Avebury; 1994. 14. Messiah A, PelletierA, ACSFgroup. Partner-specific sexual practices among heterosexual women and men with mul- tiple partners: results ...
Public Health Briefs
Sociodemographic Characteristics and Sexual Behavior of Bisexual Men in France: Implications for HIV Prevention Antoine Messiah, MD, PhD, Emmanuelle Mouret-Fourme, MD, MS, and the French National Survey on Sexual Behavior Group
Introduction
Methods
Men who have sex with men form the first or second largest group of acquired immunodeficiency syndrome (AIDS) cases in the industrialized societies.1" One quarter of this group-in the United States-also exhibit heterosexual activity (bisexuals) and represent 14% of all male cases of AIDS.9 It has been argued that bisexuals could act as a bridge for human immunodeficiency virus (HIV) transmission from homosexual men to heterosexual women4'9 and that they could increasingly contribute to heterosexually acquired HIV infection.4'7'9'10 Surveillance data reveal that only a small minority of heterosexual AIDS patients are infected by bisexuals,2'4'5'9"11 but their number may, in fact, be underestimated given that a large proportion of patients report contact with an infected partner whose transmission group status is unknown.2'5 The question of whether or not bisexual men play an important role in the heterosexual spread of HIV remains a subject for debate.4"10'11 Differences of interpretation may stem from the use of study samples that are not representative of bisexually active men at large. The recent French survey of sexual behavior12"3 provided an opportunity to conduct an analysis of a national random probability sample. The present paper compares bisexual men with heterosexual and homosexual men and analyzes their sexual behavior in order to evaluate the risk of sexual HIV transmission. Socio-
The French National Survey on Sexual Behavior is a large-scale random sample telephone survey whose methodology and sample characteristics (including nonrespondents) have been described elsewhere.12"14--7 In outline, a random sample of 20 055 subjects served to draw a subsample of 4820 individuals (2642 men and 2178 women) interviewed in detail between September 1991 and February 1992 about their sexual activity. Calculations took account of the complex sample design1822 with SUDAAN software.23 Of the 2547 men who provided information about their sexual activity, 4.1% had had at least one male partner in their lifetime (n = 210). When just the last year was considered, this figure fell to 1.1% (n = 105); 0.7% had also had female partners and were classified as bisexuals (n = 53), while the remaining 0.4% (n = 52) had had only male partners and were classified as homosexuals. The four intravenous drug users in this sample were heterosexuals. Practices in the most recent sexual encounter with the two most recent partners in the previous year were investigated in detail. Thus, 36 bisexuals described at least one homosexual encounter, and 36 described at least one heterosexual encounter. No definition was given
demographic characteristics were examined to assess the likelihood of reaching bisexual men with existing prevention programs.
The authors are with the Service de Sante Publique et Epidemiologie, H6pital de Bicetre, Le Kremlin-Bicetre, France. For a list of the members of the French National Survey on Sexual Behavior Group, see the Acknowledgments. Requests for reprints should be sent to
Antoine Messiah, MD, PhD, Observatoire Regional de Sante, 23 rue Stanislas Torrents, F-13006 Marseille, France. This paper was accepted March 21, 1995.
American Journal of Public Health 1543
Public Health Briefs
TABLE 1 -Number of Sexual Partners of Bisexual Men in Comparison with Homosexual Men, Heterosexual Men with Multiple Partners (>2 over the Past Year), and All Heterosexual Men Mean No. Partners (95% Confidence Interval)
Previous 5 years Past year Overall New partners
(1) Homosexual Men (n = 52)
(2) Bisexual Men (n = 53)
(3) Multi-partnered Heterosexual Men (n = 1040)
(4) All Heterosexual Men (n = 2359)
(2) vs (1)
(2) vs (3)
(2) vs (4)
16.2 (10.3, 22.1)
7.0 (4.8, 9.1)
8.7 (7.8, 9.5)
2.9 (2.7, 3.1)
