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Correlates of Unprotected Anal Intercourse: The Influence of Anal Sex Position Among Men Who Have Sex with Men in Beijing, China

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Abstract

Understanding barriers to consistent condom use among men who have sex with men (MSM) requires consideration of the context in which risk behaviors occur. Anal sex position is one such context. This pooled cross-sectional study used survey data from 1,230 MSM and their 2,618 reported male sexual partnerships. Overall, nearly half of the participants engaged in unprotected anal intercourse (UAI) with at least one of upto three partners in the past 6 months. “Insertive” men engaged in less UAI (39 %) than “receptive” (53 %) or “versatile” (51 %) men. Regardless of sexual position, UAI was associated with cohabiting with a male or female partner and perceiving great or moderate risk of HIV from male contact at the individual level, and steady (vs. casual) partnership at the dyad level. However, early MSM anal sex debut, high number of male partners, alcohol use, receiving and buying condoms, HIV testing, and MSM sex-seeking venues were found to be only statistically significantly correlated with UAI among some but not all sexual positions, implying that interventions to increase condom use should take into account how anal sex position may influence willingness and ability to engage in safer sex. Dyad level data appear to provide additional insight into the influence of sexual positions, and should be used to complement individual data for future intervention designs.

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Acknowledgments

This study was supported by grants from the National Natural Science Foundation of China (81273188), the National Institutes of Health (#R01 AI078933),the Ministry of Science and Technology of China (2012ZX10001-002), the International Development Research Center of Canada (grant #104519-010)and Chinese State Key Laboratory for Infectious Disease Development Grant. Stephen W. Pan was supported by a Fulbright grant from the US government.

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Authors and Affiliations

  1. Epidemiology and Biostatistics Branch of Division of Virology and Immunology, State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 155 Changbai Road, Changping District, Beijing, 102206, People’s Republic of China

    Heng Zhang, Yan Xiao, Zheya Sun, Yunan Xu, Yuhua Ruan & Yiming Shao

  2. Beijing Center for Disease Control and Prevention, Beijing, People’s Republic of China

    Hongyan Lu, Dongyan Xia, Yuejuan Zhao, Xiong He & Hai Yue

  3. The School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Stephen W. Pan

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  1. Heng Zhang
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  2. Hongyan Lu
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  3. Stephen W. Pan
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  4. Dongyan Xia
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Correspondence to Yuhua Ruan.

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Zhang, H., Lu, H., Pan, S.W. et al. Correlates of Unprotected Anal Intercourse: The Influence of Anal Sex Position Among Men Who Have Sex with Men in Beijing, China. Arch Sex Behav 44, 375–387 (2015). https://doi.org/10.1007/s10508-014-0396-x

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