Cultures of sexual adventurism as markers of HIV seroconversion: a case control study in a cohort of Sydney gay men

A case control analysis within an ongoing cohort study was used to examine differences between seroconverters and men who remained HIV-negative. The c ases were interviewed within one to 13 months prior to their seroconversion . Their responses to a structured questionnaire were compared with those of HIV-negative controls drawn from the same time period and from the same lo ngitudinal study, Sydney Men and Sexual Health. Data collected from both ca ses and controls included: demographic and contextual variables, knowledge of HIV transmission, sexual practices, drug and alcohol use and attitudinal factors. The aim was to compare the sexual behaviours, and the social and cultural contexts of such behaviours, of men prior to their HIV seroconvers ion with men who did not seroconvert. Twenty-three men had seroconverted wi thin the cohort. Cases were identified by a positive HIV antibody test or s elf-report of positive HIV status following a previous negative HIV test. T hree-hundred-and-sixty-nine controls were selected on the basis of being HI V negative at interview in 1994, and having at least one subsequent medical ly-confirmed negative HIV antibody test. Univariate predictors of seroconve rsion were: being in a regular relationship with a known HIV-positive partn er, drug use, and engaging in a range of anal and esoteric sexual practices . Practices commonly used to enhance sexual pleasure, such as group sex, wa tching and being watched having sex, the use of sex toys and dressing up/fa ntasy, were engaged in more frequently by seroconverters. Engaging in these esoteric sexual practices was highly correlated with drug use, involvement in the gay community and engagement in a wide range of anal practices. In the multivariate analysis independent predictors of seroconversion were: yo unger age; being in a regular relationship with a known HIV-positive partne r; believing withdrawal to be safe with regard to HIV transmission; and ran ge of esoteric practices. These results indicate the importance of the soci al and cultural contexts of particular sexual practices and consequent HIV transmission. Sexually adventurous men may be at increased risk for HIV bec ause the seek sex within particular sub-cultures.