Anonymous sex among homosexually active men: implications for HIV prevention

Background: Anonymous sex sites have long been the target of human immunodeficiency virus (HIV) prevention interventions. In the United Kingdom, the recent increase in venues offering sex on the premises has fuelled speculation about increases in HIV transmissions. However, there is little research regarding the role of these sites in the transmission of HIV. Methods: A questionnaire was distributed during the London Gay Pride festival in July 1997. The respondents were male, resident in the United Kingdom and homosexually active in the last year. Results: Sex in an anonymous site was most common among men in their 40s, living in London, with higher levels of education and who had tested HIV positive. Unprotected anal intercourse (UAI) in an anonymous site was significantly more common among men with lower levels of education and among those who had tested HIV positive. Discussion: Anonymous sex participants engaged in more UAI than nonparticipants but not disproportionately in anonymous sex sites. Therefore, engaging in increased UAI is a function of engaging in more sex, rather than frequenting such sites. To target men with high numbers of UAI partners it is appropriate to do so in anonymous sex sites. However, a different type of intervention is appropriate for men who engage in UAI in anonymous sex sites. Campaigns that aim to improve risk reduction strategies will need to engage with the complexities informing anonymous UAI as well as factors particular to men with lower educational qualifications