HIV risk perception and risk taking among men who have sex with men (MSM): Challenges for internet based follow up surveys among hidden populations and sexual minorities

Objectives: Risk-taking, risk reduction and risk-avoiding strategies among men who have sex with men (MSM) have been documented in follow up surveys since 1987 in Germany. From the beginning of the survey, the questionnaire has been circulated by the most important German magazines for gay men, since 2003 the survey has also been conducted online.

Methods: In 2007, the questionnaire was distributed via magazines and internet sites for gay men. Main topics of the survey were lifestyle (partnership, coming-out, drug use), sexual lifestyle (numbers of sexual partners, frequency of (un)protected anal intercourse), HIV testing behaviour and subcultural integration.

Results: With the “normalization” of AIDS, restriction of anal intercourse to primary partnerships as a risk avoiding strategy has become irrelevant. Traditional risk reduction strategies among MSM show a high degree of time stability: Condom use in anal intercourse has been relatively stable over the last seventeen years; numbers of sexual partners have been rather constant. Since 1991, about 70% of participating MSM have been reporting Safer Sex. The proportion of MSM from major German cities, who have frequently been tested for HIV antibodies, has been increasing. Time trend analysis of these large national behavioural surveys suggests that the rise of new HIV diagnoses in MSM in may partially reflect an increased uptake of HIV testing, rather than new infections due to the erosion of condom use or increased numbers of sexual partners. Connectedness to a “gay scene” seems to be declining with possible consequences for prevention approaches.

Conclusions: Since longitudinal panels on hidden populations like MSM are difficult to perform, conclusions on trends in sexual behaviour have to be drawn from careful comparisons of follow up surveys. The internet is a powerful tool to reach a broad spectrum of MSM, in terms of educational status, age group, geographical distribution, and different subcultures.