (1.2-6.5) Adj 1 3.8 (2.0-7.1) 69.2 2.3 (1.1-4.9) 61.9 Did not use condom at first sex 1 37.2 1 41.1 Used condom at first sex Any unprotected sex with regular “fuckbuddy” <6 mths 2.9 (1.5-5.6) 2.1 (0.9-4.6) Adj 1 2.8 (1.5-5.2) 87.3 2.0 (1.01-4.1) 85.0 Did not use condom at first sex 1 71.3 1 73.5 Used condom at first sex Any unprotected sex with regular “boyfriend” <6 mths 3.9 (2.8-5.5) 2.9 (1.9-4.3) Adj 1 3.9 (2.8-5.4) 67.1 2.8 (1.9-4.1) 60.6 Did not use condom at first sex 1 34.3 1 35.5 Used condom at first sex Any unprotected sex with casual partner < 6 mths Odds ratio % Odds ratio % Post-HAART Pre-HAART
  15. 15. 3. Is non-condom use at first sex associated with non-condom use now? 1 Adjusted for age at first anal sex, ethnicity, identity, modality 3.7 (1.9-7.2) 2.8 (1.2-6.5) Adj 1 3.8 (2.0-7.1) 69.2 2.3 (1.1-4.9) 61.9 Did not use condom at first sex 1 37.2 1 41.1 Used condom at first sex Any unprotected sex with regular “fuckbuddy” <6 mths 2.9 (1.5-5.6) 2.1 (0.9-4.6) Adj 1 2.8 (1.5-5.2) 87.3 2.0 (1.01-4.1) 85.0 Did not use condom at first sex 1 71.3 1 73.5 Used condom at first sex Any unprotected sex with regular “boyfriend” <6 mths 3.9 (2.8-5.5) 2.9 (1.9-4.3) Adj 1 3.9 (2.8-5.4) 67.1 2.8 (1.9-4.1) 60.6 Did not use condom at first sex 1 34.3 1 35.5 Used condom at first sex Any unprotected sex with casual partner < 6 mths Odds ratio % Odds ratio % Post-HAART Pre-HAART
  16. 16. 3. Is non-condom use at first sex associated with non-condom use now? 1 Adjusted for age at first anal sex, ethnicity, identity, modality 3.7 (1.9-7.2) 2.8 (1.2-6.5) Adj 1 3.8 (2.0-7.1) 69.2 2.3 (1.1-4.9) 61.9 Did not use condom at first sex 1 37.2 1 41.1 Used condom at first sex Any unprotected sex with regular “fuckbuddy” <6 mths 2.9 (1.5-5.6) 2.1 (0.9-4.6) Adj 1 2.8 (1.5-5.2) 87.3 2.0 (1.01-4.1) 85.0 Did not use condom at first sex 1 71.3 1 73.5 Used condom at first sex Any unprotected sex with regular “boyfriend” <6 mths 3.9 (2.8-5.5) 2.9 (1.9-4.3) Adj 1 3.9 (2.8-5.4) 67.1 2.8 (1.9-4.1) 60.6 Did not use condom at first sex 1 34.3 1 35.5 Used condom at first sex Any unprotected sex with casual partner < 6 mths Odds ratio % Odds ratio % Post-HAART Pre-HAART
  17. 17. 3. Is non-condom use at first sex associated with later STI and HIV acquisition? 1 Adjusted for age at first anal sex, ethnicity, identity, modality - - Adj 1 3.5 (0.9-13.0) 1.3 1.0 (0.5-2.0) 4.7 Did not use condom at first sex 1 0.4 1 4.7 Used condom at first sex Was later diagnosed with HIV 1.6 (1.2-2.0) 1.4 (1.1-1.9) Adj 1 1.5 (1.2-1.9) 34.6 1.3 (0.99-1.8) 54.8 Did not use condom at first sex 1 26.3 1 47.8 Used condom at first sex Reported STI in lifetime 1.7 (1.1-2.5) 1.5 (0.9-2.6) Adj 1 1.5 (1.04-2.3) 11.5 1.3 (0.8-2.2) 9.6 Did not use condom at first sex 1 7.6 1 7.3 Used condom at first sex Reported STI in previous 12 mths Odds ratio % Odds ratio % Post-HAART Pre-HAART
