AIDS and Behavior

, Volume 15, Issue 3, pp 584–595 | Cite as

Correlates of Unprotected Anal Sex at Last Sexual Episode: Analysis from a Surveillance Study of Men who have Sex with Men in Montreal

  • G. LambertEmail author
  • J. Cox
  • T. S. Hottes
  • C. Tremblay
  • L. R. Frigault
  • M. Alary
  • J. Otis
  • R. S. Remis
  • The M-Track Study Group
Original Paper


Recent increases in rates of unprotected anal sex (UAS) among men who have sex with men (MSM) signal the need to continually refine our understanding of factors associated with risky sexual behavior. Data were collected using a questionnaire eliciting information about the last sexual episode (LSE) with another man in the past 6 months. Logistic regression was used to identify both event-level and background correlates of UAS at LSE. 965 participants who reported having sex with a partner with whom they were not in a couple relationship at LSE were studied. Several event-level variables were significantly associated with UAS after adjusting for background factors, including finding the partner at LSE sexually attractive and using alcohol or cocaine at LSE. Our findings parallel the results of other HIV prevention studies which have highlighted the importance of interpersonal factors that influence risk-taking at the moment of a sexual act among MSM.


HIV Men who have sex with men Event-level analysis 



The authors wish to acknowledge the contribution of other members of the research team, René Lavoie and Dr. Jean Vincelette as well as members of the M-Track Study Group of the Center for infectious disease prevention and control of the Public Health Agency of Canada (Dr. Chris Archibald, Dr. John Kim, Dr. Paul Sandstrom, Dana Paquette, and Rhonda Kropp). Also, we would like to recognize the work of the study operations team who coordinated subject recruitment and data collection: François Tremblay, Marc-André Gadoury, and the team of interviewers. This study received financial and in-kind support from the Public Health Agency of Canada, the Ministère de la santé et des services sociaux du Québec and the Direction de santé publique de l’Agence de la santé et des services sociaux de Montréal.


