Longitudinal Event-Level Analysis of Gay and Bisexual Men’s Anal Sex Versatility: Behavior, Roles, and Substance Use

Abstract

Gay and bisexual Men Who Have Sex with Men (GBM) are sexually unique in that they can practice penile-anal sex versatility, i.e. engage in insertive and receptive anal sex. Individual-level versatility is extensively researched both as a sexual behavior linked to HIV/STI transmission, and as a GBM identity that can change over time. However, there is a dearth of research on event-level versatility (ELV), defined as taking the receptive and insertive role in the same sexual encounter. We analyzed event-level data from 644 GBM in the Momentum Health Study from February 2012-February 2017 to identify factors associated with ELV prevalence, the relationship between ELV and anal sex role preference, and sero-adaptive and sexualized drug use strategies. Univariate analysis revealed ELV prevalence rates between 15% and 20%. A multivariate generalized linear mixed model indicated ELV significantly (p < .05) associated with versatile role preference and condomless sex. However, the majority of ELV came from GBM reporting insertive or receptive role preferences, and there was significantly higher condom use among sero-discordant partners, indicating sero-adaptation. Multivariate log-linear modeling identified multiple polysubstance combinations significantly associated with ELV. Results provide insights into GBM sexual behavior and constitute empirical data useful for future HIV/STI transmission pattern modeling.

Acknowledgments

The authors are grateful for the assistance and involvement of Momentum Health Study participants, office staff and community advisory board, and our community partner agencies, the Health Initiative for Men, YouthCo HIV, and Hep C Society, and the Positive Living Society of BC.

Contributors

All authors contributed to the development, data collection, analysis and writing of this manuscript to produce the final product.

Disclosure Statement

The co-authors acknowledge that they have no financial interest or benefit arising from the direct application of this research to disclose. All co-authors saw and approved the final version of this work.

Additional information

Funding

Momentum funding is through the National Institute on Drug Abuse (Grant # R01DA031055-01A1) and the Canadian Institutes for Health Research (Grant # MOP-107544, 143342, PJT-153139). A CANFAR/CTN Postdoctoral Fellowship Award supported NJL. Scholar Awards from the Michael Smith Foundation for Health Research (#5209, #16863) support DMM and NJL. A Postdoctoral Fellowship Award from the Canadian Institutes of Health Research (Grant # MFE-152443) supports HLA. A Frederick Banting and Charles Best Doctoral Research Award from the Canadian Institutes of Health Research (#379361) supports AJR. KGC is supported by a University Without Walls/Engage Fellowship award, a Canadian HIV Trials Network/Canadian Foundation for AIDS Research Postdoctoral Fellowship award, a Michael Smith Foundation for Health Research Trainee Award.