The semantics of sexual behavior and their implications for HIV/AIDS research and sexual health: US and UK gay men's definitions of having “had sex”
Abstract
Understanding the definition and meaning of the word “sex” has implications for sexual medicine, HIV/AIDS research, and clinical practices. Previous studies have reported variations in the definition of having “had sex” and the necessity of using behaviorally specific terminology when taking sexual histories and assessing sexual risk. The purpose of the current study is to assess gay men's definitions of what constitutes having “had sex.” Two international convenience samples are compared: a UK sample of 180 self-identified gay men ranging from 18 to 56 years of age (M=36 years; SD=8.29) and a US sample of 190 self-identified gay men ranging 18–74 years of age (M=33.9 years; SD=12.49). Both groups were asked to indicate whether each of a list of sexual behaviors was considered having “had sex.” Almost all participants (~95%) believed that penile–anal intercourse constituted having “had sex.” US and UK gay men differed in defining the following as having “had sex”: giving oral–genital stimulation (US 71.6%, UK 84.9%, P=0.002); giving (G) and receiving (R) manual-anal stimulation (G: US 53.4%, UK 70.9%, P=0.001; R: US 53.7%, UK 71.2%, P=0.001); giving and receiving oral–anal stimulation (G: US 61.2%, UK 78.4%, P<0.001; R: US 59.3%, UK 78.1, P<0.001); and giving and receiving sex-toy stimulation (G: US 55%, UK 77.1%, P<0.001; R: US 56.1%, UK 77.7%, P<0.001). It is important to note that regardless of country there was not overall consensus on which behaviors constituted having “had sex.” These findings reinforce the need for behavioral specificity in documenting sexual histories and assessing sexual risk. Further, researchers and clinicians should exercise caution by not assuming that their own definitions of the term “sex” is shared by their gay male participants or patients.