Factors distinguishing homosexual males practicing risky and safer sex

Alcohol and Drug Use during Sexual Activity

The relation of alcohol and drug use during sexual activity to increased HIV risk-associated behavior was examined among 108 inner-city Black male adolescents who completed a self-administered questionnaire. Adolescents who reported a greater number of days in which they had sex while "high" reported more unprotected coitus, a greater number of coital partners, a greater number of risky coital partners, and more frequent insertive anal intercourse than did those who reported fewer days on which they had sex while high. For the most part, these relations remained significant when total frequency of sexY, a correlate of having sex while high, was included in the regression equation. The only exception was failure to use condoms. These results support the view that alcohol and drug use during sexual activity may affect the nature of the sexual behavior in which Black male adolescents engage, although it may not affect whether they use condoms.

Psychosocial Factors and Aids-Related Behavior of Homosexual Men

The primary objective of this study was to conduct measurement and data-reduction procedures of selected psychosocial measures used in AIDS-related behavioral research. Secondly, we investigated the associations of the psychosocial scales relative to other personal and health serviceslinformation factors with one selected AIDS protective behavior among asymptomatic homosexual/bisexual mern Data were collected using a self-administered questionnaire. Factor analysis and regression modeling were used to address the study objectives. Factor analyses validated the relationships between 53 survey items and 12 hypothesized constructs suggested by several theories of behavior change. These constructs included perceptions of susceptibility, beliefs of social network members, opinions about HPV testing, medical efficacy, related health habits and barriers to behavior change. Regression modeling demonstrated the relative importance of psychosocial scales to other variables in understanding associations with total number of sexual partners.

Social support and HIV-related risk behaviors: a systematic review of the global literature

Existing empirical evidence has well documented the role of social support in both physical and psychological well-being among various populations. In the context of HIV prevention, the rapid increase of studies on social support merits a systematic review to synthesize the current global literature on association between social support and HIV-related risk behaviors. The current review reveals a complex picture of this relationship across diverse populations. Existing studies indicate that higher levels of social support are related to fewer HIV-related risk behaviors among female sex workers and people living with HIV/AIDS and heterosexual adults in general. However, influences of social support on HIV-related risk behaviors are inconsistent within drug users, men who have sex with men and adolescents. These variations in findings may be attributed to different measurement of social support in different studies, specific context of social support for diverse population, or various characteristics of the social networks the study population obtained support from. Future studies are needed to explore the mechanism of how social support affects HIV-related risk behaviors. HIV prevention intervention efforts need to focus on the positive effect of social support for various vulnerable and at-risk populations. Future efforts also need to incorporate necessary structure change and utilize technical innovation in order to maximize the protective role of social support in HIV risk prevention or reduction.

Migration, neighborhoods, and networks: approaches to understanding how urban environmental conditions affect syndemic adverse health outcomes among gay, bisexual and other men who have sex with men

Adopting socioecological, intersectionality, and lifecourse theoretical frameworks may enhance our understanding of the production of syndemic adverse health outcomes among gay, bisexual and other men who have sex with men (MSM). From this perspective, we present preliminary data from three related studies that suggest ways in which social contexts may influence the health of MSM. The first study, using cross-sectional data, looked at migration of MSM to the gay resort area of South Florida, and found that amount of time lived in the area was associated with risk behaviors and HIV infection. The second study, using qualitative interviews, observed complex interactions between neighborhood-level social environments and individual-level racial and sexual identity among MSM in New York City. The third study, using egocentric network analysis with a sample of African American MSM in Baltimore, found that sexual partners were more likely to be found through face-to-face means than the Internet. They also observed that those who co-resided with a sex partner had larger networks of people to depend on for social and financial support, but had the same size sexual networks as those who did not live with a partner. Overall, these findings suggest the need for further investigation into the role of macro-level social forces on the emotional, behavioral, and physical health of urban MSM.

Drug use, community action, and public health: gay men and crystal meth in NYC

In 2004, GLBT and HIV/AIDS service providers in NYC mobilized against use of crystal methamphetamine among gay men. Both drug use and mobilization were shaped by the history of HIV, particularly the institutions, action repertoires, and social networks forged in earlier AIDS work. This paper is based on qualitative research conducted from 2007 to 2009 with advocates, service providers, and men who have sex with men recruited from diverse venues in NYC gay communities. The crystal use epidemic among gay men in NYC indicates the importance of social and historical context in shaping drug use and antidrug mobilization, including the potential for public health responses to drug use.

