Objectives: To examine gay men's patterns of self-disclosure of HIV seropositivity to friends, lovers, relatives and colleagues; to assess the effects of disclosure; and to identify reasons for not disclosing to particular individuals.Design: Longitudinal questionnaire survey of gay men.Methods: A total of 163 HIV-positive men participating in the AIDS Behavioral Research Project, a longitudinal study of San Francisco gay men, completed questionnaires about their self-disclosure patterns, health status, and psychological well-being.Results: HIV-positive men were most likely to disclose their status to lovers and closest gay friends. Asymptomatic men were less likely to disclose to relatives and colleagues than symptomatic men. Friends and lovers were rated as responding more helpfully than relatives and colleagues. Men who perceived their significant others as responding more helpfully were less depressed and anxious currently and 1 year later. A variety of reasons were given for not disclosing, including not wanting to worry others, fear of discrimination, fear of disrupting relationships, and emotional self-protection.Conclusion: While disclosure can have advantages for both HIV-positive individuals and their significant others, HIV-positive individuals must be assured that the benefits of doing so will outweigh the potential costs.

As more gay men are tested for antibodies to human immunodeficiency virus (HIV), serostatus may influence the formation of primary partner bonds in this community. We compared seropositive (n = 157), seronegative men (n = 205), and those who had not been tested (n = 158) from our ongoing AIDS Behavioral Research Project (total response in 1988 = 540). Subjects responded to mailed surveys regarding sexual behavior, relationship status, HIV antibody testing and serostatus preference when forming relationships for romance and friendship. Sixty-eight percent of seropositive gay male respondents reported no serostatus preference in partners for romance, while 83% of seronegative respondents and 74% of untested respondents preferred seronegative partners for romance. In addition, 15% of seronegative respondents and 12% of untested respondents preferred seronegative individuals for friendship. Seropositive individuals were much less likely to be desired for romance or friendship by seronegatives and those who have not been tested--at a time when emotional support and companionship are obviously needed.

Employed data from two longitudinal surveys of gay men in San Francisco (a) to examine for cohort (Study 1) and attrition (Studies 1 and 2) bias effects on reported changes in condom use by gay men and (b) to investigate predictors of condom use (Study 2). Substantial increases in condom use were observed, and these changes were unrelated to attrition and cohort bias. In terms of predictors of condom use, men who always used condoms had higher levels of social support from informal sources of help, had more positive expectations that condoms would have positive interpersonal and personal consequences, and were more likely to be HIV positive than men who used condoms occasionally or never. The results are discussed in terms of their implications for HIV-prevention research.

Three groups of San Francisco bar patrons (heterosexual men, heterosexual women, and gay men) were compared on four sexual risk reduction strategies for AIDS: safer sex practices (particularly adoption of the use of condoms), reducing the number of sexual partners, taking the HIV antibody test, and determining the characteristics of a potential sexual partner. Heterosexuals reported fewer sex partners and were more likely than gay men to interview potential partners. Gay men were more likely to use condoms and the HIV antibody test than their heterosexual counterparts. These findings encourage the design of interventions that take advantage of shaping and reinforcing strategies already in use in each group, and suggest when it is necessary to teach new strategies.

Sexual risk for HIV infection was measured among heterosexual male and female and homosexual male bar patrons in San Francisco. High levels of sexual risk for HIV transmission were reported, especially in comparison to other samples of heterosexual and homosexual populations in San Francisco. Interventions must do more than communicate knowledge about the routes of HIV transmission, since these bar patrons demonstrated high levels of AIDS knowledge and concern, yet were also characterized by high levels of risky sexual behavior. The crucial question in the prevention of the continuing spread of HIV infections is not whether education should be used to modify risky behavior, but rather what kinds of education will prove effective in reducing behavioral risk for AIDS.

Predictors of unprotected anal intercourse were examined among 508 gay men in San Francisco. The cohort was recruited in 1983-84 at which time 49.8 percent of non-monogamous men (N = 435) and 71.2 percent of monogamous men (N = 73) reported practicing unprotected anal intercourse. Only 12 percent of non-monogamous and 27.4 percent of monogamous men reported these practices in 1988. The non-monogamous men who practiced unprotected anal intercourse in 1984 were more likely to be younger, to report that unprotected anal intercourse was their favorite sexual activity, to be low in perceived efficacy to change sexual behavior, to report that friends were more likely to engage in high-risk behaviors, to have less knowledge of health guidelines, and to be less depressed at that time. Non-monogamous individuals who in 1984 reported that unprotected anal intercourse was their favorite sexual activity were more likely to practice that behavior in 1988. Those who knew their serostatus as positive were less likely to report unprotected anal intercourse in 1988. These data infer that in order to modify AIDS-related high-risk behaviors, community risk-reduction programs be differentially aimed at young persons so as to increase personal efficacy about risk reduction, challenge peer norms, promote antibody testing, and eroticize safer sexual activities.