  1. 1.
    Division of HIV/AIDS Epidemiology and Surveillance, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada. HIV and AIDS in Canada [document on the internet]. Public Health Agency of Canada. 2007. [cited 2009 July 16]. Available from:
  2. 2.
    Lampinen TM, Ogilvie G, Chan K, et al. Sustained increase in HIV-1 incidence since 2000 among men who have sex with men in British Columbia, Canada. J Acquir Immune Defic Syndr. 2005;40(2):242–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Remis RS, Liu J, Swantee C, et al. Trends in HIV incidence among men who have sex with men in Ontario: update from the Laboratory Enhancement Study (LES). Can J Infect Dis. 2007;18(Suppl B):41B. (Abstract O099).Google Scholar
  4. 4.
    Kingsley LA, Detels R, Kaslow R, et al. Risk factors for seroconversion to human immunodeficiency virus among male homosexuals. Results from the Multicenter AIDS Cohort Study. Lancet. 1987;14(8529):345–9.CrossRefGoogle Scholar
  5. 5.
    Osmond DH, Pollack LM, Paul JP, Catania JA. Changes in prevalence of HIV infection and sexual risk behavior in men who have sex with men in San Francisco: 1997–2002. Am J Public Health. 2007;97(9):1677–83.PubMedCrossRefGoogle Scholar
  6. 6.
    George C, Alary M, Otis J, et al. Nonnegligible increasing temporal trends in unprotected anal intercourse among men who have sexual relations with other men in Montreal. J Acquir Immune Defic Syndr. 2006;41(3):365–70.PubMedCrossRefGoogle Scholar
  7. 7.
    Van de Ven P, Prestage G, French J, Knox S, Kippax S. Increase in unprotected anal intercourse with casual partners among Syndey gay men in 1996–98. Aust N Z J Public Health. 1998;22(7):814–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Dodds JP, Nardone A, Mercey DE, Johnson AM. Increase in high risk sexual behaviour among homosexual men, London 1996–8: cross sectional, questionnaire study. BMJ. 2000;320(7248):1510–1.PubMedCrossRefGoogle Scholar
  9. 9.
    Cox J, Beauchemin J, Allard R. HIV status of sexual partners is more important than antiretroviral treatment related perceptions for risk taking by HIV positive MSM in Montreal, Canada. Sex Transm Infect. 2004;80(6):518–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Dudley MG, Rostosky SS, Korfhage BA, Zimmerman RS. Correlates of high-risk sexual behavior among young men who have sex with men. AIDS Educ Prev. 2004;16(4):328–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Poppen PJ, Reisen CA, Zea MC, Bianchi FT, Echeverry JJ. Serostatus disclosure, seroconcordance, partner relationship, and unprotected anal intercourse among HIV-positive Latino men who have sex with men. AIDS Educ Prev. 2005;17(3):227–37.PubMedCrossRefGoogle Scholar
  12. 12.
    Dufour A, Alary M, Otis J, et al. Correlates of risky behaviors among young and older men having sexual relations with men in Montreal, Quebec, Canada. J Acqir Immune Defic Syndr. 2000;23(3):272–8.Google Scholar
  13. 13.
    Crepaz N, Marks G. Are negative affective states associated with HIV sexual risk behaviors? A meta-analytic review. Health Psychol. 2001;20(4):291–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Rogers G, Curry M, Oddy J, Pratt N, Beilby J, Wilkinson D. Depressive disorders and unprotected casual anal sex among Australian homosexually active men in primary care. HIV Med. 2003;4(3):271–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Parsons JT, Bimbi DS. Intentional unprotected anal intercourse among sex who have sex with men: barebacking—from behaviour to identity. AIDS Behav. 2007;11(2):277–87.PubMedCrossRefGoogle Scholar
  16. 16.
    Colfax G, Vittinghoff E, Husnik MJ, et al. Substance use and sexual risk: a participant- and episode-level analysis among a cohort of men who have sex with men. Am J Epidemiol. 2004;159(10):1002–12.PubMedCrossRefGoogle Scholar
  17. 17.
    Shuper PA, Fisher WA. The role of sexual arousal and sexual partner characteristics in HIV+ MSM’s intentions to engage in unprotected sexual intercourse. Health Psychol. 2008;27(4):445–54.PubMedCrossRefGoogle Scholar
  18. 18.
    Rietmeijer CA, Lansky A, Anderson JE, Fichtner RR. Developing standards in behavioral surveillance for HIV/STD prevention. AIDS Educ Prev. 2001;13(3):268–78.PubMedCrossRefGoogle Scholar
  19. 19.
