Alex Parr & Carrie Llewellyn Brighton and Sussex Medical School, UK A quantitative study to understand the sexual appetites of men who have sex with men (MSM) Alex Parr & Carrie Llewellyn Brighton and Sussex Medical School, UK

Introduction 3360 new MSM HIV diagnoses in 2014 (UK) HIV prevention strategies Behavioural interventions Increasing risky behaviour – unprotected anal intercourse (UAI) Libido, sexual compulsivity, hypersexuality… 14 % unaware Alongside pharmacological interventions, non-drug interventions are important Intrusive/overwhelming thoughts/desires Lots of terminiology –getting at the same thing, thoughts becoming intrusive or disruptive

Research question To what extent is libido associated with risk behaviour? Hypotheses: There would be a positive correlation between high libido and: Low incidence of condom use High number of sexual partners High incidence of repeat prescription for post-exposure prophylaxis (PEP) within 1 year High incidence of HIV/STI diagnosis within 1 year Wanted to understand how much of a problem it is, and extent of association Explain PEP

Methods Project PEPSE – paper survey Participants: MSM, ≥16 years, PEPSE, Sexual Health clinic (6 centres across SE England) 10 items to assess libido Risk behaviour measures Psychological measures Number of partners Information Inconsistent condom use Motivation Repeat PEP prescription in 1 year Behavioural skills HIV/STI diagnosis in 1 year Univariate + multivariate statistical analyses Introduce project PEPSE – 2ndary analysis of data Baseline data (+follow up) Cross sectional data Recruitment info – who they are, entering into behavioural intervention study, but this was baseline data before intevention Psychological measures based on a psy model

Results - demographics N ( % ) Age mean (range) 34.5 (19-66) Sexuality Gay Bisexual Heterosexual / Rather not say 160 (92.5) 11 (6.4) 2 (1.2) Ethnicity White UK White other Black / Asian / Mixed / Other 80 (45.7) 61 (34.9) 34 (19.4) Employment (Self) Employed Student Unemployed / Retired / Other 141 (80.6) 20 (11.4) 14 (8.1) Education Below degree level Degree / Post-graduate degree 48 (27.4) 127 (72.6)

Results - libido items I find myself thinking about sex while at work or college My sexual appetite gets in the way of my relationships My sexual thoughts and behaviours are causing problems in my life I think about sex more than I would like to I sometimes get so horny I could lose control I feel that my sexual thoughts and feelings are stronger than I am My desires to have sex have disrupted my daily life I sometimes fail to meet my commitments and responsibilities because of my sexual behaviour I have to struggle to control my sexual thoughts and behaviours It has been difficult for me to find sex partners who desire having as much sex as I want to

Results – univariate analysis Inconsistent condom use rs = .235 p = .007 Libido Number of sexual partners rs = .292 p < .001

Results – multivariate analysis Lower levels of HIV information (OR = 0.73, p = .030, CI = .54 – .97) Less intention of using risk reduction strategies (OR = 0.83, p = .008, CI = .73 – .95) Inconsistent condom use (active) Less likelihood of planning to have safer sex (OR = 0.8, p = .023, CI = .66 – .97) Higher libido (OR = 1.69, p = .007, CI = 1.16 – 2.46) Inconsistent condom use (passive) Less intention of using risk reduction strategies (OR = 0.85, p = .014, CI = .75 – .97) Higher libido (OR = 1.71, p = .003, CI = 1.21 – 2.43) High number of sexual partners Less likelihood of planning to have safer sex (OR = 0.68, p = .001, CI = .53 – .86) HIV/STI diagnosis in 1 year Constructed 5 mathematical models… seeking to find significant factors for each of our surrogate meausres for risk

Discussion & Recommendations Libido plays a role in risk taking sexual behaviour Explore intentions or levels of knowledge within clinics Target individuals Identify high risk MSM Libido assessment We’ve shown associations b/w surrogates for risk outcomes libido and behavioural Understanding knowledge and/or intentions within clinics then perhaps targeting ?libido scores could be used to identify high risk people Information – information about condoms, using them Motivation – inraesing willingness to use condoms – why important to do this BS – having condoms with you, using them correctly Corroborates previous work

Strengths & Limitations First quantitative study assessing the role of libido on risk behaviour in UK Self-reporting bias Chemsex, drugs and alcohol Specific sample of men

Acknowledgements Thank you to: The participants Alex Pollard Dr Chris Jones Division of Public Health and Primary Care at BSMS