  18. 18. 3. Is non-condom use at first sex associated with later STI and HIV acquisition? 1 Adjusted for age at first anal sex, ethnicity, identity, modality - - Adj 1 3.5 (0.9-13.0) 1.3 1.0 (0.5-2.0) 4.7 Did not use condom at first sex 1 0.4 1 4.7 Used condom at first sex Was later diagnosed with HIV 1.6 (1.2-2.0) 1.4 (1.1-1.9) Adj 1 1.5 (1.2-1.9) 34.6 1.3 (0.99-1.8) 54.8 Did not use condom at first sex 1 26.3 1 47.8 Used condom at first sex Reported STI in lifetime 1.7 (1.1-2.5) 1.5 (0.9-2.6) Adj 1 1.5 (1.04-2.3) 11.5 1.3 (0.8-2.2) 9.6 Did not use condom at first sex 1 7.6 1 7.3 Used condom at first sex Reported STI in previous 12 mths Odds ratio % Odds ratio % Post-HAART Pre-HAART
  19. 19. 3. Is non-condom use at first sex associated with later STI and HIV acquisition? 1 Adjusted for age at first anal sex, ethnicity, identity, modality - - Adj 1 3.5 (0.9-13.0) 1.3 1.0 (0.5-2.0) 4.7 Did not use condom at first sex 1 0.4 1 4.7 Used condom at first sex Was later diagnosed with HIV 1.6 (1.2-2.0) 1.4 (1.1-1.9) Adj 1 1.5 (1.2-1.9) 34.6 1.3 (0.99-1.8) 54.8 Did not use condom at first sex 1 26.3 1 47.8 Used condom at first sex Reported STI in lifetime 1.7 (1.1-2.5) 1.5 (0.9-2.6) Adj 1 1.5 (1.04-2.3) 11.5 1.3 (0.8-2.2) 9.6 Did not use condom at first sex 1 7.6 1 7.3 Used condom at first sex Reported STI in previous 12 mths Odds ratio % Odds ratio % Post-HAART Pre-HAART
  20. 20. 3. Is non-condom use at first sex associated with later attitudes to condoms? 1 Adjusted for age at first anal sex, ethnicity, identity, modality 2.2 (1.7-2.8) 2.5 (1.8-3.4) Adj 1 2.0 (1.6-2.6) 50.3 2.3 (1.7-3.0) 54.0 Did not use condom at first sex 1 33.3 1 34.3 Used condom at first sex AGREE that “ I don’t like wearing condoms because they reduce sensitivity” 3.7 (2.6-5.1) 2.8 (1.8-4.3) Adj 1 3.6 (2.6-4.9) 23.0 2.8 (1.8-4.3) 21.4 Did not use condom at first sex 1 7.7 1 8.9 Used condom at first sex AGREE that “I’d sometimes rather risk HIV transmission than use a condom during anal sex” 4.4 (2.5-7.5) 3.2 (1.6-6.4) Adj 1 4.2 (2.5-7.0) 9.2 3.0 (1.6-5.6) 9.4 Did not use condom at first sex 1 2.4 1 3.4 Used condom at first sex DISAGREE that “ condoms are ok as part of sex” Odds ratio % Odds ratio % Post-HAART Pre-HAART
  21. 21. 3. Is non-condom use at first sex associated with later attitudes to condoms? 1 Adjusted for age at first anal sex, ethnicity, identity, modality 2.2 (1.7-2.8) 2.5 (1.8-3.4) Adj 1 2.0 (1.6-2.6) 50.3 2.3 (1.7-3.0) 54.0 Did not use condom at first sex 1 33.3 1 34.3 Used condom at first sex AGREE that “ I don’t like wearing condoms because they reduce sensitivity” 3.7 (2.6-5.1) 2.8 (1.8-4.3) Adj 1 3.6 (2.6-4.9) 23.0 2.8 (1.8-4.3) 21.4 Did not use condom at first sex 1 7.7 1 8.9 Used condom at first sex AGREE that “I’d sometimes rather risk HIV transmission than use a condom during anal sex” 4.4 (2.5-7.5) 3.2 (1.6-6.4) Adj 1 4.2 (2.5-7.0) 9.2 3.0 (1.6-5.6) 9.4 Did not use condom at first sex 1 2.4 1 3.4 Used condom at first sex DISAGREE that “ condoms are ok as part of sex” Odds ratio % Odds ratio % Post-HAART Pre-HAART