Relationship of alcohol use and sexual risk taking among hazardously drinking incarcerated women: an event-level analysis

OBJECTIVE

To understand the association of alcohol use with sex and unprotected sex among hazardously drinking incarcerated women, we examined the relationship of these behaviors on any given day.

METHOD

Participants endorsed unprotected sex and hazardous alcohol consumption (four or more drinks at a time on at least 3 separate days in the previous 3 months or a score of 8 or above on the Alcohol Use Disorders Identification Test). Participants recalled behaviors in the 90 days before incarceration using the Timeline Followback method. Generalized estimating equation models estimated the effect of daily alcohol use and selected covariates on the odds of sexual-risk behavior.

RESULTS

The 245 participants averaged 34 years of age and were 71.4% white; 67.8% used cocaine. On most (84.7%) drinking days, women consumed four or more drinks. One hundred forty-one participants (57.6%) reported sex with only main partners, 10.6% with only casual partners, and 30.6% with both casual and main partners. The likelihood of having any sex (odds ratio = 1.78, p < .01) and unprotected sex (odds ratio = 1.95, p < .01) was higher on days when participants consumed alcohol compared with nondrinking days. However, when the analysis was restricted to days on which participants reported having sex, the odds of having unprotected sex was not significantly associated with drinking.

CONCLUSIONS

Among incarcerated women who reported hazardous drinking, alcohol use was associated with an increased likelihood of sexual activity and a concomitant increase in unprotected sex. However, use of alcohol was not significantly associated with condom use on days when participants were sexually active.

The Relationship of Depressive Symptoms, Self-Esteem, and Sexual Behaviors in a Predominantly Hispanic Sample of Men Who Have Sex With Men

Despite public health campaigns and safer sex messages, many men who have sex with men (MSM) continue to participate in high-risk sexual behaviors, which may make them vulnerable to HIV infection and sexually transmitted infections. The purpose of this study was to determine the relationship of depressive symptoms, self-esteem, and sexual behaviors in a predominantly Hispanic sample of MSM. This correlational study sampled 205 MSM ( M = 37 years of age, SD = ±8) representing the diverse ethnic composition of South Florida. This sample consisted of ethnic minorities (79%) with a large number of foreign-born men (69%). Participants completed measures of depressive symptoms, self-esteem, and sexual behaviors. Results indicated that higher levels of depressive symptoms and higher levels of self-esteem had a statistically significant relationship to lower levels of safer sexual behaviors. Lower income, lower educational level, and preference for Spanish language were associated with higher levels of depressive symptoms; lower income was associated with lower levels of self-esteem; and foreign birth and a preference for Spanish language were associated with lower levels of safer sex behaviors. Higher levels of depressive symptoms and higher levels of self-esteem were associated with high-risk sexual behaviors in this sample of MSM. Further research needs to be directed at culturally specific mental health and HIV prevention strategies for these vulnerable MSM.

The relation between beliefs about drug treatments for HIV and sexual risk behavior in gay and bisexual men

This study examined the relation between gay and bisexual men's (N = 575) beliefs about highly active antiretroviral therapy (HAART) and other HIV-related beliefs, intentions, and risk behaviors. Confirmatory factor analysis verified three belief factors: the extent to which HAART improves health among HIV-infected individuals, decreases the risk of HIV transmission, and is complicated and of limited efficacy. Men who endorsed the belief that HAART decreases HIV transmission risk expressed lower intentions to use condoms for anal sex and were more likely to have engaged in unprotected anal intercourse with a casual partner HIV-negative men who believed that HAART decreases transmission risk also perceived themselves to be more susceptible to HIV infection. Statistical evidence indicated that perceptions of susceptibility partially mediate the relation between sexual risk behavior and beliefs about HAART suggesting that beliefs may result from, rather than cause, increased risk behavior.

Substance use and sexual risk behavior: understanding their association among four ethnic groups of Latino men who have sex with men

PURPOSE

To explore the association between substance use in conjunction with sex and unprotected anal sex among Colombian, Dominican, Mexican, and Puerto Rican men who have sex with men (MSM), considering ethnicity, acculturation, and mediating variables.

METHODS

A New York City convenience sample of 307 men provided information on past year's sexual behavior, substance use, acculturation, attendance at bars, discos, and parties, self-worth, machismo, and sensation seeking.

