Age at First Anal Sex and HIV/STI Vulnerability
Age at First Anal Sex and HIV/STI Vulnerability
Objectives To determine whether there is a link between age at first anal intercourse (AFAI) and gay men's HIV/sexually transmissible infection (STI) vulnerability, including tendencies to engage in higher risk sexual behaviour.
Methods A nationwide cross-sectional survey was conducted online involving 845 Australian gay men born between 1944 and 1993.
Results Median AFAI fell from 35 years for men born between 1944 and 1953 to 18 years for men born between 1984 and 1993. Of those who reported having had anal intercourse (N=822), HIV-positive men were found to be significantly younger on average when they first had anal intercourse compared with HIV-negative men (18.5 vs 21.3 years, p<0.001). Men with a history of other STIs were also significantly younger. Engaging in higher risk sexual behaviour is a likely factor, with AFAI generally younger among men who reported >10 sexual partners in the past year (p<0.001) and who engaged in group sex (p<0.001), receptive anal intercourse (p=0.008) or were drug or alcohol affected (p=0.06) during their most recent sexual encounter.
Conclusions There appears to be a strong link between AFAI and infection with HIV/STIs, as well as tendencies to engage in higher risk sexual behaviour. While further research is needed to understand this link, these findings highlight a need for sexuality education aimed at gay-identified youth to ensure their sexual debut does not lead to poorer sexual health outcomes.
Gay men continue to carry a disproportionate burden of HIV. Worryingly, rates of new diagnoses have increased in almost all developed countries over the past decade, despite many of these countries investing heavily in safer sex programmes. In light of these trends, new information may be needed about factors associated with HIV infection and higher risk sexual behaviour. The age at which men first have anal intercourse (AFAI) with another man may be one important factor. For instance, many young same-sex attracted adolescents have sex, yet receive no homosexual-based sex education from parents, peers or schools, potentially leaving them with limited understanding of safer sex practices. This is particularly concerning, given that our earliest sexual experiences often begin a pattern that persists in future years, such as not using condoms. Thus, in the absence of adequate education, engaging in anal intercourse at a young age may often be unprotected and may establish patterns involving riskier behaviour that extend into the future. In fact, a recent study found the earlier that gay men had their first experience of anal intercourse, the less likely they were to have used a condom during that experience. For some, having anal intercourse at an early age may also indicate sexual adventurism, thus also providing a marker for future higher risk behaviour.
At present, the only indications of links between AFAI and future HIV or higher risk sexual behaviour among gay men come from research involving heterosexual men and women in which age at first intercourse has been shown to be a strong marker for future sexual health and behaviour patterns. For example, compared with adults who had their first intercourse later, those who had their debut in early to mid-adolescence tend to have a greater number of sexual partners, are more likely to engage in higher risk sexual practices, have a higher prevalence of sexually transmissible infections (STIs), as well as a higher prevalence of sexual difficulties or dysfunctions, and tend to have more negative attitudes towards condom use. These findings are particularly concerning due to continued declines in the median age of first sexual intercourse, now under 18 years for both heterosexual men and women and gay men in a number of countries worldwide.
While detailed information about the association between age at first intercourse for heterosexual men and women and their future sexual health is already guiding sex education and other sexual health strategies, a need exists for similar information on gay men. Using data collected from a nationwide cross-sectional online survey of Australian gay men born between 1944 and 1993 (aged 16–65 years), we report (1) patterns of AFAI across five age cohorts, (2) socio-demographic differences in AFAI and (3) associations between AFAI and future HIV infection, other STIs and sexual behaviour.
Abstract and Introduction
Abstract
Objectives To determine whether there is a link between age at first anal intercourse (AFAI) and gay men's HIV/sexually transmissible infection (STI) vulnerability, including tendencies to engage in higher risk sexual behaviour.
Methods A nationwide cross-sectional survey was conducted online involving 845 Australian gay men born between 1944 and 1993.
Results Median AFAI fell from 35 years for men born between 1944 and 1953 to 18 years for men born between 1984 and 1993. Of those who reported having had anal intercourse (N=822), HIV-positive men were found to be significantly younger on average when they first had anal intercourse compared with HIV-negative men (18.5 vs 21.3 years, p<0.001). Men with a history of other STIs were also significantly younger. Engaging in higher risk sexual behaviour is a likely factor, with AFAI generally younger among men who reported >10 sexual partners in the past year (p<0.001) and who engaged in group sex (p<0.001), receptive anal intercourse (p=0.008) or were drug or alcohol affected (p=0.06) during their most recent sexual encounter.
Conclusions There appears to be a strong link between AFAI and infection with HIV/STIs, as well as tendencies to engage in higher risk sexual behaviour. While further research is needed to understand this link, these findings highlight a need for sexuality education aimed at gay-identified youth to ensure their sexual debut does not lead to poorer sexual health outcomes.
Introduction
Gay men continue to carry a disproportionate burden of HIV. Worryingly, rates of new diagnoses have increased in almost all developed countries over the past decade, despite many of these countries investing heavily in safer sex programmes. In light of these trends, new information may be needed about factors associated with HIV infection and higher risk sexual behaviour. The age at which men first have anal intercourse (AFAI) with another man may be one important factor. For instance, many young same-sex attracted adolescents have sex, yet receive no homosexual-based sex education from parents, peers or schools, potentially leaving them with limited understanding of safer sex practices. This is particularly concerning, given that our earliest sexual experiences often begin a pattern that persists in future years, such as not using condoms. Thus, in the absence of adequate education, engaging in anal intercourse at a young age may often be unprotected and may establish patterns involving riskier behaviour that extend into the future. In fact, a recent study found the earlier that gay men had their first experience of anal intercourse, the less likely they were to have used a condom during that experience. For some, having anal intercourse at an early age may also indicate sexual adventurism, thus also providing a marker for future higher risk behaviour.
At present, the only indications of links between AFAI and future HIV or higher risk sexual behaviour among gay men come from research involving heterosexual men and women in which age at first intercourse has been shown to be a strong marker for future sexual health and behaviour patterns. For example, compared with adults who had their first intercourse later, those who had their debut in early to mid-adolescence tend to have a greater number of sexual partners, are more likely to engage in higher risk sexual practices, have a higher prevalence of sexually transmissible infections (STIs), as well as a higher prevalence of sexual difficulties or dysfunctions, and tend to have more negative attitudes towards condom use. These findings are particularly concerning due to continued declines in the median age of first sexual intercourse, now under 18 years for both heterosexual men and women and gay men in a number of countries worldwide.
While detailed information about the association between age at first intercourse for heterosexual men and women and their future sexual health is already guiding sex education and other sexual health strategies, a need exists for similar information on gay men. Using data collected from a nationwide cross-sectional online survey of Australian gay men born between 1944 and 1993 (aged 16–65 years), we report (1) patterns of AFAI across five age cohorts, (2) socio-demographic differences in AFAI and (3) associations between AFAI and future HIV infection, other STIs and sexual behaviour.
