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On the other hand men who had never tested were most likely to be unsure of what their best sex life might contain, perhaps reflecting a broader ambivalence about the world. This paper describes an exploratory analysis of responses to one open question about what constitutes the best sex life, which were often only several words in length and occasionally ambiguous.

• What constitutes the best sex life for gay and bisexual men? Implications for HIV prevention.
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A more in-depth, purely qualitative investigation of this issue may reveal greater complexity and richness to these themes, or better illustrate how they are interconnected. As with all social survey research, this data may reflect a social desirability bias, particularly given that common place discourse surrounding the desire for a partner or for love is widely accessible. Comparisons between demographic groups are tentative but provide some useful insight into how ideas of the best sex life, and its role in a broader sense of sexual well-being, may differ among men at different points in their lives or in different personal circumstances.

The principle of health promotion conceived by the Ottawa and Bangkok Charters notwithstanding, a significant body of social marketing and communication literature highlights the importance of attending to what people value and what is meaningful in their everyday lives when attempting to elicit health behaviour change [ 40 , 41 ]. Such an understanding on the part of health and social care professionals seeking to reduce transmission of HIV and other STIs among gay and bisexual men may assist in the development of engaging and effective interventions to help men make sexual choices that maximise pleasure or satisfaction and minimise potential harms.

That gay, bisexual and other men who have sex with men value emotional connection or meaningful, romantic relationships with other men is by no means a new finding [ 42 , 43 ] but what the current study adds is better sense of the primacy placed on these themes as key components of an idealised sex life. Nearly two-thirds of respondents described their idea of the best sex life in these terms, while responses relating to variety of sexual contact or specification of sexual acts were substantially less common. This finding stands in stark contrast to a predominate media and commercially driven representation of gay men as promiscuous and interested primarily in anal intercourse [ 44 ].

While a still sizeable proportion of men described their idea of the best sex in ways that related to volume and variety, such articulation decreased with the advancing age of respondents. As age increased so too did a tendency to describe specific sexual acts or behaviours, perhaps reflecting how some men gain a greater sense of what is sexually satisfying with experience. The current study is unable to unpick these maturational and chronological processes but see Weeks, [ 45 ]. Public health interventions for HIV prevention emphasise risk reduction but pay little attention to pleasure promotion.

This is clearly at odds with what men themselves are aiming for in their sex lives. The purpose of safer sex has always been to continue to have an adequate sexual life in the presence of potential harms by reducing the probability of those harms.

The current study suggests that the kind of sex lives MSM aspire to are varied and multifaceted. Interventions should therefore not presuppose what a good sex life is, but instead endeavour to equip men with the skills, awareness and resources to enable them to move towards better sex with less harm. Some existing community-based HIV prevention interventions have sought to consider the wider sexual health and well-being of MSM, which intersect with several of the themes described in this paper.

However, even interventions such as these have a tendency to focus on more mechanical aspects of sex such as how to effectively perform fellatio or how to feel comfortable during receptive anal intercourse rather than the more psycho-social dimensions of emotional connection, intimacy and relationships to which men taking part in EMIS clearly aspired. While it does incorporate information about how to deal with confidence or self-esteem issues as they relate to sex, the extent to which it facilitates a broader sense of well-being and emotional connection with sexual partners is limited.

Of course, it is impossible for any single intervention to meet the diverse needs of an equally diverse population of gay and bisexual men. Psychosocial interventions to help individuals and couples to increase their capacity for intimacy and emotionally connected relationships do exist see, for example, PACE Health in London, UK [ 49 ] and ACON in New South Wales, Australia [ 50 ] , however these are often small-scale and lack the visibility of mass-media interventions, which tend to focus on HIV testing options and condom use e. This approach facilitated the presentation and discussion of gay relationships, including associated thoughts and feelings of the characters, as well as articulating information about how to have safer sex that limits the possibility of HIV or other STI transmission.