RESULTS

Alcohol use and drug use were positively associated with unprotected anal sex, particularly with casual partners. Different rates of substance use among the four ethnic groups were found, but were not significant when adjusting for acculturation. Among men who engaged in both unprotected and protected anal sex, substance use was not more common on unprotected occasions than on protected occasions. Attendance at bars, clubs, etc. was not associated with unprotected anal sex. Sensation seeking, self-worth, and machismo were related to substance use and unprotected anal sex. In multivariate analyses, the substance use/unprotected sex association remained when adjusting for ethnicity, acculturation, partner type, attendance at bars, and personality variables.

IMPLICATIONS

Substance use and unprotected sex are associated among these Latino MSM. However, there does not appear to be a simple causal relationship between the variables. Several other variables co-vary with these factors but did not statistically explain their association.

A double epidemic: crystal methamphetamine drug use in relation to HIV transmission among gay men

Emerging research on methamphetamine use among gay men suggests that growth in the use of this drug could present serious problems for HIV/AIDS prevention within the gay community. This article summarizes current studies on the extent, role, and context of methamphetamine use among gay men and its relationship to high risk sexual behaviors related to HIV transmission. Methamphetamine is often used by gay men to initiate, enhance, and prolong sexual encounters. Use of the drug is, therefore, associated with particular environments where sexual contact among gay men is promoted, such as sex clubs and large "circuit" parties. Research with gay and bisexual men indicates that methamphetamine use is strongly associated with risky sexual behaviors that may transmit HIV. This relationship, coupled with emerging evidence that methamphetamine use is on the rise among gay men, suggests that the drug could exacerbate the HIV/AIDS epidemic among this community. The article offers recommendations for further research and suggestions for prevention programs regarding methamphetamine use by gay men.

Correlates of risky behaviors among young and older men having sexual relations with men in Montréal, Québec, Canada. Omega Study Group

OBJECTIVE

To assess characteristics associated with 1) age and 2) recent unprotected anal sex with casual partners among men having sexual relations with men (MSM) participating in the Omega Cohort, Montréal, Québec, Canada.

METHODS

The Omega Cohort is a study of the incidence and psychosocial determinants of HIV infection among MSM living in Montréal. MSM complete a questionnaire and are tested for HIV every 6 months.

RESULTS

Thirteen percent of young MSM (< 30 years of age, n = 355) and 12% of older MSM (> or = 30 years of age, n = 455) reported recent unprotected anal sex with casual partners. The predictors of this latter behavior were: not living with a male sexual partner, unprotected anal sex with regular partner, > 5 casual partners, alcohol/drug use before anal sex, and having difficulties with procedures needed for safe sex. Among young MSM, additional predictors were: to have been living in Montreal for less than 1 year and to have exchanged money for sex. Among older MSM, additional predictors were: female sexual partners, unprotected anal sex with an HIV-infected partner, and feeling invulnerable to AIDS.

CONCLUSION

Young Omega participants do not have more risky behaviors than older participants. Some predictors of recent risk behaviors with casual partners were different between the two groups. Prevention programs should be adapted consequently.

Influence of HIV positive status on sexual behavior among males

OBJECTIVE

To compare HIV seronegative (HIV-) and HIV seropositive (HIV+) males in terms of sexual behavior with female and male partners of different types.

METHOD

Cross-sectional study. From August 1994 to February 1995, a sample of 236 respondents (150 HIV- and 86 HIV+) recruited from public health centers in the State of S. Paulo (Brazil), answered a questionnaire, including questions on demographic aspects, HIV and AIDS related knowledge, sexual orientation, use of alcohol and other drugs, sexual behavior with regular and casual female and male partners, and perceived risk of HIV infection. Sexual behavior with regular and casual female and male partners within the previous three months, was investigated.

RESULTS

A lower proportion of HIV+ engaged in sexual contact with regular female partners (p < .01) and in vaginal intercourse with this type of partner (p < .01). A lower proportion of HIV+ engaged in overall sexual activity (p < .001) and reported lower frequency of penetrative sexual practices (p < .05). A high level of condom use with female and male partners was identified with no significant differences being found between the two serostatus groups. Some risky sexual behavior was identified, however, especially with regular partners, suggesting that some men were continuing to practice unsafe sex.

CONCLUSIONS

The high level of condom use identified suggests that safer sex advice has been taken up. Condom use was not universal, however, and some men continue to place themselves at risk, especially with regular partners. Prevention programs should strive not only to encourage HIV- to practice safer sex, but also to encourage HIV+ to do so in order to prevent further transmission of the virus.

