title: Rates of condom and non-condom-based anal intercourse practices among homosexually active men in Australia: deliberate HIV risk reduction?
abstract: OBJECTIVE
  Three decades into the HIV epidemic and with the advancement of HIV treatments, condom and non-condom-based anal intercourse among gay men in resource-rich countries needs to be re-assessed.
  
  
  METHODS
  The proportions of men engaging in a range of anal intercourse practices were estimated from the ongoing cross-sectional Gay Community Periodic Surveys in six states in Australia from 2007 to 2009. Comparisons were made between HIV-negative men, HIV-positive men with an undetectable viral load and those with a detectable viral load.
  
  
  RESULTS
  Condoms play a key role in gay men's anal intercourse practices: 33.8% of HIV-negative men, 25.1% of HIV-positive men with an undetectable viral load and 22.5% of those with a detectable viral load reported consistent condom use with all male partners in the 6&emsp14;months before the survey. Among HIV-negative men, the second largest group were men who had unprotected anal intercourse (UAI) only in the context of HIV-negative seroconcordant regular relationships. Among HIV-positive men, the second largest group was men who had UAI in casual encounters preceded by HIV status disclosure to some, but not all, casual partners.
  
  
  CONCLUSIONS
  A minority, yet sizeable proportion, of men consistently engaged in a number of UAI practices in specific contexts, suggesting they have adopted deliberate HIV risk-reduction strategies. While it is important that HIV behavioural prevention continues to reinforce condom use, it needs to address both the challenges and opportunities of the substantial uptake of non-condom-based risk-reduction strategies.
authors.affiliation: National Centre in HIV Social Research, University of New South Wales, Sydney, NSW 2052, Australia. limin.mao@unsw.edu.au
authors.forename: Limin
authors.initials: L
authors.lastname: Mao
authors.forename: Susan C
authors.initials: SC
authors.lastname: Kippax
authors.forename: Martin
authors.initials: M
authors.lastname: Holt
authors.forename: Garrett P
authors.initials: GP
authors.lastname: Prestage
authors.forename: Iryna B
authors.initials: IB
authors.lastname: Zablotska
authors.forename: John B F
authors.initials: JB
authors.lastname: de Wit
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000453:epidemiology / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D040242:Risk Reduction Behavior; D012747:Sexual Partners; D014342:Truth Disclosure; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data; D019562:Viral Load