Epidemiologic Notes and Reports Self-Reported Behavioral Change Among Gay and Bisexual Men -- San Francisco

In August 1984 and April 1985, surveys of risk factors for human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) infections in gay and bisexual men living in San Francisco, California, were conducted (1). The surveys used a random probability sample designed to provide information about sexual practices of self-identified gay and bisexual men in San Francisco. The sample was drawn from telephone numbers listed with only male names. City census tracts were weighted according to the proportion of unmarried males residing in each tract.

Exceptional care was taken to identify appropriate respondents. Following a brief introduction about the survey, and after an assurance of confidentiality, each potential respondent was told, "We are interested in speaking with one group of people who are at highest risk for AIDS: men who have sex with other men or who identify themselves as gay or bisexual." The interviewer then asked, ". . . would you include yourself in one of these groups?" Those who responded positively were considered eligible and asked to participate. Among those eligible, 81.4% agreed to participate. A total of 500 men were interviewed in the August 1984 survey. In April 1985, participants from the original panel of 500 were randomly selected and telephoned. Of those contacted, 93.2% agreed to participate again for a total of 301 repeat interviews.

Results of the initial survey were used by the San Francisco AIDS Foundation to plan an educational campaign designed to encourage gay and bisexual men to avoid "unsafe" sexual practices. Practices defined as "unsafe" by the San Francisco AIDS Foundation included anal intercourse without a condom and oral sex with exchange of semen. These practices were specifically discouraged in advertisements that were placed primarily in gay newspapers.

Between August 1984 and April 1985, the proportion of gay and bisexual men who reported that they were monogamous, celibate, or performed "unsafe" sexual practices only with their steady partner increased from 69% to 81% (Table 1). Similarly, fewer gay and bisexual men reported having more than one sexual partner in the past 30 days. Similar changes also were noted for other "unsafe" sexual practices. Reported by SB Puckett, M Bart, San Francisco AIDS Foundation, LL Bye, Research and Decisions Corporation, J Amory, San Francisco Health Dept; Div of Health Education, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: The virus that causes AIDS (HTLV-III/LAV) is spread by sexual contact, needle sharing, and parenteral exposure to blood or blood products and from mother to child during the perinatal period (2). Groups concerned about reducing the transmission of HTLV-III/LAV, such as the San Francisco AIDS Foundation, are addressing certain practices of homosexual men that appear likely to facilitate the transmission of HTLV-III/LAV. Published reports have associated AIDS or HTLV-III/LAV infection with practices such as having multiple sex partners and participating in anal intercourse (3-6). Oral-genital sex has also been addressed as a practice which may facilitate virus transmission because HTLV-III/LAV has been isolated from semen (7).

The multiple and varied sources of information about AIDS and its presumed methods of transmission preclude attribution of behavioral change among homosexuals to any single source or educational intervention. The self-reported changes observed in these two telephone surveys are consistent with the aims of the campaign conducted by the San Francisco AIDS Foundation and those of similar efforts by other groups. Although the data are self reported, alterations in sexual practices appear to have occurred over a relatively short period of time.

These two surveys suggest that some gay and bisexual men in San Francisco have modified their sexual practices. They provide support for continued efforts to promote change in behaviors that may reduce transmission. However, the importance of any behavioral changes in reducing the risk within a high-risk population of acquiring AIDS must be assessed in relation to any change in the prevalence of HTLV-III/LAV infection within that population. In San Francisco, between 1978 and 1985, the prevalence of serum antibodies to HTLV-III/LAV among a selected cohort of gay men in the San Francisco City Clinic increased from 4.5% to 73.1% (8). If the prevalence of infection has increased as much among all gay and bisexual men in San Francisco, much larger changes in sexual practices will be necessary to achieve a substantial reduction of risk among those who remain uninfected. However, most communities probably have infection prevalences lower than those reported in the San Francisco cohort. In such communities, significant modification of sexual practices may have a greater effect on risk reduction. Modification of sexual practices is the main means available at present by which gay and bisexual men who are HTLV-III/LAV-antibody negative can reduce their risk of becoming infected.

Continued surveillance of behaviors that may result in the transmission of HTLV-III/LAV is essential for designing information and education campaigns and for evaluating the impact of those campaigns and may provide information permitting prediction of AIDS incidence.

References

1. Research and Decisions Corporation. Designing an effective AIDS prevention campaign strategy for San Francisco: results from the second probability sample of an urban gay male community. San Francisco, California: Research and Decisions Corporation, June 28, 1985.

2. CDC. Prevention of acquired immune deficiency syndrome (AIDS): Report of inter-agency recommendations. MMWR 1983;32:101-3.

3. Jaffe HW, Choi K, Thomas PA, et al. National case-control study of Kaposi's sarcoma and Pneumocystis carinii pneumonia in homosexual men: Part 1. Epidemiologic results. Ann Intern Med 1983;99:145-51.

4. Marmor M, Friedman-Kien AE, Zolla-Pazner S, et al. Kaposi's sarcoma in homosexual men. A seroepidemiologic case-control study. Ann Intern Med 1984;100:809-15.

5. Goedert JJ, Biggar RJ, Winn DM, et al. Determinants of retrovirus (HTLV-III) antibody and immunodeficiency conditions in homosexual men. Lancet 1984;ii:711-15.

6. Darrow WW, Jaffe HW, Echenberg DF, et al. Risk factors for HTLV-III/LAV seroconversions in a cohort of homosexual male clinic patients. Atlanta, Georgia: International conference on acquired immunodeficiency syndrome (AIDS), April 14-17, 1985.

7. Ho DD, Schooley RT, Rota TR, Kaplan JC, Flynn T. HTLV-III in the semen and blood of a healthy homosexual man. Science 1984;226:451-3.

8. CDC. Update: acquired immunodeficiency syndrome in the San Francisco cohort study, 1978-1985. MMWR 1985;34:573-5.

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