Further creative or innovative ways to help men achieve a broader sense of sexual well-being need to be identified, up-scaled and resourced. The emergence of new HIV prevention options that utilise anti-retroviral therapy reinforces the need for early diagnoses of HIV and the urgency of increasing HIV testing among those sexually active in higher risk groups. However, with an ever increasing focus on prevention of infection by testing and medical treatment, it is possible that HIV prevention activity may move further still from the principles of health promotion that seek to achieve more than the absence of disease or infection.

Emerging medical technologies may have the potential to prevent many new infections, but these will only be successful if they take account of the lived experience and beliefs as well as community and broader social structures of individuals most at risk of contracting HIV, including what they value most in the context of their sexual lives.

Interventions that utilise new medical HIV prevention technologies, as well as those that rely on condom use, need to take better account of the themes presented above to ensure that their translation from controlled trial to wider population is as efficacious as possible. Future studies may wish to use the broad themes described in this paper as the basis of further quantitative enquiry, which may enable more sophisticated analysis of how constructions of the best sex life differ according to demographic groups, relationship status or HIV status, and how they correlate with current or recent feelings of sexual happiness.

The themes may also assist in the future development of a scale to assess sexual aspirations or sexual satisfaction among gay and bisexual men, or in the development of more in-depth qualitative research that explores sexual well-being among this population.

The Curious Connection Between Apps for Gay Men and Sex Offenders

The findings described in this paper reflect the views of men resident in the United Kingdom who were completing the survey in English. There is a need to explore if and how constructions of the best sex differ among men from different social, cultural, national or linguistic backgrounds. Data described in this survey are diverse but cluster around several key themes which highlight the primacy of meaningful interaction with other men as a key component of the best sex life.

As HIV prevention activity becomes increasingly medicalised, with an associated focus on HIV testing and pharmaceuticals, it is important that the broader sexual well-being of gay and bisexual men is not forgotten. Sexual health does not begin and end with HIV and the extent of sexual unhappiness previously documented among this population should be a cause for concern for all those working across the clinical, health, human rights and social care spectrum.

By taking account of what men value or aspire to in the context of their sexual lives we may be able to develop interventions that are both engaging and valuable for them in achieving the best possible sex, while at the same time facilitating an environment in which HIV transmission may be less likely to occur.

Coding of the data was performed by GH, supported by AB. The manuscript was drafted by AB and commented on by all other authors. AB and FH prepared the revision. All authors approved the final manuscript. We begin by thanking all of the men who took part in EMIS We also thank the websites who placed the EMIS banner, and particularly to those who sent individual messages to their users: We also thank all NGOs who promoted the survey.

University College Maastricht; UK: Aids-Hilfe Wien; BE: Vstrecha; CH: Positive Voice; HR: GenderDoc-M; MK: Safe Pulse of Youth; RU: OZ Odyseus; TR: We also wish to thank Catherine Dodds, Rebecca French and Paul Steinberg for their very helpful comments on earlier versions of this paper. The EMIS project was funded by: National Center for Biotechnology Information , U. BMC Public Health. Published online Nov Author information Article notes Copyright and License information Disclaimer.

Corresponding author. Adam Bourne: Received Jul 18; Accepted Nov This is an open access article distributed under the terms of the Creative Commons Attribution License http: This article has been cited by other articles in PMC. Abstract Background While a large body of research has sought to understand HIV transmission risk behaviours among gay men, bisexual men and other men who have sex with men MSM , less attention has been paid to the wider sexual health and well-being of this population.

Method The EMIS survey of recruited more than , respondents from 38 European countries to complete an online questionnaire about sexual health and behaviour. Conclusions Attending to what men value or aspire to can help ensure interventions are engaging and meaningful to the target population. Background Gay men, bisexual men and other men who have sex with men MSM remain the group at highest risk for contracting HIV in the UK [ 1 ], as in many other parts of the world [ 2 , 3 ]. Table 1 Key participant demographic information. Open in a separate window.

Figure 1.

