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. 2021 Jan 22;11(1):e033290.
doi: 10.1136/bmjopen-2019-033290.

Sexual behaviour patterns and STI risk: results of a cluster analysis among men who have sex with men in Portugal

Karel Blondeel #  1   2 , Sonia Dias #  3   4 , Martina Furegato #  5   6 , Armando Seuc  7 , Ana Gama  3 , Ricardo Fuertes  8 , Luís Mendão  8 , Marleen Temmerman  2 , Igor Toskin  1   9
Affiliations

Sexual behaviour patterns and STI risk: results of a cluster analysis among men who have sex with men in Portugal

Karel Blondeel et al. BMJ Open. .

Abstract

Objectives: Portugal has the highest HIV incidence rate in Western Europe. The proportion assigned to sexual contact between men recently increased to more than 30% of all HIV infections. Men who have sex with men (MSM) are vulnerable to the acquisition of other sexually transmitted infections (STIs), increasing the per-contact risk of HIV infection. Building on syndemic theory, the aim of this analysis was to identify patterns of current sexual behaviour in MSM, and explore their relationship with self-reported current, past STI diagnoses and HIV positive serostatus.

Design: A cross-sectional behavioural survey was conducted in Portugal among MSM, using a community-based participatory research approach. Hierarchical cluster analysis was used to identify patterns including behavioural and demographic factors.

Results: The analysis resulted in six clusters. Three clusters showed higher rates of current STI diagnosis (ranging from 11.7% to 17.1%), past STI diagnosis (ranging from 25.5% to 41.5%) and HIV positive serostatus (ranging from 13.0% to 16.7%). From the three clusters scoring lower on current and past STI and HIV diagnoses, one was characterised by a high number of sexual partners (62% had more than 12 partners in the last year), a high proportion (94.6%) of frequent visits to gay venues to meet sexual partners and high alcohol use (46.1%). The other two clusters scored lower on high risk sexual behaviour.

Conclusion: Factors other than sexual behaviour appear to reinforce the vulnerability to STIs and HIV of some MSM in this study, suggesting a syndemic of STIs, HIV and other adverse conditions. More research is needed to better understand the drivers of the STI/HIV epidemic in Portuguese MSM, using a concept that goes beyond risk behaviour, to develop effective combination prevention interventions.

Keywords: HIV & AIDS; MSM; STI; sexual health; syndemic.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of variable selection for the study.
Figure 2
Figure 2
Percentages of reported current STI diagnosis, history of STI diagnosis and HIV positive sero-status in the six clusters.
See this image and copyright information in PMC

References

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