Prevention campaigns to reduce sexual transmission of human immunodeficiency virus (HIV) typically emphasize the initial adoption of safer sex techniques. We present data from a 5-year prospective study to show that the vast majority of resident gay men in San Francisco have made these initial risk reductions. Rather, relapse from safer sex techniques is now the predominant predominant kind of high-risk sex, accounting for approximately two thirds of all prevalent high-risk sex in the 1988 wave of data collection. Predictors of relapse from safer sex are identified, and these are discussed in terms of their implications for preventing relapse from the exclusive practice of safe sex. In communities that have already manifested widespread behavioral risk reductions and in which HIV infection is highly prevalent, finding ways to prevent relapse of behavioral risk reductions will be the next important challenge in the fight against acquired immune deficiency syndrome.

Beliefs about AIDS were surveyed among opportunistic samples of 1572 adolescents to compare four subgroups of youth: urban public high school students; suburban private school students; youth incarcerated in a detention facility; and a group who were contacted through a gay youth organization. The questionnaire items formed four important theoretical constructs derived by an expert group extensively involved with AIDS education. The constructs were: 1) agreement with health guidelines; 2) perceived personal threat of AIDS; 3) a sense of personal efficacy to prevent infection and the spread of AIDS; and 4) perceived norms of safe sex behaviors. In all groups, females were more likely to endorse higher norms for safe sex practices than males. Older adolescents of both sexes tended to perceive less personal threat of AIDS, and also rated lower norms for safe sex practices than did the younger adolescents. The incarcerated group of adolescents demonstrated significantly poorer knowledge and lower agreement with health guidelines (p = 0.0000), lower perceived personal threat of AIDS (p = 0.005), lower personal efficacy to prevent AIDS (p = 0.003), and lower perceived norms of safe sex practices (p = 0.0000), compared to the other groups. The education implications of these findings are discussed, including the necessity of program elements directed toward subculture peer norms and support, a realistic sense of vulnerability about AIDS, and self-confidence building as well as specific skills to prevent the infection and spread of the human immunodeficiency virus among adolescents.

We tested the impact of stress management training on sexual behavior and immune functioning in 64 gay men infected with human immunodeficiency virus (HIV). Subjects randomized to the stress management group met for eight two-hour sessions and one all day retreat to learn systematic relaxation, health behavior change, and stress management skills. Compared to those randomized to a wait list control, treatment subjects reported significantly fewer sexual partners in the prior month at post-test (1.10 vs 2.29 for controls). There were no differences between groups in lymphocyte numbers and function.

This article describes the association between drug and alcohol use during sexual activity and high-risk sex for AIDS. Data to test this association are drawn from a pros pective study of the behavioral changes made by gay men in San Francisco in response to the AIDS epidemic. Findings drawn from the May, 1984 and May 1985 waves of data collection are described. The cross-sectional analysis showed that use of particular drugs during sex, the number of drugs used during such activity, and the frequency of combining drugs and sex are all positively associated with risky sexual activity for AIDS. The retrospective data showed that men who currently abstained from com bining drug use with sexual activity were likely to have been at no risk for AIDS over two measurement points during the previous year. The men who currently combined drug use with sex were most likely to have a history of high-risk sexual activity over the previous year. These findings show a strong relationship between drug and alcohol use during sex and non-compliance with safe sex techniques to prevent the spread of AIDS. Implications of this relationship for AIDS health education efforts are dis cussed.

We surveyed 454 men in November 1983 and in May 1984 regarding their sexual practices during the month before the survey. In the 1983 survey, we also asked for reports about sexual behavior during the same month 1 year prior to the survey. The sample consisted of men recruited as they left bath-houses and bars, men who had not used bars or baths for meeting sexual partners for 2 months prior to the November 1983 survey, and men in committed primary relationships with another man. We found substantial changes in reported sexual behavior with persons other than a primary partner. The average number of male partners declined from 6.3 in November 1982 to 3.9 in May 1984. Receptive anal intercourse without condom declined from 1.9 to 0.7, oral-anal contact declined from 1.1 to 0.3, and swallowing semen declined from 2.8 to 0.7 in terms of the number of times that the respondent engaged in the act in the last month. These same changes did not occur in relation to sex with a primary partner. Only one variable, namely, increased length of time since the first homosexual experience, distinguished persons maintaining few sexual partners from those increasing the number of sexual partners from November 1983 to May 1984. Four variables distinguished those retaining high numbers of sexual partners from those lowering the number of sexual partners, namely, ability to remember a visual image of AIDS deterioration, age, relationship status, and length of time since first homosexual experience.

The authors convened a conference at the University of California, San Francisco, to provide a framework for developing health education programs to reduce high-risk sexual activity associated with the acquired immunodeficiency syndrome (AIDS). Operating on a consensus model, four groups of experts defined the sexual behaviors that place an individual at high risk for AIDS, the principles of health psychology that can be applied to health education programs for reducing high-risk sexual activity among gay men, the health education and media strategies that might be used, and the factors unique to gay men that need to be considered. We hope that these reports will not only provide a foundation for the discussion of health education strategies for reducing the risk of AIDS, but will also prove useful to local, regional, and national organizations in developing such programs.

AIDS and sexual behavior in gay men. H H HandsfieldCopyRight https://doi.org/10.2105/AJPH.75.12.1449 Published Online: October 07, 2011