THE UNFOLDING OF A RISKY ENCOUNTER AS TOLD BY MEN WHO HAVE AFFECTIVE AND SEXUAL RELATIONS WITH OTHER MEN (MASM)

J Otis^1,2, R Le Clerc², M Alary^3,4, R Lavoie⁵, M Gaudreault^1,2, K Engler¹, R Remis⁶, J Vincelette⁷, B Turmel⁸, R Parent⁴, B Mâsse³, Omega Study Group
¹Université du Québec à Montréal, Département de sexology; ²Coalition des Organismes Communautaire Québécois de lutte contre le sida; ³Centre Hospitalier Affilié Universitaire de Québec; ⁴Institut National de Santé Publique du Québec; ⁵Action Séro Zéro; ⁶University of Toronto, Department of Public Health Sciences; ⁷Hôpital Saint-Luc, Service d’Immunologie; ⁸Direction Générale de Santé Publique, MSSS

Objective: Determine which aspects of a sexual encounter that MASM judged to be risky distinguish those who reported unprotected anal sex from those who engaged in low risk practices (ex: oral sex/hygiene issues)
Methods: By August 31 2001, 708 participants had completed their sixth follow-up visit (T₅) with Omega, a longitudinal study underway in Montreal since October 1996. Of the T₅ participants, 71.9% reported an encounter that they judged to be risky. These participants were divided into 3 groups: condom breakage (6.8%) (CB), low risk (17.9%) (LR) and unprotected anal sex (75.3%) (UAS). The CB group was excluded and UAS, compared to LR with multivariate logistic regression.
Results: UAS differ from LR by: having partners who were assumed to be HIV- (Odds Ratio (OR): 2.62; 95% Confidence Interval (95%CI): 1.16-5.95); having partners who were, at the time of the encounter, visibly under the influence of alcohol (OR: 2.70; 95%CI: 0.99-7.39); strongly feeling physically/sexually desired by the partner at the outset (OR: 1.71; 95%CI: 1.05-2.78); sex arising as a part of a joint initiative (OR: 4.49; 95%CI: 1.52-13.27); having lesser intentions to use condoms as sex began (OR: 0.32; 95%CI: 0.14-0.77); being driven by a desire to penetrate or to be penetrated (OR: 2.65; 95%CI: 1.14-6.14); and taking control of the sexual choreography (OR: 8.68; 95%CI: 1.58-47.66) without safer sex being explicitly discussed before or during sex.
Conclusion: Examining the various aspects that unfold during what men see as risky sexual encounters can guide prevention into new directions. These encounters communicate a temporary emotional triumph over cognitive or rational faculties. Feeling desired appears to set the stage for an intensifying drive towards anal sex, a lesser preoccupation with condom use and a need to direct the encounter to maintain its sexual charge and not necessarily its safety.