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The percentage of gay men in London reporting high-risk sex has increased significantly between 1998 and 2003, according to a study in the journal Sexually Transmitted Infections. Gay and bisexual men attending gyms in central London have responded since 1998 to questionnaires about their HIV status, their sexual behavior, and the HIV status of their partners. Between 1998 and 2002, there was a significant increase in the percentage of men reporting unprotected anal sex both with partners of known and unknown HIV status. The percentage of gay men reporting unprotected anal sex with a partner of unknown HIV status climbed from 15% in 1998 to 22% in 2003. "The increase in high-risk sexual behavior among London homosexual men between 1998 and 2003 was seen only with casual partners and not with main partners," the researchers wrote. "STD- and HIV-prevention interventions among these men should therefore target high-risk practices with casual partners since these appear to account entirely for the recent increase in high-risk sexual behavior." The researchers offer various explanations for the increase in high-risk sexual activity among London's gay men since 1998, including that the likelihood of unprotected anal sex with casual partners of unknown or different HIV status coincided with the introduction and widespread use of triple-drug anti-HIV therapy. Other factors that researchers say might play a role in the rise in unsafe sex include increased opportunities for sex afforded by bars offering backrooms, an increased use of bathhouses and saunas by gay men, and the growing use of the Internet, which many gay men use to find sex partners. Gay men also may be growing complacent about safer sex after nearly two decades of HIV-prevention messages stressing condom use.