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

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

  • Authors: Karel Blondeel, Sónia Dias, Martina Furegato, Armando Seuc, Ana Gama, Ricardo Fuertes, Luís Mendão, Marleen Temmerman, Igor Toskin
  • Publication Year: 2021
  • Journal: BMJ Open, 11(1), art e033290
  • Link: http://dx.doi.org/10.1136/bmjopen-2019-033290

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.

STRENGTHS AND LIMITATIONS OF THIS STUDY

• Hierarchical cluster analysis was used to identify behavioural patterns among men who have sex with men (MSM) participating in a behavioural survey in Portugal.

• The main findings from the cluster analysis are in line with the literature supporting linked epidemics of sexually transmitted infections (STIs) and HIV in Portuguese MSM.

• Using a syndemic approach, it was possible to identify that factors not directly linked to sexual behaviour are linked to these epidemics.

• The outcomes of this analysis relate to the study sample population and cannot be generalised to the wider MSM population.

• We acknowledged that the reliance on self-reported STI and HIV outcomes is a weakness that may have caused social desirability bias.

 

KEYWORDS

Portugal; AIDS; HIV; infections; Men who have sex with men; MSM; sexually transmitted infections; STIs.

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About GHTM

GHTM is a R&D Unit that brings together researchers with a track record in Tropical Medicine and International & Global Health. It aims at strengthening Portugal's role as a leading partner in the development and implementation of a global health research agenda. Our evidence-based interventions contribute to the promotion of equity in health and to improve the health of populations.

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