Sex and drugs: Popular gay dating app allows users to find more than a date

Proportion of responses including each theme not mutually exclusive. Relationship formulations When asked what their idea of the best sex life was, the most common response by Sexual actions or behaviours Around one in six men Sex free from physical harm A relatively small proportion of men Overcoming psychological and social barriers For 9. Physical attributes of sexual partner s A small number of men 5. Settings or physical spaces for sex For a very small number of men 1.

Table 2 Demographic variation in best sex themes represented in each response. Figure 2. Age variation in best sex themes represented in each response. Discussion This paper describes an exploratory analysis of responses to one open question about what constitutes the best sex life, which were often only several words in length and occasionally ambiguous.

Competing interests The authors declare that they have no competing interests. Pre-publication history The pre-publication history for this paper can be accessed here: References Health Protection Agency. HIV in the United Kingdom: Collindale, London: Health Protection Agency; Associations like those listed in the Android Marketplace or Apple's Genius system, Amazon's recommendation engine or Bing's search suggestions can be starting points for good conversation or chilling silencers of individual expression and community identity.

To be starting points for conversation, designers must first acknowledge that recommendation systems both those that are run by humans and those relying upon algorithms have the power to suggest and constrain expression. Bizarre links between Grindr and Sex Offender Search can be great starting points for those who are privileged enough to recognize nonsensical associations, possess enough technical knowledge to understand how such systems might make links, and have the confidence and communication skills to argue the point with friends, family members and others.

These can be great opportunities to debunk bad thinking that would otherwise go unchallenged.

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But if we think that technologies are somehow neutral and objective arbiters of good thinking -- rational systems that simply describe the world without making value judgments -- we run into real trouble. For example, if recommendation systems suggest that certain associations are more reasonable, rational, common or acceptable than others we run the risk of silencing minorities. This is the well-documented " Spiral of Silence " effect political scientists routinely observe that essentially says you are less likely to express yourself if you think your opinions are in the minority, or likely to be in the minority in the near future.

Background

Imagine for a moment a gay man questioning his sexual orientation. He has told no one else that he's attracted to guys and hasn't entirely come out to himself yet. His family, friends and co-workers have suggested to him -- either explicitly or subtly -- that they're either homophobic at worst, or grudgingly tolerant at best.

He hears about Grindr, thinks it might be a low-risk first step in exploring his feelings, goes to the Android Marketplace to get it, and looks at the list of "relevant" and "related" applications. He immediately learns that he's about to download something onto his phone that in some way -- some way that he doesn't entirely understand -- associates him with registered sex offenders.

What's the harm here? In the best case, he knows that the association is ridiculous, gets a little angry, vows to do more to combat such stereotypes, downloads the application and has a bit more courage as he explores his identity.

What constitutes the best sex life for gay and bisexual men? Implications for HIV prevention

In a worse case, he sees the association, freaks out that he's being tracked and linked to sex offenders, doesn't download the application and continues feeling isolated. Or maybe he even starts to think that there is a link between gay men and sexual abuse because, after all, the Marketplace had to have made that association for some reason. If the objective, rational algorithm made the link, there has to be some truth to the link, right? Now imagine the reverse situation where someone downloads the Sex Offender Search application and sees that Grindr is listed as a "related" or "relevant" application.

In the best case, people see the link as ridiculous, questions where it might have come from, and start learning about what other kind of erroneous assumptions social, legal and cultural might underpin the Registered Sex Offender system. In a worse case, they see the link and think "you see, gay men are more likely to be pedophiles, even the technologies say so. The point here is that reckless associations -- made by humans or computers -- can do very real harm especially when they appear in supposedly neutral environments like online stores.

Like all websites and apps, the gay dating platform is protected by Section of the Communications Decency Act of The legislation, passed in the early days of the internet, is known as one of the most important tech industry laws. But while Grindr is not legally obligated to moderate drug content on its platform, some experts say it would be relatively easy to do so.

While Grindr may not be policing drug activity on its app — real police are. There have been several examples in the past few years of men being arrested for selling illicit substances through the app.