HIV serostatus and risk behaviors in a multisite sample of drug users

In developing HIV prevention efforts, it is critical to determine whether interventions are effective in achieving declines in risk behavior among both HIV-positive and HIV-negative individuals. Based on a multisite intervention study of injection drug users (IDUs) and crack smokers, 488 seropositive IDUs and 364 seropositive crack users were compared with randomly selected matched samples of seronegatives (with matching based on recruitment site, gender, age group and ethnicity) at baseline and six-month follow-up to compare changes in risk behaviors by serostatus. Results indicated that overall, risk behaviors declined substantially over time; significant interaction effects indicated that seropositives reported a greater decline in sex risk behaviors than seronegatives. These data support the utility of HIV testing for high-risk drug users, and indicate that interventions have produced reductions in risk behaviors of both seropositives and seronegatives. Further research on the impact of site seroprevalence, and to enhance our understanding of those who continue to engage in risky behaviors, is needed.

Reliability of the timeline follow-back sexual behavior interview

The reliability of self-reported sexual behavior is a question of utmost importance to human immunodeficiency virus (HIV) prevention research. The Timeline Follow-Back (TLFB) interview, which was developed to assess alcohol consumption on the event level, incorporates recall-enhancing techniques that result in reliable information. In this study, the TLFB interview was adapted to assess HIV-related sexual behaviors and their antecedents, and its reliability was assessed. The interview was administered to 110 participants (46% women, M age = 19.7; range = 18-41), and 58 participants who reported sexual behavior during the previous three months returned one week later for a second interview. Test-retest intraclass correlations (rho) from the TLFB protocol showed that all sexual behaviors were reported reliably (rho range = .86 to .97, median = .96). Bootstrapping, a nonparametric statistical technique, was used for significance testing in the reliability analyses. Reliability was equivalent across each of the three months assessed with the TLFB and was equivalent to conventional assessment methods (i.e. single-item questions). These findings show that the TLFB sexual behavior interview provides reliable reports of sexual behavior over three months and yields event-level data that are extremely valuable for sexual behavior and HIV-prevention research.

The role of self-esteem in safer sexual practices

Self-esteem appears in the literature as a variable that influences the practice of risky sexual behaviors. It is often assumed that higher levels of self-esteem are associated with safer sexual behaviors, especially those that prevent the spread of HIV. The research literature was reviewed to examine the relationship between self-esteem and the practice of safer sexual behaviors. Research indicates that higher levels of self-esteem are found in adolescents who practice risky sexual behaviors and have more sexual partners. Research and clinical implications are discussed.

The relationship between risk networks' patterns of crack cocaine and alcohol consumption and HIV-related sexual behaviors among adult injection drug users: a prospective study

Social context may be an important determinant of drug and alcohol consumption and HIV-related behaviors. To assess the influence of peers on drug users' risk behaviors this study examined the association between individual level and group level behaviors. This analysis reports on the prospective association between baseline self-reported drug and alcohol use of the network members of injection drug users, and self-reported sexual behaviors and alcohol use at 5-month follow-up. Participants were a nontreatment sample of inner-city injection drug users who volunteered for a network-oriented HIV preventive intervention. They were predominantly unemployed, African American males. Of the 71 index participants who completed both the baseline and follow-up interviews, 227 of their drug network members were enrolled in the study. At baseline indexes' sexual risk behaviors were significantly associated with their drug network members' level of crack cocaine use. At follow-up higher levels of alcohol and crack use among drug network members were associated with indexes' reports of multiple sex partners and increased alcohol consumption. Higher levels of crack use among the drug network members were associated with the indexes' reporting casual sex partners at follow-up. These results highlight the importance of studying the role of peer group influence and the social context of risk behaviors.

Safer sex behavior and alcohol consumption. Research Group of the Swiss HIV Prevention Study

To test the hypothesis that safer sex procedures are less consistently observed by persons under the influence of alcohol, data from the Swiss human immunodeficiency virus (HIV) Prevention Study (HIPS) were evaluated. HIPS is a large prospective cohort study involving 724 HIV-negative and mainly heterosexual subjects who entertain casual sexual contacts. Of the 724 participants, 36% reported that they had had sex while under the influence of alcohol. Of this group, 31% indicated that safer sex procedures were neglected owing to the influence of alcohol. No significant differences with regard to unprotected sexual intercourse were found between subjects who combine sex and alcohol and those who do not. The same was found to be true among subjects with different levels of general alcohol consumption. However, a significant correlation was found between the intensity of alcohol consumption (i.e., the quantity of alcohol intake per sitting) and the incidence of unprotected sexual intercourse. These findings show that the relationship between alcohol consumption and safer sex is complex; they also emphasize the need for preventive efforts to reinforce safer sexual behavior, for example through individual counseling of persons at risk for HIV-infection.

