In turn, the impact of this more frequent intercourse on condom use may be somewhat greater than results would indicate, as the uncounted numbers may represent commercial sex workers with a relatively high condom use.
Reasons for this include changes in people's sexual behaviour, such as reduced promiscuity and more frequent use of condoms; the spread of antiretroviral drugs which, in addition to saving the lives of those infected, also stop them passing the virus on; reductions in mother-to-child transmission; and a new fashion for circumcision amongst Africa's men.
The more frequent use of condoms by gay and bisexual men probably reflects an awareness of their increased HIV risk.
Reporting two or more sexual partners without consistent condom use was more frequent in MSM (66.1%, n = 652) than in MSW (58.5%, n = 488) and women (53.3%, n = 540).
The regression analysis of actual condom carrying on possible antecedents revealed that condom carrying was more likely to occur among participants who reported more frequent sexual activity.
As Grieg et al. argue, 'notions of masculinity prevalent in many parts of the world that equate being a man with dominance over women, sexual conquest and risk-taking are associated with less condom use, more STIs, more partners, including more casual partners, more frequent sex, more abuse of alcohol and more transactional sex' (27).
In our study, MESM had a greater number of lifetime sexual partners, and were less likely to report using condoms with their casual sexual partners, suggesting that they had more frequent, often unprotected, casual sexual contacts than non-MESM.
Of course, what we found was, at that time, that male-to-female sexual transmission was a lot more frequent than female to male, that risk factors for transmission were primarily not using condoms, anal intercourse and S.T.D.'s in either partner.
Condom use did not increase with duration since initial intervention exposure, nor with more frequent contacts with Avahan staff.
Although neither factor was associated with condom use, we found that MSM with longer exposure to Sangama also reported more frequent contacts, including over the eleven months for which Sangama had delivered Avahan services.