    Leigh BC, Stall R. Substance use, risky sexual behavior for exposure to HIV. Issues in methodology, interpretation, and prevention. Am Psychol. 1993;48(10):1035–45.PubMedCrossRefGoogle Scholar
  20. 20.
    Chiasson MA, Hirshfield S, Remien RH, Humberstone M, Wong T, Wolitski RJ. A comparison of on-line and off-line sexual risk in men who have sex with men: an event-based on-line survey. J Acquir Immune Defic Syndr. 2007;44(2):235–43.PubMedCrossRefGoogle Scholar
  21. 21.
    Clutterbuck DJ, Gorman D, McMillan A, Lewis R, Macintyre CC. Substance use and unsafe sex amongst homosexual men in Edinburgh. AIDS Care. 2001;13(4):527–35.PubMedCrossRefGoogle Scholar
  22. 22.
    Davidovich U, de Wit JB, Stroebe W. Behavioral and cognitive barriers to safer sex between men in steady relationships: implications for prevention strategies. AIDS Educ Prev. 2004;16(4):304–14.PubMedCrossRefGoogle Scholar
  23. 23.
    Gillmore MR, Morrison DM, Leigh BC, Hoppe MJ, Gaylord J, Rainey DT. Does “high = high risk”? An event-based analysis of the relationship between substance use and unprotected anal sex among gay and bisexual men. AIDS Behav. 2002;6(4):361–70.CrossRefGoogle Scholar
  24. 24.
    Irwin TW, Morgenstern J, Parsons JT, Wainberg M, Labouvie E. Alcohol and sexual HIV risk behavior among problem drinking men who have sex with men: an event level analysis of timeline followback data. AIDS Behav. 2006;10(3):299–307.PubMedCrossRefGoogle Scholar
  25. 25.
    Kalichman SC, Weinhardt LW, DiFonzo K, Austin J, Luke W. Sensation seeking and alcohol use as markers of sexual transmission risk behavior in HIV-positive men. Ann Behav Med. 2002;24(3):229–35.PubMedCrossRefGoogle Scholar
  26. 26.
    Vanable PA, McKirnan DJ, Buchbinder SP, et al. Alcohol use and high-risk sexual behavior among men who have sex with men: the effects of consumption level and partner type. Health Psychol. 2004;23(5):525–32.PubMedCrossRefGoogle Scholar
  27. 27.
    Prestage G, Van de Ven P, Mao L, Grulich A, Kippax S, Kaldor J. Contexts for last occasions of unprotected anal intercourse among HIV-negative gay men in Sydney: the health in men cohort. AIDS Care. 2005;17(1):23–32.PubMedCrossRefGoogle Scholar
  28. 28.
    ARGUS [document on the internet]. Agence de la santé et des services sociaux de Montréal; 2009 [cited 2009 July 16]. Available from: from
  29. 29.
    Guidelines for Second Generation HIV Surveillance [document on the internet]. World Health Organization and Joint United Nations Programme on HIV/AIDS (UNAIDS); 2000 [cited 2009 July 16]. Available from:
  30. 30.
    HIV/AIDS: M-Track Survey [document on the internet]. Public Health Agency of Canada; 2008 [cited 2009 July 16]. Available from:
  31. 31.
    Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005;19(S2):S67–72.Google Scholar
  32. 32.
    Brewer DD, Golden MR, Handsfield HH. Unsafe sexual behavior and correlates of risk in a probability sample of men who have sex with men in the era of highly active antiretroviral therapy. Sex Transm Dis. 2006;33(4):250–5.PubMedGoogle Scholar
  33. 33.
    Drumright LN, Strathdee SA, Little SJ, et al. Unprotected anal intercourse and substance use before and after HIV diagnosis among recently HIV-infected men who have sex with men. Sex Transm Dis. 2007;34(6):401–7.PubMedGoogle Scholar
  34. 34.
    Folch C, Marks G, Esteve A, Zaragoza K, Munoz R, Casabona J. Factors associated with unprotected anal intercourse with steady male, casual male, and female partners among men who have sex with men in Barcelona, Spain. AIDS Educ Prev. 2006;18(3):227–42.PubMedCrossRefGoogle Scholar
  35. 35.
    Sanchez T, Finlayson T, Drake A, et al. Human immunodeficiency virus (HIV) risk, prevention, and testing behaviors—United States, National HIV Behavioral Surveillance System: men who have sex with men, November 2003–April 2005. MMWR Surveill Summ. 2006;55(6):1–16.PubMedGoogle Scholar
  36. 36.
    Joint United Nations Programme on HIV/AIDS (UNAIDS). National AIDS programmes: a guide to monitoring and evaluation. Geneva: UNAIDS; 2000.Google Scholar
  37. 37.
    Koblin BA, Chesney MA, Husnik MJ, et al. High-risk behaviors among men who have sex with men in 6 U.S. cities: baseline data from the EXPLORE Study. Am J Public Health. 2003;93(6):926–32.PubMedCrossRefGoogle Scholar
