[Final Program, International Conference on AIDS (4th: 1988: Stockholm, Sweden), Book 2]

6541

DETERMINANTS OF SAFER HOMOSEXUAL PRACTICES
Jane McCusker*, J Zapka*, A Stoddard*,
M Zorn*, C Morrison*, K Mayer**.

*Univ. of Massachusetts/Amherst, **Fenway Community
Health Center, Boston, and Brown Univ., Providence, RI.
Objective. To identify behavioral and psychosocial determinants of the adoption and maintenance of safer
sexual practices among homosexually active men.
Methods. 322 homosexually active males were enrolled
into a cohort study at a Boston community health center
from 1/1/85, and 294 (91%) were followed at least through
1987. Self-reported sexual practices assessed included
number of homosexual partners during the previous 6
months, receptive and insertive anogenital contact (RAG
and IAG). Multivariate modeling of sexual practices at
the most recent visit used independent variables measured at the initial visit.
Results. Of 238 men who were not initially monogamous,
16% had entered a mutually monogamous relationship by
the last visit. Predictors of monogamy included a lover
wi:th AIDS or ARC (p<0.05). Of those reporting initially
unprotected RAG or IAG, 61% had eliminated each practice
by the most recent visit. Variables which predicted
elimination of unprotected IAG were greater perceived
susceptibility to AIDS and no nitrite use (p<0.05).
Elimination of unprotected RAG was predicted only by
greater perceived efficacy of clinical interventions
(p<0.05).
Conclusions. Predictors of unprotected anogenital sex
are more clearly identified for IAG than for RAG, which
may indicate that IAG is more easily modifiable.

6542 ALCOHOL AND DRUG USE CHANGES AMONG HOMOSEXUAL
MALES: ASSOCIATION WITH SEXUAL BEHAVIOR
CHANGES
Jane McCusker*, A Stoddard*, J Zapka*,
C Morrison*, M Zorn*, K Mayer**.
*Univ of Massachusetts/Amherst, **Fenway Community Health
Center, Boston, and Brown Univ., Providence, RI.
Objective. To examine changes in drug and alcohol use
among homosexual men, and the relationship of these
changes to adoption of safer sexual practices.
Methods. 322 homosexually active males were enrolled
into a cohort study at a Boston community health center
from 1/1/85, and 294 (91%) were followed at least through
1987. Self-reported behaviors during the previous 6
months assessed at each visit included frequency of drug
and alcohol use, number of homosexual partners, receptive
and insertive anogenital contact (RAG and IAG). Associations were examined using dnivariate and multivariate
methods.
Results. Initial 6-month prevalences were: alcohol 91%,
marijuana 86%, nitrites 77%, and cocaine 57%. However,
reductions in drug use were much greater than for alcohol.
At the most recent visit, impairment during sex was repor--
ted by 34% of alcohol users and 27% of drug users. Drug/
alcohol users, regardless of impairment, were more likely
to report less safe sexual practices than non-users. Reduction in drug use and, to a lesser extent, in alcohol
use, was associated in general with adoption of safer
sexual practices over time, particularly safer IAG and
reduction in number of partners.
Conclusion. HIV risk reduction interventions among homosexual males need to target substance abuse as well as
sexual behaviors.

Notes:

6543 SAFER SEX GROUPS AS A WAY OF VALORIZING AND
ENHANCING NEW SEXUAL BEHAVIOUR.
0 Bergs?,M.D., G Pelh, M Pollak'"
*Health and Gay Pleasure (Sante et Plaisir Gai),.WC.N.R.S.,Paris, France.
Objective. Promoting safer sex and condom use among gay
and bisexual men as means of HIV prevention as well as
new way of sexual and affective pleasure.
Methods. February 1987: creation in France of a Jack Off
Club as in different cities around the world;organization
of regular collective safer sex meetings-no body fluid
exchange-.
Prevention activities include: monthly newsletter,
diffusion of leaflets about Aids prevention, free distribution of condoms, collecting funds for Aids research and
self-help groups.
Presently a survey is underway among our participants to
evaluate our activities.
Results. 8 Jack Off Parties organized in 1987:
200 participants per month;aroud 2000 people serviced by
diffusion of leaflets and newsletters; 14 000 F fundraising collected for Fondation pour La Recherche Medicale
and Association Aides.
Our survey will evaluate if our activities reach their
objectives: health prevention(adoption of safer sex on
a regular basis inside and outside the club), and
defining safer sex as a positive way of life.
Conclusion. Results of the survey will be presented
at the Conference.

6544 RISK REDUCTION AND SEROCONVERSION IN
A COHORT OF HOMOSEXUAL MEN
Brian Willoughby, MT Schechter, B Douglas, KJP
Craib, P Constance, M Maynard, et al.
The Vancouver Lymphadenopathy-AIDS Study, St Paul's
Hospital, University of British Columbia, Vancouver, CANADA
Objective. To measure the magnitude of risk reduction and decline
in seroconversion within a cohort of homosexual men.
Methods. Eligible subjects completed at least one visit during both
04/84-03/85 and 10/86-09/87, denoted V1,V2 respectively. Selfadministered questionnaire responses pertaining to numbers of
partners, anal receptive intercourse (ARI), and condom use in the
prior 12 months were compared at V1 and V2. At V2, distinctions
were made concerning regular (>1 contact/month) and casual
partners. Comparisons were stratified by serologic status at V1.
Actuarial methods were applied to seroconversions to estimate
annual rates from 1983-87.
Results. A total of 361 subjects were eligible (231 HIV-/130 HIV+).
The median interval between V1 and V2 was 29 months. The
annual number of sex partners declined significantly (median 8.0 to
5.0; p<0.001). Declines were not different in the HIV- and HIV+
groups. At V1, 28.1% of negatives and 16.9% of positives reported
never engaging in ARI in the prior year. At V2, these had risen to
45.3% and 35.6% respectively with regular sexual partners, and
74.5% and 36.9% with casual partners. The majority of subjects in
both groups (79.3% and 72.2% respectively) reported never using
condoms during ARI at VI. At V1, only 1.8% of negatives reported
usually (>60% of encounters) using condoms during ARI At V2,
this proportion has risen to 31.4% with regular partners and
63.8% with casual partners. Of positives, 0.9% reported usually
using condoms during ARI at V1. At V2, the proportion had risen to
51.1% with regular partners and 69.2% with casual partners.
Annual seroconversion rates in our entire cohort from 1983-87
were 3.9%, 9.8%, 7.3%, 4.1%, and 0.9%.
Conclusion. 1) Marked risk reductions have occurred although safe
sex practices are still not universal; 2) These reductions could
explain in part marked declines in seroconversions in this group
although closed cohort effect must be acknowledged;
3) Monitoring sex practices should account for the type of partner.

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