McDaid and Hart BMC Public Health 2010, 10:798 http://www.biomedcentral.com/1471-2458/10/798 Page 9 of 10 Table 4 Factors associated with contact with HIV prevention activities in the past 12 months: multivariate logistic regression (N = 1318) (Continued) Number of anal intercourse partners Less than 10 10 or more Number of unprotected anal intercourse (UAI) partners 0/1 partner 2 or more partners UAI with casual partners No Yes STI No Yes 1 1.67 1 1.06 1 1.16 1 0.73 (0.83-3.35) (0.60-1.88) (0.77-1.77) (0.42-1.27) 1 1.20 1 1.15 1 1.54 (0.75-1.91) (0.86-1.55) (0.98-2.44) 1 1.56 (0.85-2.85) 1 1.18 (0.66-2.11) 1 1.10 (0.68-1.79) 1 1.35 (0.80-2.27) 1 1.38 1 2.53 (0.80-2.41) (1.40-4.57) AOR = adjusted 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 2 - ‘I believe that new drug therapies make people with HIV less infectious’. behaviour). Prevention efforts have been ongoing at a time when HIV-related sexual risk behaviour has essen- tially stabilised in this population (at a high level first observed in 2002 [13,30]). Although this plateau could be interpreted as evidence of successful prevention efforts, and stabilisation of risk behaviours during peri- ods of intensified prevention efforts have been noted elsewhere [31,32], continued efforts are needed to address sexual risk among the minority of men for whom this appears to have become the norm [30]. Our results suggest high-risk men, those in contact with sex- ual health services, are accessing HIV prevention. There- fore, it is possible such prevention needs to be renewed, reinvigorated, or changed entirely, if reductions in sex- ual risk behaviours are to be achieved. Conclusions Calls for a renewed community response to HIV among MSM have been based on the early, successful HIV pre- vention and the widespread adoption of safer sex beha- viours, which resulted from this [4]. However, recent research has highlighted the evolving nature of the gay community [5-7], questioning the likelihood and poten- tial of a renewed community response to the HIV epi- demic among MSM. Furthermore, although there is growing evidence of the potential effectiveness of indivi- dual, group and community-level behavioural HIV pre- vention interventions in reducing high-risk sexual behaviour among MSM [33], behaviour change alone is unlikely to achieve the sustained reductions in HIV transmission necessary to change the course of the HIV epidemic [3]. Multi-level, combination prevention could be the way forward [3], and opportunities exist to exploit men’s current contact with HIV prevention activities further. We have demonstrated that men at highest risk, and those likely to be in contact with sexual health services, are those who report most contact with current HIV prevention activities. In addition, our previous research has shown that peer outreach can increase the uptake of sexual health services [10]. If we are to offer combina- tion prevention, a model for delivering this could there- fore include outreach by peer health workers, encouraging increased uptake of sexual health services delivering behavioural and biomedical interventions, and supported by social marketing to ensure continued com- munity engagement and support. Whilst general educa- tion to encourage condom use by MSM should continue, focused investment in the needs of those at highest risk, including those diagnosed HIV positive, may generate a prevention dividend in the long term. Additional material Additional file 1: Questionnaire. 2008 survey questionnaire Acknowledgements We thank the survey staff and fieldworkers in each city, the venue managers, their staff, and the men who agreed to participate in the survey. The UK Medical Research Council funds LMcD and the Gay Men’s Survey as part of the Sexual and Reproductive Health Programme (WBS U.1300.00.005) at the Social and Public Health Sciences Unit. Author details 1MRC/CSO Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow, G12 8RZ, UK. 2Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK. Authors’ contributions LMcD devised the paper, conducted the analyses and wrote the first draft. GH made substantial comments and contributed to subsequent drafts. Both