  22. 22. 3. Is non-condom use at first sex associated with later attitudes to condoms? 1 Adjusted for age at first anal sex, ethnicity, identity, modality 2.2 (1.7-2.8) 2.5 (1.8-3.4) Adj 1 2.0 (1.6-2.6) 50.3 2.3 (1.7-3.0) 54.0 Did not use condom at first sex 1 33.3 1 34.3 Used condom at first sex AGREE that “ I don’t like wearing condoms because they reduce sensitivity” 3.7 (2.6-5.1) 2.8 (1.8-4.3) Adj 1 3.6 (2.6-4.9) 23.0 2.8 (1.8-4.3) 21.4 Did not use condom at first sex 1 7.7 1 8.9 Used condom at first sex AGREE that “I’d sometimes rather risk HIV transmission than use a condom during anal sex” 4.4 (2.5-7.5) 3.2 (1.6-6.4) Adj 1 4.2 (2.5-7.0) 9.2 3.0 (1.6-5.6) 9.4 Did not use condom at first sex 1 2.4 1 3.4 Used condom at first sex DISAGREE that “ condoms are ok as part of sex” Odds ratio % Odds ratio % Post-HAART Pre-HAART
  23. 23. Summary <ul><li>Condom use at first anal sex increased substantially until mid-to-late 1990s then levelled off </li></ul><ul><li>Non-condom use at first sex clearly associated with younger age at first anal sex, both in pre-HAART and post-HAART first sex periods </li></ul><ul><li>Non-condom use at first sex associated with recent non-use of condoms, both in pre-HAART and post-HAART first sex periods </li></ul><ul><li>Non-condom use at first sex also associated with increased STI risk and current negative attitudes towards condoms </li></ul>
  24. 24. Discussion <ul><li>Lifting condom use in the MSM population takes a long time and requires action at many different levels </li></ul><ul><li>Once raised, maintaining condom use takes specific effort and ground can easily be lost by neglect </li></ul><ul><li>Important to examine reasons for condom use, not just reasons for non -condom use </li></ul><ul><li>On its own, condom use at first sex is a useful alternative indicator of trends in safe sex norms </li></ul><ul><li>In conjunction with measures of later condom use, it provides additional capacity to examine patterns of condom maintenance </li></ul>Prevention Research
  25. 25. Potential limitations <ul><li>Self-report </li></ul><ul><li>Short questionnaire </li></ul><ul><li>Retrospective – lack data surrounding context of first anal sex </li></ul><ul><li>Recall error – though expect less because first anal sex is unique experience </li></ul>
  26. 26. Acknowledgements <ul><li>All offline and online participants (n=3369) </li></ul><ul><li>Co-authors Peter Saxton, Nigel Dickson, Katrina Sharples </li></ul><ul><li>NZ Ministry of Health (funding) </li></ul><ul><li>New Zealand AIDS Foundation (funding and support) </li></ul><ul><li>University of Otago (funding and support) </li></ul>

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