Co-factors affecting substance abuse among homosexual men: an investigation within a midwestern gay community

In an effort to begin formation of an empirically based model of gay substance abuse, this study examined the effects of three psychosocial factors, homosexual identity formation, self-esteem and a familial history of substance abuse in the evolution of this phenomenon among homosexual men, a group that appears to manifest appreciably higher rates and concomitantly greater associated problems than the general population. Data were obtained by voluntary subject return of a self-report instrument that was distributed widely over a 6 month period in the metropolitan Cleveland area, resulting in a moderately sized sample. Although the sampling method limited the generalizability of the results, diminished self-esteem and a familial history of substance abuse had significant associations with both alcohol and drug abuse and were confirmed to be salient predictors, together accounting for almost half the variance in alcohol abuse and over one-third the variance in drug abuse. Moreover, both had the ability to significantly discern between alcohol and drug use groups versus groups found to be alcohol and drug abusive. Levels of a gay identity were not meaningfully associated with substance abuse. Finally, recommendations for further research were explicated.

Condom use among gay/bisexual male substance abusers using the timeline follow-back method

Sexual risk for HIV transmission under the influence of alcohol and/or other drugs is not simply a cause-effect relationship: not everyone who drinks or uses other drugs has unprotected sex. The purpose of this study is to explore differences between substance using gay/bisexual men who use condoms during anal sex from those who do not. These differences are identified by comparing men whose anal sex while under the influence of alcohol and/or drugs is consistently protected to men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected. Gay/bisexual men entering substance abuse treatment at a gay-identified agency in San Francisco were recruited to complete surveys and to be interviewed about sexual behavior, substance use, and related variables using an extended version of the Timeline Follow-back (TL). The TL procedure uses a blank calendar form and a series of questions to cue recall of drinking, drug use, and anal intercourse on each of the 30 days prior to the last date of alcohol and/or drug use. Men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected were significantly more likely to report having less than a college education (p = .04), more likely to have an income of less than $20,000 (p = .01), more likely to use amyl nitrite (p = .01) and cocaine (p = .02), and more likely to report a higher frequency of anal sex (p = .007). In addition, they were less likely to approve of sex without love (p = .003), less likely to perceive that safer sex is the community norm (p < .001), and less likely to have encouragement from friends to practice safer sex (p = .001). However, HIV status did not differentiate between the two groups. These two groups provide clear and interesting contrasts in terms of behavior, thus comparisons of the factors influencing sexual safety in these subgroups may enhance our understanding of risk taking. A better understanding of possible mediating variables can be important both in guiding future research in this area and in formulating intervention strategies to target gay men who drink or use drugs in combination with sexual activity.

Is there a relationship between "heavy drinking" and HIV high risk sexual behaviors among general population subjects?

The authors investigated the association between "heavy drinking" and sexual behaviors among 2,581 general population subjects from the St. Louis Epidemiologic Catchment Area survey conducted from 1981 to 1983. Lifetime sexual behaviors included promiscuity, infidelity, receiving money for sex, and same gender sex. It was found that sexual behaviors were associated with lifetime heavy drinking. Regardless of gender, race, or age, "heavy drinkers" were significantly more likely to report each of the high risk sexual behaviors, except same gender sex, compared to "nonheavy drinkers." With the multiple logistic regression analyses it was found that "heavy drinking" non-Black females, Black males regardless of drinking history, "heavy drinking" males, and younger subjects regardless of drinking history were at higher risk to report the high risk sexual behaviors. This study confirms that there is a strong association between "heavy drinking" and high risk sexual behaviors in a midwestern population. This is the first study to find an association between alcohol drinking patterns and high risk sexual behaviors in the general population. Implications of these findings for public health education efforts are discussed.

