Would gay men change their sexual behavior to reduce syphilis rates?

Background: The community at which public health strategies for reducing syphilis epidemics are potentially targeted may have different considerations with regards to their sexual and health priorities. We aimed to elicit information on the acceptability of behavior change interventions among gay men for reducing syphilis transmission.

Methods: We conducted an online survey (n = 2306 participants) and focus groups to determine whether further sexual behavior change to reduce syphilis is likely to be acceptable to gay men in Australia.

Results: One quarter of survey respondents (26%) indicated that they would be highly likely to reduce partner acquisition rates in order to reduce their chances of syphilis infection. However, among the 475 (21%) men who reported greater than 10 partners in the previous 6 months, only 11% indicated being "highly likely" to reduce partner numbers to avoid syphilis. Among 606 (26%) survey respondents who reported not always using condoms in the previous 6 months, 34% indicated being highly likely to always use condoms with casual partners to avoid syphilis. In the focus groups, men indicated little commitment to sexual behavior change but some willingness to consider short-term changes to reduce community syphilis levels.

Conclusions: Interventions promoting partner reduction or increased condom use are unlikely to be adopted on a long-term basis by men at greatest risk. Behavioral interventions alone are unlikely to materially contribute to syphilis prevention among gay men.