Many Straight Men Have Gay Sex

Sept. 18, 2006 -- Nearly one in 10 men who say they're straight have sex only with other men, a New York City survey finds.

And 70% of those straight-identified men having sex with men are married.

In fact, 10% of all married men in this survey report same-sex behavior during the past year.

This means safe-sex messages aimed at straight and gay men are likely missing this important subgroup, suggest Preeti Pathela, DrPH, New York City Department of Health and Mental Hygiene, and colleagues.

"To reduce the burden of sexually transmitted diseases and HIV infection among men who have sex with men, it is of utmost importance for [health care] providers to take a sexual history that ascertains the sex of a partner," Pathela and colleagues report. "Asking about a patient's sexual identity will not adequately assess his risk."

Straight Men Who Have Sex With Men

In 2003, Pathela's team performed telephone interviews with nearly 4,200 New York City men. They conducted the interviews in English, Spanish, Chinese, and Russian; a translation service helped with interviews in Greek, Korean, Yiddish, Polish, and Haitian Creole.

In nearly every study of sexual behavior, the percentage of men who report sex with men is higher than the percentage of men who report being gay.

So Pathela and colleagues first asked the men if they were bisexual, gay, or straight. Then they asked about specific sexual behaviors.

Some of the findings:

• Straight-identified men who have sex with men report fewer sex partners than gay men.
• Straight-identified men who have sex with men report fewer STDs in the past year than gay men.
• Straight-identified men who have sex with men are less likely than gay men to report using a condom during their last sexual encounter.
• Straight-identified men who have sex with men are more likely to be foreign born than gay men.

Also, a man who says he is straight but is having sex with other men is more likely to be married than a straight man who has sex with women, according to the survey. Only 54% of the men who say they're straight and have sex with women are married, compared with the 70% marriage rate among the men who say they're straight but have sex with men.

Pathela and colleagues note that because they report fewer STDs and fewer sex partners than gay men, straight-identified men who have sex with men may think they are at lower risk of HIV and STDs. This isn't necessarily so.

The men with whom these straight-identified men have sex may themselves have multiple sex partners and elevated STD and HIV risk. The low rate of condom use makes the straight-identified men vulnerable.

"Prevention messages should focus on the activities that pose risk -- for example, unprotected receptive anal sex -- and should not be framed to appeal solely to gay-identified men," Pathela and colleagues suggest.

The findings appear in the Sept. 19 issue of the Annals of Internal Medicine.