The relationship of alcohol use to sexual activity in a U.S. national sample

Recent reports have indicated that the use of alcohol is related to sexual behavior (such as unprotected intercourse) that is high-risk for HIV infection. However, most of these studies have collected data from convenience samples, using measures of varying specificity. This paper describes a study designed to investigate the relationship of alcohol use to unsafe sexual activity in a representative sample of adults. Data were collected from 2058 respondents as part of a survey of a multi-stage area probability sample of the adult household population of the 48 contiguous United States. The interview instrument included measures of alcohol use, sexual activity and condom use. Logistic regression analyses showed that heavier drinkers were more likely to be sexually active, and if sexually active, were more likely to have had more than one sexual partner in the previous year. However, drinking variables were in general not significantly related to condom use. These results suggest that alcohol use may be more strongly related to lifestyle variables (general sexual activity and number of sexual partners) than to more concrete behavioral variables such as condom use. Because these data are correlational, the findings are also consistent with the notion of a general constellation of risk-taking or sensation-seeking activities that includes alcohol use and sexual activity.

A review of the HIV-related sexual behaviour of gay men and men who have sex with men

In the last decade studies have identified a myriad of factors associated with continued risky sex in gay men and men who have sex with men. More recently the phenomenon of 'relapse' has been identified among this population. The results of such studies have been fed into the ongoing development of strategies to prevent HIV transmission. This paper critically examines this research--most of which is quantitative--and argues that the usefulness of the research is limited. Because of methodological problems, the evidence is contradictory and indeed, comparison across studies is almost impossible. An examination of the concept of 'relapse' illustrates the problems of relying on quantitative research which, in the main, removes individuals from their social context. The paper concludes that more qualitative research is required to locate individuals within their social milieu and to better understand them as individuals interacting with others and involved in an ongoing decision-making process about sexual pleasure and risk.

Correlates of sexual risk-taking among gay male substance abusers

This paper examines sexual risk-taking within a sample of sexually active gay and bisexual men entering substance abuse treatment (n = 383), and identifies correlates of unprotected anal sex within this group. Sexual risk-taking was high, with 55% of these men engaging in anal intercourse without a condom within a 90-day period. Correlates of unprotected anal sex varied somewhat when looking at unprotected anal sex with a primary partner only and with non-primary partners; substance use variables (number of drugs used, use of inhalant nitrites or stimulant drugs with sex, length of time since use of alcohol/drugs, loss of control problems associated with alcohol/drug use) appear to play more of a role in unprotected anal sex with non-primary partners. Overall, logistic regression analyses indicated that sexual risk was greater for those who were more sexually active, enjoyed unprotected anal sex with withdrawal prior to ejaculation, did not approve of sex outside of a love relationship, and identified themselves as more risky. In addition, those who reported more social problems due to substance use had fewer expectations that substance use increased risk, had been HIV-tested, and used reappraisal/problem-solving coping strategies showed greater risk with a primary partner only. Sexual risk with non-primary partners was greater for those who used more drugs, reported more difficulty avoiding high-risk sex when aroused and were HIV+. The paper discusses the implications of these findings for the design of sexual risk-reduction interventions.

Modelling and modifying young heterosexuals' HIV-preventive behaviour; a review of theories, findings and educational implications

Studies applying social cognitive frameworks such as the health belief model and the theory of reasoned action to HIV-prevention are reviewed. These models suggest that appropriate beliefs, attitudes, social norms, intentions and perceived self-efficacy are sufficient psychological conditions for safer sexual behaviour. Limitations inherent in these accounts are identified and additional factors which need to be incorporated in psychological models and health education programmes are highlighted. These include, the motivational complexity of sexual behaviour, the emotional and arousal states in which it is enacted, the difficulties of planning what is regarded as spontaneous interaction and contextual factors which can undermine HIV-preventive intentions. Health education interventions aimed at individual, group and community levels are examined in light of this theoretical review and action-focused, empowering interventions grounded in youth culture are recommended.

Acculturation, sexual behavior, and alcohol use among Latinas

We explored the relationship of alcohol use to unsafe sex in Latinas. Telephone interviews were conducted with 523 currently sexually active Latinas aged 18-49 years. Only 7.5% of these women used alcohol half of the time or more prior to sex. "Regular" alcohol users had more sexual partners, but also had more experience with condom use, used condoms with primary partners as frequently as nonusers of alcohol, and used condoms more with secondary partners. While Latinas who use alcohol prior to sex more often have multiple sexual partners, alcohol use does not appear to interfere with condom use.

