title: High-risk behaviour in steady and in casual relationships among men who have sex with men in Israel.
abstract: OBJECTIVE
  To explore the differences in sexual risk behaviour between men who have sex with men (MSM) with steady partners versus casual partner(s) in the gay community.
  
  
  METHODS
  This online cross-sectional convenience-sampling study assessed MSM practices, their knowledge and their motivation regarding safe sex. Participants not knowing their HIV status or who performed insertive or receptive unprotected anal intercourse (UAI) or with a sex partner whose HIV status was unknown or discordant were considered 'at-risk'.
  
  
  RESULTS
  Of all 2569 participants who completed the questionnaire, 907/2569 (35.3%) had a steady partner, and 896/2569 (34.9%) had a casual partner(s) in the past 6&emsp14;months. 262/907 (28.9%) with steady partners and 248/896 (27.7%) with casual partners demonstrated at-risk sexual behaviour. Of all participants with steady partners, 108/907 (11.9%) performed UAI with their partner without undergoing mutual HIV testing. Of all participants with steady partners, 476/907 (52.5%) had a concurrent casual partner, and 144/476 (30.3%) performed UAI with both the steady and the casual partner. Of all participants with steady partners, 775/907 (85.4%) negotiated the possibility of sex outside their relationship with their main partner. The length of the steady relationship correlated with the number of concurrent casual partners.
  
  
  CONCLUSIONS
  At-risk sexual behaviour was associated with insufficient negotiation skills, difficulties in condom use and a general risk-taking profile. Health educators should encourage MSM with steady partners to perform HIV testing before practising UAI, to improve their negotiation skills during the contact and to support open discussions with regard to sexual contact besides the steady relationship, as it may not be monogamous.
authors.affiliation: Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem 91010, Israel. zohar.mor@rml.health.gov.il
authors.forename: Zohar
authors.initials: Z
authors.lastname: Mor
authors.forename: Udi
authors.initials: U
authors.lastname: Davidovich
authors.forename: Niva
authors.initials: N
authors.lastname: Bessudu-Manor
authors.forename: Mary
authors.initials: M
authors.lastname: McFarlane
authors.forename: Gil
authors.initials: G
authors.lastname: Feldshtein
authors.forename: Daniel
authors.initials: D
authors.lastname: Chemtob
mesh_terms: D000328:Adult; D001294:Attitude to Health; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel; D008297:Male; D012309:Risk-Taking; D021841:Safe Sex / Q000523:psychology* / Q000706:statistics & numerical data; D012747:Sexual Partners; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D047568:Unsafe Sex / Q000523:psychology* / Q000706:statistics & numerical data