Higher risk male-male sex in the last year
Unprotected anal sex is by far the highest risk behaviour for transmission of HIV among men who have sex with men. Most interventions in this group aim both to decrease the overall number of partners and to increase condom use in all partnerships. This indicator is similar to Sexual Behaviour Indicator 1, Higher risk sex in the last year, in that it attempts to measure the extent of exposure to sexual networks. Since in many countries cohabitation with same-sex partners is rare, this measure drops distinctions based on cohabitation or regular partnership and looks just at sexual activity with multiple partners in the past six-month period.
Number of male respondents who report having anal sex with more than one male partner in the last sex months
All male respondents who are likely to be sexually active
This indicator is intended for use in special surveys among men who have sex with other men. In a behavioural survey in a sample of men who have sex with men, respondents are asked about sexual partnerships in the preceding six months. For male partners, they are asked how many they had anal sex with. If the response is more than one, the respondent enters the numerator for this indicator. The denominator is all respondents; it is assumed that the sampling strategy focuses on men who are likely to be sexually active. Note that the time reference period for this denominator differs from those used for other groups. The standard time reference period for indicators of sexual behaviour is 12 months. The six month period is used because in most cases where BSS is used in sub-populations of men who have sex with men, the sampling strategy tends to focus on cruising areas and other areas where men congregate specifically to seek other male partners. This means that those included in the sample are likely to be at the higher end of the spectrum of risk behaviour, and to have a high turnover of partners. Indeed these are precisely the individuals of greatest interest to HIV prevention programs. Groups with a high average turnover of partners are likely to have difficulty recalling the total number of partners over one year, the reference period commonly used in indicators of sexual behaviour. The time reference period is reduced to six months to provide for more accurate recall. In situations where rapid assessment shows that a high proportion of men sampled have very high levels of sexual behaviour, a time reference period of one month may even be considered for all indicators of sexual behaviour among men who have sex with men.
Condom type: N/A
Geographic location: N/A
HIV status: N/A
Pregnancy status: N/A
Service Type: N/A
Time period: N/A
Type of orphan: N/A
Vulnerability status: N/A
As with other sub-population surveys, there are difficulties associated with sampling and extrapolation of results, and this in turn may lead to difficulties in comparing indicators both across different countries and across time. Increasingly, respondents in surveys of sexual behaviour are questioned specifically about their last three partners. Most sexual behaviour indicators are constructed on the basis of information given about the last three partners, minimising recall bias. However that is not possible in the construction of this indicator, since not all male partners with whom anal sex took place necessarily fall within the last three sexual partners. This measure may therefore be more subject to recall bias than other measures of sexual behaviour. In many societies, men who have sex with men also have sex with women. In general, the risk of HIV transmission in anal sex between men is greater than the risk of transmission in vaginal sex between men and women. Men who have sex with men and women may represent an important “bridge” group between a subpopulation at high risk for HIV infection and a larger population at lower risk for infection. To track the risk of bridging between men who have sex with men and the heterosexual population, programmes in countries where bisexual activity is common will probably want to ask men about their female as well as their male partners. However most HIV prevention programmes aimed at men who have sex with men concentrate on decreasing risky sex between men, and put very little emphasis on behaviour with female partners. It is therefore not suggested that female partners be included in calculating this indicator.