Risky business: the cultural construction of AIDS risk groups

AIDS researchers and policy makers have often employed the concept of 'culture' to characterize 'high risk groups' and explain why members of these groups continue to practice 'risky behavior.' We argue that the widespread interest in ethnography tends to reflect a usage of the concept of culture that distances and subordinates. People with AIDS are portrayed as either minority street people abandoned by friends and family or as white gay men who live within a gay community, and in either case as socially deviant. This construction of HIV disease has facilitated distancing and denial of personal risk by persons outside the 'high risk groups,' impeding prevention efforts. Perceptions of subcultures of risk groups are contrasted with data on a random sample of persons with AIDS in New Jersey.

Human studies on alcohol and susceptibility to HIV infection

Here we review existing evidence that alcohol intake may influence the susceptibility to human immunodeficiency virus type 1 (HIV-1) infection and the effect that alcohol may have on accelerating the onset of AIDS after the initial infection. Possible immunological and psychosocial mechanisms to explain the increased incidence of HIV-1 infection in alcoholism are discussed.

Coming out and AIDS-related high-risk sexual behavior

How the withdrawal of social support associated with the coming out of gay men influences AIDS-related sexual risk-taking among Flemish (Belgian) gay men is analyzed. Recruited via key persons, the 379 gay men in this nonclinical cohort completed a lengthy, computerized questionnaire dealing with diverse aspects of gay life and culture. Independent variables include demographic characteristics, AIDS knowledge, coming-out histories, six social support dimensions, and personal resources. The dependent variables were insertive and receptive anal intercourse with and without a condom. Stepwise regression explained, respectively, 41.2, 38.4, 18.4, and 14.2% of the variance. Absence of appraisal (the view that others approve of the way one does things or feels about things) led to higher frequencies of insertive anal sex (both with and without a condom). The experience of emotional conflict lowered the use of condoms by the insertive partner in anal intercourse. Disapproval by significant others of being gay also led to higher levels of receptive anal intercourse without a condom. Subjects with a high belief in mastery had higher frequencies of risk-taking, suggesting that the combination of the experience of negative reactions and high mastery lead to greater involvement in risky sexual behavior. Findings are interpreted within the theoretical framework of the coming-out process and gay identity formation.

Substance use and risky sexual behavior for exposure to HIV. Issues in methodology, interpretation, and prevention

Recent reports have suggested that the use of alcohol or drugs is related to sexual behavior that is high risk for HIV infection. If substance use leads to unsafe sexual activity, understanding the dynamics of this relationship can contribute to research and preventive and educational efforts to contain the spread of AIDS. In this article, we review research on the relationship between substance use and high-risk sexual behavior. We then consider the inherent limitations of the research designs used to study this relationship, outline some methodological concerns including measurement and sampling issues, and comment on causal interpretations of correlational research findings. We end with a consideration of potential avenues for future research and a discussion of implications of these findings for current AIDS prevention policies.

Social support and HIV

This paper reviews research about the relationship between social support and health for people with HIV. Current studies linking social support and HIV are described and the major findings summarized in order to identify gaps in the literature. It is argued that, to date, research in this area has focused primarily upon gay white men in the USA at a symptomatic stage of the illness. There are few studies which have considered the impact of social position on the relationship between social support and health, and few which have included HIV-negative controls. Whilst there is evidence of a link between social support and the psychological well-being of people with HIV, research is still in its infancy. Much information is required about which particular aspects of social support and health are associated, how this association changes over time according to the stage of the disease, and with the socio-economic and cultural characteristics of those with HIV.

Cofactors of Substance Use among Male Street Prostitutes

Two hundred and eleven male street prostitutes were surveyed using a semi-structured interview schedule and standardized self-report instruments. Information about substance use, occupational and lifestyle characteristics, levels of psychological symptomatology and self-esteem was gathered to delineate prostitutes' substance use patterns and possible cofactors to substance use. Results indicate that daily polysubstance use among male prostitutes is normative for both IDU and non-IDUs. Additionally, data demonstrate a direct link between substance use and economic dependence on prostitution. Most importantly, prostitutes' substance use was found to increase significantly while engaging in acts of prostitution and was exacerbated by the presence of psychological distress and conflicts about sexual orientation. Findings suggest that social policy surrounding interventions aimed at male prostitutes' substance use should not be conceptualized solely in terms of recreational and or addictive factors, but also as the resultant outgrowth of the need for self-medication to cope with negative feelings and/or conflicts associated with practicing prostitution.