Factors associated with anal sex involving internal ejaculation in men who have sex with men (MSM) and who use the Internet to find partners for unprotected sex

BACKGROUND: MSM, particularly those who bareback (i.e., have unprotected anal sex), are at high risk for acquiring or spreading HIV. This study examines the factors associated with anal sex with internal ejaculation. METHODS: In 2008 and 2009, 332 American MSM were sampled randomly from 16 websites. All used the Internet to search specifically for unprotected sex partners. Interviews were conducted by telephone and lasted 1-2 hours. RESULTS: 79.9% of men reported anal sex with internal ejaculation during the previous month (average rate of internal ejaculation during anal sex = 52.6%). Of these men, 12.1% reported internal ejaculation between 75% and 99% of the time they had anal sex and 24.2% reported internal ejaculation every time they had anal sex. Three separate analyses were conducted: one for all partners (those met online and offline), one for partners only met online, and one for partners only met offline. 7.8% of men were more likely to report internal ejaculation with offline partners, 38.0% were equally likely to have internal ejaculation with online and offline partners, and 54.2% were more likely to have internal ejaculation with online partners. In all three analyses, there were three factors related to whether internal ejaculation was involved with anal sex acts: (1) negative attitudes towards condom use, (2) a greater number of sex partners during the previous thirty days, and (3) the extent to which a man had AIDS information burnout. CONCLUSIONS: Internal ejaculation during anal sex represents a very high risk for Internet-using MSM who bareback and it is a common practice in this population. HIV risk reduction intervention efforts need to: (1) change the way that these men feel about using condoms, (2) target MSM with multiple sex partners, and (3) find ways to keep HIV/AIDS prevention messages "fresh".