Sexual partners: getting the terminology right

Accuracy of terminology matters in
assessing sexual risk

by Anne Crawford

Public health strategies targeting men who have sex with men (MSM) may be ineffective because the terminology describing sexual partners used in risk assessments by clinicians is not accurate, a study by Monash University researchers at the Melbourne Sexual Health Centre suggests.

The researchers raised the issue of the definition and classification of partner terminology in MSM in two recent studies focusing on what are called 'fuckbuddies' – defined as regular sexual partners with whom men have ongoing sexual contact, generally in the absence of romantic attachment.


The first study, published in the ‘International Journal of STD AIDS’, surveyed 989 MSM to determine the frequency of 'fuckbuddy' partnerships among sexual health clinic attendees, and assessed their sexual risk.

It found that ‘fuckbuddies’ accounted for 60% of the 1139 regular partnerships the interviewees had. Most MSM (63%) with a 'fuckbuddy' had multiple 'fuckbuddies'. They were more likely to also have casual sexual partners and had more casual sexual partners.

The study found that such patients were at particular risk of rectal chlamydia, experiencing twice as much rectal chlamydia as MSM without 'fuckbuddies' (12.4% versus 5.7%).  Rectal chlamydia is a marker of HIV risk.

The study recommended that clinicians should specifically ask about 'fuckbuddy' partnerships as part of a patient’s risk assessment, as patients with these partnerships may benefit from HIV prevention strategies such as pre-exposure prophylaxis (PrEP). The researchers, however, were not able to assess the association between HIV positivity and MSM with ‘fuckbuddies’ due to small number of HIV diagnoses in the study.

Dr Vincent Cornelisse, the first author on the paper, said the study challenged the general assumption that casual partners confer a higher risk of HIV/STI compared to regular partners.

“This study shows that there is a subcategory of regular partners, labelled as ‘fuckbuddies’, that confer a high risk of STIs/HIV, and that this risk may be missed if people are only asked about regular and casual partners,” Dr Cornelisse said. “Understanding this partner category is important for both clinician-patient interactions and for data collection in sexual health epidemiology,” he said.

“A recent Australian study named the Seroconversion Study showed that 22% of new HIV diagnoses in MSM were acquired from a fuckbuddy. As mentioned, this risk is not adequately captured by the usual classification of sexual partners into ‘regular’ and ‘casual’ partners.”

The other study, published in the journal ‘Sexually Transmitted Infections’, called for more research to ascertain the ways in which MSM conceptualise sexual relationships and define or classify partner types, particularly 'fuck buddy' relationships.

Based on 30 semi-structured interviews it found that MSM often defined a relationship by the degree of emotional attachment involved. There was a consensus that partners they engaged with for 'sex only' were classified as ‘casual’ partners and partners with whom there was an emotional attachment or formalisation of the relationship were classified as 'regular partners'. However, the classification of 'fuck buddy' as a regular or casual partner was less clear.

It was possible that public health strategies could be ineffective as the target population may be inaccurate if definitions in research differed from general consensus in the MSM population, the study said. A third category to identify partners who fall between regular and casual may be necessary, it said.

References

Cornelisse VJ, Fairley CK, Phillips T, Walker S, Chow EP. Fuckbuddy partnerships among men who have sex with men - a marker of sexually transmitted infection risk. Int J STD AIDS. 2017 Jan 1:956462417717647. doi: 10.1177/0956462417717647. [Epub ahead of print]

Bellhouse C, Walker S, Fairley CK, Chow EP, Bilardi JE. Getting the terminology right in sexual health research: the importance of accurately classifying fuck buddies among men who have sex with men. Sex Transm Infect. 2017 Mar 29. pii: sextrans-2016-053000. doi: 10.1136/sextrans-2016-053000. [Epub ahead of print]