GENEVA, Switzerland--Cultural messages regarding "acceptable" sexual behavior vary among ethnic groups, and those messages may contribute to the risk of transmitting disease for some men and their male and female partners, researchers reported here today (June 29) at the 12th World AIDS Conference. Their conclusions are drawn from the largest multi-ethnic study to date of sexual behavior and attitudes among HIV positive men who have sex with men.
"Culture counts when the goal is to prevent the spread of the virus," said Cynthia A. Gómez, PhD, assistant professor of medicine at the University of California San Francisco Center for AIDS Prevention Studies (UCSF CAPS). Gómez is co-principal investigator of the Sero-Positive Urban Men's Study (SUMS), which in its first phase has surveyed 255 HIV positive men who have sex with men in New York City and the San Francisco Bay Area.
The cohort includes significant numbers of whites, African Americans and Latinos.
SUMS is a joint project of researchers at UCSF CAPS; Jersey City State University in Jersey City, N.J.; Rutgers University; and the Centers for Disease Control and Prevention in Atlanta, Ga. Nine presentations at Geneva are based on data from the study.
Gómez and her colleagues reported on SUMS survey data regarding unprotected sex. Participants were asked to recall encounters that involved unprotected sex in the past three months and in the past year before their interviews.
Gómez found that based on reports of the previous year, most sex behavior that might spread HIV did not differ significantly between African-Americans, whites and Latinos. But whites, for example, most often identified themselves as gay and reported a larger number of male sex partners than did Latinos and African Americans. Whites also were more likely to have oral insertive sex with men who were HIV negative or whose HIV status was unknown.
African-American men were more likely than either whites or Latinos to also report sex with women, to identify themselves as bisexual, and to be uncomfortable with their same-sex behavior. When recalling encounters within the past three months, African Americans and Latinos reported higher rates of unprotected anal intercourse with a partner whose HIV status was negative or unknown. Interviews suggested that both groups are less likely to consider oral sex as a substitute for penetrative sex.
The survey showed that 47 HIV positive men across all ethnic groups reported unprotected anal insertive sex with a male partner, though they knew the partner's HIV status was negative.
In one-on-one interviews with each man, surveyors determined that "These encounters usually were rare, and there were very few men who did not consider it an issue to have sex with a man whom they might infect," Gómez said. Often an HIV negative partner was willing, or even demanded to take the risk, she said. Even more often, drugs, alcohol or other factors limited the men's perceived sense of control over their behavior.
Gómez said a more worrisome statistic was that more than half the HIV positive men (132) had sex with partners whose HIV status was unknown. "We learned that people are not asking the question. Or both HIV positive and HIV negative men are making assumptions. An HIV negative man may assume, for example, 'Well, if he is willing to have unprotected sex with me, he must be negative.'"
For the first cohort of the SUMS survey, each participant joined in a semi-structured interview and filled out a detailed questionnaire to collect quantitative data. Information from both will be used to design intervention programs.
Interview data also contributed to refinements in the design of the quantitative survey, now being used to gather data from a second cohort of men, to include a significant number of Asians as well as the other three ethnic groups. Results are expected in 1999 from the full survey of 400 men.
The long-term goal of the SUMS study is to develop interventions, Gómez said, to help change perceptions about what is safe and about how much control men can exercise over their behavior, and ultimately to help them change behavior. Such interventions will have to be tailored to communities, she added. A message that strikes a chord with gay white males may not influence an African-American man who does not think of himself as gay, and therefore may not reach his female or male partners.
"It is critical to develop an intervention for HIV positive men that adequately covers the issues and that goes across communities. This has been a gap in primary prevention efforts," Gómez said. "We have focused a lot on service, but until now we've avoided giving help with behavior change due to fear of blaming the victim or stigmatizing HIV positive people."
NOTE TO THE MEDIA: At Geneva, six poster sessions and three abstracts report on data from the SUMS survey. The poster sessions will appear on Monday, June 29 (lead authors Gómez #14223, and Hoff #14176) and Tuesday, June 30 (Parsons #23405; Purcell #23137; Remien #23389 and Wolitski #23361). Lead authors of the abstracts are Halkitis, O'Leary and Stirratt.