McDaid and Hart BMC Public Health 2010, 10:798 http://www.biomedcentral.com/1471-2458/10/798 Page 7 of 10 Table 3 Factors associated with contact with HIV prevention activities in the past 12 months (N = 1318) (Continued) UAI with partners of unknown/discordant HIV status No Yes STI No Yes 701 72.6 250 77.9 870 72.4 89 81.7 1 1.33 (0.99- 1.80) 1 1.70 (1.03-2.80) 503 52.1 163 50.8 593 49.3 76 69.7 1 0.95 (0.74- 1.22) 1 2.37 (1.55-3.61) 127 13.1 49 15.3 148 12.3 26 23.9 1 1.19 (0.83- 1.70) 1 2.23 (1.39-3.58) 74 7.7 31 9.7 77 6.4 24 22.0 1 1.29 (0.83- 2.00) 1 4.13 (2.48-6.86) OR = odds ratio; 95% CI = 95% confidence interval; significant odds ratios are shown in italics, p < 0.05. *Black African, Black Caribbean, Indian, Pakistani, Chinese, Arab, Latin American & Other/Mixed. † HIV treatment optimism 1 - ‘I am less worried about HIV infection now that treatments have improved’, HIV treatment optimism 2 - ‘I believe that new drug therapies make people with HIV less infectious’. services to change risk behaviour. Furthermore, our examination of associations between prevention activ- ities and sexual risk is limited to the behaviours for which data were collected and these aggregate measures may miss more complex risk reduction strategies being employed by individual men. However, the results pro- vide interesting insight into men’s current contact with a range of HIV prevention activities available to them and the following discussion concentrates on the impli- cations of the findings for future HIV prevention efforts. It is encouraging that the majority of men had some contact with HIV prevention activities. Condom provi- sion is a core component of HIV prevention [19]. Con- siderably more men reported obtaining free condoms than any of the other activities and it presents an oppor- tunity for further prevention efforts and community engagement (e.g. using existing condom distribution methods to distribute other sexual health or HIV com- munications). Half of the men surveyed had accessed such sexual health materials, either via leaflets or online, and mass communication, or social marketing, cam- paigns (some of which include the provision and distri- bution of leaflets in addition to more general poster or media advertising) continue to be frequently employed as a means of HIV-related health promotion [20]. Indeed, the recently published Scottish HIV Action Plan includes a specific recommendation to develop and implement social marketing materials for MSM [2]. With the Internet now a recognised setting that MSM are likely to utilise to meet sexual partners [21], and evi- dence supporting online health promotion [22], interest has grown in using the Internet as a setting for HIV prevention interventions. However, both mass commu- nication and Internet interventions are often difficult to evaluate and, to date, have been shown to have limited impact on risk behaviour [20,23]. Talking to outreach workers in bars, clubs or saunas, though markedly less common than obtaining free con- doms or accessing sexual information via leaflets or the Internet, appears to continue to have a role in increasing access to sexual health services, as evidenced here by the association between this and HIV/STI testing. Our pre- vious evaluation of the Gay Men’s Task Force peer edu- cation intervention reported similar findings, with higher rates of service use among men who had talked to peer educators in bars [10]. Outreach workers are ideally placed to direct at risk men to sexual health ser- vices and to support other, more general, social market- ing campaigns. Utilising one to one or group counselling on sexual health or HIV prevention, the most intensive form of prevention examined here, was also the least commonly reported. The association between testing, HIV, STIs and counselling could reflect the risk reduction counselling provided by sexual health practitioners when men pre- sent for testing or treatment. As such, these interactions represent the opportunity for interventions to effect behaviour change, as noted in existing UK guidance [24]. Intervention delivery by health care providers, and in set- tings where people receive routine HIV care or services, are two of the characteristics of successful interventions [25]. Sexual health services would be appropriate settings for such interventions in the UK. They would also be the most appropriate setting for the combination of these with biomedical interventions, such as early treatment for HIV to contribute to reducing community viral load, in which there is growing interest [26-29]. This is a highly sexually active sample, and at the bivariate level, contact with HIV prevention activities was consistently more common among men with more sexual partners and greater sexual risk behaviours (with the exception of UAI with partners of unknown or dis- cordant HIV status). Although this suggested men at greater risk were making use of existing activities (which theoretically could help reduce their risk), it is striking that these associations did not remain significant in multivariate analysis (though, as noted above, frequency of gay scene use could be taken as a proxy for risk