"Due, in part, to changing attitudes about safer sex because of the successfulness of HAART, huge increases in risky behavior by gay men are going on everywhere, not just in the gay meccas. But we have found that an intensive community building intervention based on theories of empowerment, diffusion, and peer mobilization can reverse this trend by giving young gay men the means to establish healthy communities that provide intimacy, validation, and peer support for safer sex," said study author, Susan M. Kegeles, PhD, UCSF professor of medicine and associate director of UCSF's CAPS.
"With AIDS deaths down dramatically-and along with that, visible reminders of the deadly consequences of AIDS-just handing out condoms or discussing safer sex is not going to do the job. You need to establish places that are not gay bars or cruising areas where young gay men can create a community that supports them in all aspects of their lives," said Kegeles who will present the findings at the XIV International AIDS Conference in Barcelona, Spain.
The baseline data for the study were collected in 1996, prior to widespread HAART use, from gay men ages 18 to 28 recruited from gay bars and social networks and through advertising in Albuquerque, New Mexico, Austin, Texas, and Phoenix, Arizona. They were surveyed independently of the intervention in 1996 and then again in 1998/1999 with additional men recruited for the follow-up survey. Unprotected anal intercourse (UAI) with a non-primary partner was the measure for risky sexual behavior. Twenty-eight percent of young gay men in Albuquerque, 23% in Austin and 25% in Phoenix reported UAI in 1996.
A peer-led community-level HIV prevention intervention consisting of five components was implemented in Albuquerque for 12 months in 1997-98. The components were a young gay men's community center, informal outreach conducted among friends, formal outreach conducted at gay venues and social events, small peer-led groups that teach safer sex through discussions about dating and relationships and that encourage the participants to assist in community building and a small publicity campaign about the project.
In 1999, 33% of young gay men in Austin reported unprotected anal intercourse, a 42% increase from baseline. In Phoenix, 32% reported UAI, a 26% increase. In Albuquerque, the intervention city, 24.5% reported UAI, a 12% decrease.
Study co-authors are Greg M. Rebchook. PhD, research psychologist, the late Robert B. Hays, PhD, research psychologist, and Lance Pollack, PhD, research specialist, all at UCSF's CAPS.
The study was funded by a grant from the National Institute for Mental Health.