SURVEILLANCE OF SEXUAL-BEHAVIOR AMONG HOMOSEXUAL MEN IN A CENTRAL LONDON HEALTH AUTHORITY

Objective: To establish a surveillance mechanism of high risk sexual b ehaviour among homosexual and bisexual men living, socialising and usi ng services in a central London health authority. Design: Baseline sur vey for a system of repeatable behavioural surveillance using a self-c ompleted questionnaire delivered by healthcare providers. Setting: Gen itourinary medicine clinics, gay bars, clubs, community groups and a c ruising ground in the defined geographical area of a central London he alth authority. Participants: Five hundred and fifty three homosexual and bisexual men. Main outcome measures: Self-reported behaviours incl uding unprotected anal intercourse (UAI), HIV status of unprotected an al intercourse partners, uptake of HIV testing and use of condoms at f irst time of anal intercourse. Results: Five hundred and sixty questio nnaires were returned (response rate 76%) from 553 men. A third (35%) of men surveyed had had UAI in the previous year. Nearly a fifth (19%) of the sample had had UAI with one or more partners of a discordant o r unknown HIV status. A total of 343 (63%) men had had an HIV test. Th e proportion of men using condoms on the occasion of first anal interc ourse has risen from 6% before 1980 to 88% after 1993. Conclusions: We have demonstrated that a surveillance programme to monitor high risk sexual behaviour among homosexual men can be easily established. The r esults can be employed to assess progress towards risk reduction targe ts and also inform future policy development. Our baseline data demons trate that a large proportion of homosexual men are continuing to enga ge in high risk sexual behaviour, although there is some evidence of i mprovement in condom use at first anal intercourse over time. There is a need for continuing health promotion with evaluation among homosexu al men.