  38. 38.
    Nguyen M, Archibald CP, Siushansian J, Houston SM. Development of behavioural indicators to monitor the HIV epidemic among men who have sex with men in Canada. Canadian Association of HIV/AIDS Research (CAHR) 10th Scientific Conference. Toronto, Ontario, June, 2001 [abstract 330P].Google Scholar
  39. 39.
    Hosmer D, Lemeshow S. Applied logistic regression. 2nd ed. Wiley-Interscience Publication; 2000.Google Scholar
  40. 40.
    Chen SY, Gibson S, Weide D, McFarland W. Unprotected anal intercourse between potentially HIV-serodiscordant men who have sex with men, San Francisco. J Acquir Immune Defic Syndr. 2003;33(2):166–70.PubMedCrossRefGoogle Scholar
  41. 41.
    Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior. JAMA. 2004;292(2):224–36.PubMedCrossRefGoogle Scholar
  42. 42.
    Williams ML, Elwood WN, Bowen AM. Escape from risk: a qualitative exploration of relapse to unprotected anal sex among men who have sex with men. J Psychol Human Sex. 2000;11(4):25–49.CrossRefGoogle Scholar
  43. 43.
    Eaton LA, Kalichman SC, Cain DN, et al. Serosorting sexual partners and risk for HIV among men who have sex with men. Am J Prev Med. 2007;33(6):479–85.PubMedCrossRefGoogle Scholar
  44. 44.
    Truong HM, Kellogg T, Klausner JD, et al. Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting? Sex Transm Infect. 2006;82(6):461–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Xia Q, Molitor F, Osmond DH, et al. Knowledge of sexual partner’s HIV serostatus and serosorting practices in a California population-based sample of men who have sex with men. AIDS. 2006;20(16):2081–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Purcell DW, Parsons JT, Halkitis PN, Mizuno Y, Woods WJ. Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men. J Subst Abuse. 2001;13(1–2):185–200.PubMedCrossRefGoogle Scholar
  47. 47.
    Otis J, Girard M, Alary M, et al. Drogues, sexe et risques dans la communauté gaie montréalaise: 1997–2003. Drogues, santé et societé. 2006;5(2):161–97.Google Scholar
  48. 48.
    Department of Mental Health and Substance Dependence, Noncommunicable Diseases and Mental Health Cluster. International Guide for Monitoring Alcohol Consumption and Related Harm [document on the internet]. World Health Organization; 2000 [cited 2009 July 16]. Available from:
  49. 49.
    Dilley JW, McFarland W, Sullivan P, Discepola M. Psychosocial correlates of unprotected anal sex in a cohort of gay men attending an HIV-negative support group. AIDS Educ Prev. 1998;10(4):317–26.PubMedGoogle Scholar
  50. 50.
    Strathdee SA, Hogg RS, Martindale SL, et al. Determinants of sexual risk-taking among young HIV-negative gay and bisexual men. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;19(1):61–6.PubMedGoogle Scholar
  51. 51.
    Leonard L, Ross MW. The last sexual encounter: the contextualization of sexual risk behaviour. Int J STD AIDS. 1997;8(10):643–5.PubMedCrossRefGoogle Scholar
  52. 52.
    Evans JL, Hahn JA, Page-Shafer K, et al. Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study). J Urban Health. 2003;80(1):137–46.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • G. Lambert
    • 1
    • 2
    • 3
    Email author
  • J. Cox
    • 1
    • 2
    • 4
  • T. S. Hottes
    • 4
    • 5
  • C. Tremblay
    • 1
  • L. R. Frigault
    • 1
  • M. Alary
    • 2
    • 6
    • 7
  • J. Otis
    • 8
  • R. S. Remis
    • 9
  • The M-Track Study Group
  1. 1.Direction de santé publique de MontréalAgence de la santé et des services sociaux de MontréalMontrealCanada
  2. 2.Institut national de santé publique du QuébecQuebecCanada
  3. 3.Département de médecine sociale et préventiveUniversité de MontréalMontrealCanada
  4. 4.Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
  5. 5.British Columbia Centre for Disease ControlVancouverCanada
  6. 6.Unité de recherche en santé des populationsCentre hospitalier affilié universitaire de QuébecQuebecCanada
  7. 7.Département de médecine sociale et préventiveUniversité LavalQuebecCanada
  8. 8.Chaire de recherche du Canada en éducation à la santéUniversité du Québec à MontréalMontrealCanada
  9. 9.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada

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