title: Beyond Anal Sex: Sexual Practices of Men Who have Sex with Men and Associations with HIV and Other Sexually Transmitted Infections.
abstract: BACKGROUND
  Unprotected anal intercourse is often used as a single indicator of risky behavior in men who have sex with men (MSM), yet MSM engage in a variety of behaviors that have unknown associations with sexually transmitted infection (STI) and HIV.
  
  
  OBJECTIVE
  To assess the prevalence of a wide range of sexual behaviors and their associations with prevalent STI and HIV.
  
  
  METHODS
  We used a standardized, self-administered survey to collect behavioral data for this cross-sectional study of 235 MSM seeking care in a public clinic for sexually transmitted diseases.
  
  
  METHODS
  Using modified Poisson regression, we generated unadjusted and adjusted prevalence ratios (PRs) to characterize associations between recent participation in each behavior and prevalent STI and HIV.
  
  
  RESULTS
  Participants' median age was 26 years. One third (35%) were positive for STI. STI prevalence was significantly associated with using sex slings (adjusted PR [aPR] = 2.35), felching (aPR = 2.22), group sex (aPR = 1.86), fisting (aPR = 1.78), anonymous sex (aPR = 1.51), and sex toys (aPR = 1.46). HIV prevalence was 17% and was significantly associated with fisting (aPR = 4.75), felching (aPR = 4.22), enemas (aPR = 3.65), and group sex (aPR = 1.92).
  
  
  CONCLUSIONS
  Multiple behaviors were significantly associated with prevalent STI and HIV in adjusted analyses. To provide a more comprehensive understanding of sexual risk in MSM, prospective studies are needed to examine whether these behaviors are causally associated with HIV and STI acquisition.
authors: Department of Biobehavioral Health, The Methodology Center, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA. Electronic address: cer5374@psu.edu.
authors: Cara E
authors: CE
authors: Rice
authors: Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA.
authors: Courtney
authors: C
authors: Maierhofer
authors: Sexual Health Clinic, Columbus Public Health, Columbus, OH, USA.
authors: Karen S
authors: KS
authors: Fields
authors: Sexual Health Clinic, Columbus Public Health, Columbus, OH, USA.
authors: Melissa
authors: M
authors: Ervin
authors: Department of Biobehavioral Health, The Methodology Center, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA.
authors: Stephanie T
authors: ST
authors: Lanza
authors: Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA.
authors: Abigail Norris
authors: AN
authors: Turner
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000523:psychology*; D055815:Young Adult
keywords: Chlamydia; Gonorrhea; HIV; Homosexuality; Male; Men Who Have Sex With Men (MSM); Sexual Behavior; Sexual Health; Sexually Transmitted Infections; Syphilis