Self-Identification as a “Top” Versus a “Bottom” and HIV Risk Preferences among Men Who Specifically Seek Unprotected Sex Partners Via the Internet

Purpose: Recent research has revealed that men who have sex with men (MSM) who wish to engage in unprotected sex increasingly are turning to internet websites to identify potential partners. This paper focuses on MSM who use the internet to locate sex partners, and focuses on the role that being a “top” versus a “bottom” plays in HIV risk preferences.

Methods: A content analysis was conducted during 2006 and 2007 using a popular internet website targeting MSM who wish to locate unprotected sex partners. 1,316 profiles were coded, selected randomly by ZIP code. Data collected include age, race, psychosocial factors underlying risky practices, and numerous sexual risk behaviors.

Results: 43.7% of study participants considered themselves “top”; 56.3% considered themselves “bottom” men. “Versatile” men (n = 295) were excluded from analysis. Identification as a “bottom” was associated with a greater propensity for preferring risk-enhanced sexual practices (all statistically significant), including wanting large-group sex (OR = 2.51), desiring rough sex (OR = 1.93), preferring sex while high (OR = 1.57), overtly expressing a dislike of condoms (OR = 2.49), wanting anonymous sex (OR = 6.30), and wanting uninhibited sex (OR = 1.95).

Conclusions: MSM who consider themselves to be “bottoms” and who use the internet to locate sex partners tend to seek high rates of risky sexual practices and express a preference for risk-enhanced sex. Such men constitute a high-risk group in need of targeted intervention, and interventionists need to develop innovative approaches to providing appropriate, culturally-sensitive prevention information to this population.