Factors distinguishing homosexual males practicing risky and safer sex

Alcohol and risky sex: in search of an elusive connection

Since the publication of the 1986 article by Stall, McKusick, Wiley, Coates and Ostrow, the conclusion that drinking alcohol prior to or during erotic encounters increases the probability of engaging in high-risk sexual behavior has been widely accepted, despite some contradictory findings from research on this hypothesis. This paper presents the results of tests of the alcohol/risky-sex hypothesis in a cohort of gay men in Flanders, Belgium. Failing to find evidence to support the hypothesis of a general effect of alcohol on sexual risk taking, we argue that previous conclusions on this matter must be viewed with extreme caution, especially in light of the implications that this failure to replicate has for AIDS prevention programs. Cultural, social, and methodological factors that could account for this failure to replicate are discussed in the context of a review of the literature on this hypothesis.

AIDS and promiscuity: muddles in the models of HIV prevention

AIDS has been blamed on promiscuity and the promiscuous, and a major goal of many HIV-prevention programs has been to induce people to reduce the number of their sexual partners. Despite the salience of this concept in the AIDS discourse of scientists, policymakers, the media, religious leaders, and the gay community, critical analysis of the role of promiscuity in this epidemic has been lacking. Following a review of promiscuity in various genres of AIDS discourse, this article discusses promiscuity in American society and in HIV-prevention campaigns. The relative risks associated with monogamy, abstinence and promiscuity are examined, and the author concludes that the partner-reduction strategy, instead of contributing to a reduction in HIV transmission has been an impediment to AIDS prevention efforts, exacerbating the problem by undermining the sex-positive approaches to risk reduction that have proven effective. Responsibility for this misguided strategy is attributed to a moralistic approach to AIDS and to the misapplication of epidemiological concepts and inappropriate social science models to the task of promoting healthy forms of sexuality.

Alcohol, drugs, and adolescent sexual behavior

In a 1990 Massachusetts-wide random digit-dial telephone survey of 16-19 year olds, 66% reported sexual intercourse of whom 64% had sex after drinking and 15% after other drug use. Thirty-seven percent always used condoms. Forty-nine percent were more likely to have sex if they and their partner had been drinking, and 17% used condoms less often after drinking. Fewer, 32%, said they would be more likely to have sex if they and their partner had used drugs, with 10% less likely to use condoms after drug use. Since so few adolescents consistently use condoms, the greatest risk for HIV, sexually transmitted diseases, and unwanted pregnancy is the increased likelihood of having sex after drinking or drug use, not the decreased likelihood of condom use after drinking and drug use.

HIV, substance use and related behaviour of gay and bisexual men: an examination of the talking sex project cohort

This paper reports on the substance use of 612 gay and bisexual men who participated in an HIV risk reduction project. Use/non-use, level of substance use, and reported frequency of use prior to sexual activity were examined in relation to number of sexual partners, sexual activities, HIV antibody test seeking behaviour and known HIV status. The use of substances among the study cohort appear to be higher than in a comparable heterosexual male group. An association was found between substance use, and both number of sexual partners and sexual activities. However, no significant difference was found in substance use between men participating in protected versus unprotected anal sex. Similarly, no significant difference was found in the reported frequency of substance use prior to sex by those participating in protected and unprotected anal intercourse. Greater drug use was reported among those who were known to be HIV antibody positive. These findings raise issues for further research. The high use of alcohol and drugs by gay and bisexual men may pose significant health risks for this group of men.

The HIV test and sexual behaviour in a sample of homosexually active men

This paper aims to assess the effects of voluntary anti-HIV testing on homosexual sexual behaviour. A sample of 502 men were recruited from four different areas of England. The criterion for inclusion was 'any man who had had sex with another man in the previous 5 years'. Men were interviewed about their recent sexual behaviour, histories of sexually transmitted diseases, experience of HIV tests and attitudes to the test. Men with a history of sexually transmitted diseases were more likely to have had the test. Thirty-one percent of men reported passive anal sex in the last month and 19% had had unprotected passive anal sex. These behaviours were most often reported by those testing HIV antibody positive and least by those never tested. The findings suggest that homosexually active men who volunteer for an anti-HIV test are broadly similar to those who do not. The absence of any clear effects of the test alone on sexual behaviour suggests that the quality of counselling in this area needs urgent attention.

Factors influencing condom use in a sample of homosexually active men

A sample of 502 homosexually active men were recruited from genitourinary medicine clinics and non clinic sources and interviewed in relation to their sexual behaviour and factors that might influence their use of condoms. Three hundred and eighty three men (76%) reported penetrative anal sex in the previous year. Ninety four (25%) had not used condoms in penetrative sex. Failure to use condoms was associated with unfavourable attitudes to them, not knowing close friends or partners who had HIV-related health problems, having fewer sexual partners and being in a closed monogamous relationship. On the other hand levels of awareness about the risks of unprotected anal sex and involvement in gay networks and social groups were not predictors of condom use.

The many faces of AIDS: opportunities for intervention

Social and cultural issues may have a profound impact on different populations' responses to the AIDS epidemic. To maximize their own effectiveness, clinicians need to be aware of special needs and concerns.