Sexual risk behaviour and its determinants among men who have sex with men in Catalonia, Spain.

To evaluate the prevalence of sexual risk behaviours among men who have sex with men (MSM) in Catalonia and to identify sociodemographic, psychosocial, and behavioural factors associated with unprotected anal intercourse (UAI) with casual partners a convenience sample of 850 MSM was recruited in 2006. An anonymous questionnaire was used to explore risk behaviours during the previous 12 months. Logistic regression models were used to examine the variables associated with UAI. Mean age was 41 years and 20.4% were immigrants. Among those with casual partners (91.7% of all respondents), 31.4% had UAI. The multivariate analysis revealed that the likelihood of UAI was higher in men who were HIV-positive (OR: 1.77), used more than four drugs before sex (OR: 4.90 for +6), were not from Spain (OR: 2.10 for Latin American; OR: 1.86 for other immigrants), had more than 20 sexual partners (OR: 1.56), met casual sex partners on the Internet (OR:1.45) and presented a high level of internalised homophobia (OR: 2.40). HIV/STI prevention programmes for MSM in Catalonia should incorporate activities that strengthen self-esteem, take into account the impact of internalised homophobia, and adapt to the sociocultural reality of immigrants. Furthermore, these programmes should also address substance abuse and alert HIV-positive men about the risk of HIV re-infection and transmission of other STI.