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28 Mar 2005

2004 s'pore MSM survey results

A total of 1,529 valid responses were collected in the second survey among men who have sex with men (MSM) in Singapore.

The survey was conducted by Action for AIDS from June 2004 to Aug 2004 to determine if there had been any significant changes in sexual and HIV-related knowledge, attitudes, and behaviour since the previous survey in 2002/2003. There was an 18.4% increase in responses as compared to the previous survey.

Sexual Orientation

There was a significant drop in the proportion of respondents identifying as 'gay' and a corresponding rise in identification as 'Others', possibly because of the addition in 2004 of a new category, 'Undecided or Not Sure'.

Sexual Identity: 2004 % / 2003%
'Gay', 'Homosexual' or similar terms: 76.3 / 81.7
'Bisexual': 16.7 / 16.3
'Heterosexual' or 'Straight': 1.4 / 1.3
Others: 5.5 / 0.7

Number of Male Sexual Partners in the Previous 4 Weeks
More than half the respondents had had either one male partner or none at all in the previous four weeks. Only one in ten had had more than 5 partners during this time frame and those who had had more than 10 partners had a higher chance of being HIV-positive.

No. of Male Partners: %
None: 22
1: 33.9
2-5: 33.6
6-10: 7.2
>10: 2.8

Ways of Meeting Sexual Partners
Most respondents who had had sex reported they already knew or had had sex with their sexual partners before. Otherwise, most sexual partners were acquired through the Internet and gay saunas. In contrast, 60.6% of the respondents reported getting male sexual partners through the Internet in the 2002/2003 survey.

Ways of meeting sexual partners: %
Already knew him/them from before: 56.1
Through the internet: 51.1
At a gay sauna, bathhouse: 29.3
Being in the same workplace/ camp/ school: 15.2
Cruising area: 12

Venue for Sex
Among those who had had sex, home was the most common venue, followed by hotel rooms and cars. In the 2002/2003 survey, having sex in hotel rooms (52.2%) and gay saunas (45.7%) was much more common though home was still the most popular choice (85.2%).

Venue for Sex: %
Home (mine, his, or a friend's): 80.5
Hotel room: 28.8
Car: 19
Gay sauna/bathhouse: 14

Sex while 'High' on Alcohol/Recreational Drugs
12.0% of the respondents who had had sex had done so under the influence of alcohol while 5.8% had consumed recreational drugs.

Substance: %
On alcohol: 12
On drugs: 5.8

Unprotected Anal Sex
Almost two out of five sexually active respondents had had unprotected sex with either a regular or casual partner in the previous four weeks. The likelihood was higher with a regular partner but one in five had engaged in unprotected anal sex with a casual partner.

Partner: %
Boyfriend/Regular: 30.8
Casual: 20.1
Either: 38.6

Reasons for Unprotected Anal Sex
The most common reason was that the sexual partner was a boyfriend, a repeat sexual partner, or someone who seemed healthy and clean. Condoms being unavailable became a less likely reason for having unprotected anal sex, as compared to the earlier survey.

Reason: 2004 % / 2003 %
He is my boyfriend: 65.6 / 43.3
We have already had sex a few times before: 44.5 / 14.2
He seems healthy and clean: 31.6 / 14.3
No condoms were available: 14.2 / 15.4

Sexually-Transmitted Infections (STI)
There was a rise in the proportion of respondents who reported having been diagnosed with any STI, from 19.0% in 2003 to 25.0% in 2004. The most common STI reported were gonorrhoea (8.0%) and genital/anal warts (6.0%), but syphilis and HIV/AIDS overtook non-gonococcal urethritis as the next most common STI reported in 2004.
STI: 2004 % / 2003 %
Gonorrhoea: 8 / 7.2
Genital/Anal Warts: 6 / 5
Syphilis: 4.4 / 2
HIV/AIDS: 3.3 / 1.6
Herpes: 2.6 / 2.6
NGU (non-gonococccal urethritis): 2.6 / 2.9

HIV Testing
Worryingly, about half the respondents had never been for an HIV test, a rise from 40.4% in 2003, although there was more knowledge about the availability of Action for AIDS' anonymous HIV testing service.
HIV Testing History: 2004 % / 2003 %
Been for an HIV test: 50.1 / 59.6
Never been for an HIV test: 49.9 / 40.4

Knowledge about Anonymous HIV testing: 2004 % / 2003 %
Knew about Anonymous HIV testing: 56.9 / 40.4
Did not know about Anonymous HIV testing: 12.2 / 8.4
Was not sure about Anonymous HIV testing: 30.9 / 51.1

Areas of Concern
It seems that there is still a significant amount of unprotected anal sex practised by MSM, the main reason being that their sexual partners were boyfriends or repeat sexual partners. This is worrying as we are seeing more MSM being infected by regular partners.

There is also some concern about:
- lower levels of HIV testing, especially among those engaging in unprotected anal sex, despite higher levels of knowledge about anonymous HIV testing being available; and
- higher levels of STI reported by respondents.

The following factors appear to be linked to unsafe sexual practices and/or HIV transmission:
- having had more than 5 sexual partners in the previous 4 weeks;
- meeting male sexual partners through the Internet, through work, camp or school, or at cruising areas;
- having sex in hotel rooms or cruising areas;
- having sex while under the influence of alcohol and/or drugs; and
- being below 20 years of age.






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