The number of gay men having unprotected anal sex is increasing dramatically, according to researchers at the University of California, San Francisco. A study of more than 500 young gay men in San Francisco revealed that the prevalence of unprotected anal sex rose by a third to a half in just four years. Furthermore, about half of the men having unprotected anal sex had partners of unknown or different HIV status. The results are published in the current issue of the journal AIDS.
"Occasional high-risk sex has now become pervasive among gay men in San Francisco," said Maria Ekstrand, PhD, research psychologist, UCSF Center for AIDS Prevention Studies at San Francisco General Hospital Medical Center and lead author of the study. "It is apparent that many gay men find it difficult to maintain safe sex practices over the long haul. Prevention efforts must address this problem."
The researchers followed 510 gay men, aged 18 to 29, who were identified for the San Francisco Young Men's Health Study (SFYMHS) in 1992. The participants were tested for HIV and filled out a self-administered questionnaire on numerous topics related to HIV and sexual behaviors during each study year between 1993 and 1997.
During the first study year, 37 percent of the participants reported having unprotected anal intercourse. By the fourth study year, this number had increased to one half. Sixty-eight percent reported having unprotected anal sex during at least one of the four years studied.
Men who didn't know the HIV status of their partners or had a dissimilar status were considered to be at high risk of transmission. This group made up nearly one fourth of the total sample during the last year of the study. Compared with men who had the same HIV status as their partners or who practiced safe sex, the men in the high-risk group were significantly more likely to be HIV positive, have greater numbers of sexual partners, and have more frequent sex, said Ekstrand. In addition, only 32 percent reported having disclosed their HIV status to all of their anal sex partners.
"People who are sexually adventurous are pushing the envelope," said Ekstrand. "They're engaging in high-risk behavior and aren't talking about their HIV status with their partners."
The reasons for having unprotected sex differed among the different transmission risk groups. Men who shared the same HIV status as their partners were significantly more likely to say they had unprotected sex because they were in love. The high-risk group reported they had unprotected sex because condoms were unavailable, they were turned on, or they had been drinking or using other drugs. This group was also more likely to use nitrate inhalants, or "poppers," to enhance their sexual experience.
"Sexual expression is highly valued in the gay community," said Ekstrand. "Gay and bisexual men have had to curtail their sexual behaviors as a means of both individual and community survival. Compared to groups who have had to make other health behavior changes, they have done a tremendous job. But different psychological and social issues make it difficult for them and as a result, some men report feeling discouraged to the point of doubting that they'll ever be able to practice safe sex consistently."
The researchers speculate that a need for sexual expression combined with the effectiveness of protease inhibitors may have created a popular perception of AIDS as a manageable chronic disease rather than a deadly epidemic.
"Gay men might think it's not that bad to become infected with HIV these days, but in spite of treatment advances, it's still a big deal," said Ekstrand. "Many of these young men have a lot to lose by getting infected."
New combination therapy treatments don't work for everyone, and for some men, they result in terrible side effects, said Ekstrand. The emergence and spread of resistant strains of HIV is also a danger.
Although rates of new HIV infection in San Francisco have remained stable at two percent a year among 18 to 29 year-old gay men, the researchers worry that an increase in risky sexual behavior will result in higher rates of HIV infection. Already, several US cities have reported an increase in rectal gonorrhea, including San Francisco.
"We want to go back to the community with our findings before HIV rates follow suit," said Ekstrand. "Unless we can find ways to help gay men devise practical and long-term HIV prevention strategies, ongoing HIV infection will remain a permanent problem among gay male populations."
In addition to Ekstrand, co-authors of the paper include Ron Stall, PhD, UCSF associate adjunct professor of epidemiology and biostatistics; Jay Paul, PhD, UCSF psychologist in medicine; Dennis Osmond, PhD, UCSF associate adjunct professor of epidemiology and biostatistics; and Thomas Coates, PhD, director of the UCSF AIDS Research Institute (ARI). All authors are affiliated with the UCSF Center for AIDS Prevention Studies of the UCSF ARI.
NOTE: A copy of the AIDS journal article in PDF format can be found at www.aidsonline.com under the latest issue icon.
Journal
AIDS