NZAF Senior Researcher Peter Saxton says the findings suggest “tops” can have a selfish approach to casual sex that puts personal pleasure ahead of concerns for protecting their sexual partners from HIV. The attitude was most marked among young men-who-have-sex-with-men (MSM).
Among respondents who had casual sex in the six months prior to survey, just under a third had no anal sex, about 40% had both insertive and receptive anal sex with at least one casual partner, 19% had insertive sex only and 13% had receptive sex only.
Eighteen per cent of “bottoms only” had any unprotected sex compared with 28% of “tops only”. These differences were greater among younger respondents. Only 7% of “bottoms only” under the age of 25 had any unprotected sex compared to 22% of “tops only” in the same age group.
Saxton suggests these results reflect the fact that tops and bottoms can have different interests when it comes to using (or not using) condoms – tops being more interested in making sex feel better for themselves and bottoms having more interest in avoiding HIV.
“How these divergent preferences are resolved in a casual sex encounter becomes the key HIV prevention issue, and one that determines whose set of interests (“feeling good” or “remaining HIV negative”) end up being prioritised.
“I wonder how people would react if all drivers heading northbound on a motorway argued they ought to be able to use both sides of the road, but all those heading south had to keep left? I’m not sure it’s all that different.”
Saxton said the findings also suggest that “tops only” might think they are at less risk of HIV.
However, studies show that one in five MSM with HIV are “tops only”, which still places them in the “high risk” zone.
The GAPSS study is a collaboration between the Research, Analysis and Information Unit at the New Zealand AIDS Foundation and the AIDS Epidemiology Group at the Department of Preventive and Social Medicine, University of Otago.
