Final Program and Oral Abstracts [International Conference on AIDS (8th: 1992: Amsterdam, Netherlands)]

TuD 0542-TuD 054 7

TRACK D: SOCIAL IMPACT AND RESPONSE

TuD 0542 A TRIAL APPROACH TO REACHING GAY MEN
IN A MUSLIM COUNTRY.
Neal Jr., Richard B. Association Marocaine de Lutte Contre le
SIDA, Rabat, Morocco
Issue/Problem: Communicating information about avoiding HIV infection to men who
have sex with other men is perceived to be difficult if not impossible due to
negative societal reactions to homosexual activity and the lack of a visible gay
community.
Description of Project: A trial project was set up that included going to a
popul]ar cruising area in the city in order to distribute information and condoms,
To facilitate communication, homosexuality was never discussed in terms of personal
behavior and personal questions were never posed. The telephone number of a local
AIDS service organization was also given out, and contacts were encouraged to call
if they had questions.
Results: Given the atmosphere of anonymity and the willingness to talk with the
men as they were cruising for sexual contacts, contact was easily made, usually
resulting in discussions lasting up to an hour; an average of three men were
contacted per night. By the end of the trial period, one of the contacts expressed
an interest in continuing the project in cooperation with the local AIDS service
organization.
Lessons Learned: Perspectives will be shared on the possibilities of reaching
gay men despite a situation where the existence of homosexual activity is not
widely recognized. Strategies will be discussed for going directly to the
population with information and focusing on HIV prevention as they would with any
other group.
Neal Jr., Richard B,, Corps de la Paix, I rue Benzerte, Rabat,
Morocco; Telephone (212) (07) 70-60-20.
TuD 0544 STAGING SEXUAL BEHAVIOR CHANGE AMONG
MEN WHO HAVE SEX WITH MEN BUT DO NOT GAY IDENTIFY. Rietmelier. Cornelis;
Davis, T; Martindale, C; Kane, M; Cole, V; Schnell, D*, Cohn, D. Denver Disease
Control Service, Denver, CO, and *Centers for Disease Control, Atlanta, GA, USA.
Obectives; To evaluate stages of behavior change (SBC) in a community-based intervention program for
men who have sex with men but do not gay Identify (MSM).
Methods: Based on principles from different behavior-change theories, a community-based intervention has
been developed to promote safe-sex behavior among MSM. Peer-volunteers and the use of role-model
stories are instrumental in this program. Multiple pre- and post-intervention, cross-sectional data collections
are conducted to evaluate SBC as an outcome measurement of the intervention. Since the program is
designed to induce behavior change 'step-wise' along the spectrum of SBC, repeated SBC measurements
will also be used to direct specific interventions. For condom use during anal and vaginal sex with main and
other partners, SBC are defined as follows: ore-contemolation (Pre-C): no intention to change, contemplation
(Cont): planning to change in the future, ready-for-action (RFA): just starting to change, action (Act):
consistent change for less than 6 months, maintenance (Maint): consistent change for more than 6 months.
Results: Pre-intervention evaluations were completed for 117 MSM.
N Pre-C (%) Cont (%) RFA (%) Actn (%) Maint (%)
Anal Intercourse
Main Partner 51 47 33 4 0 16
Other Partners 115 17 34 17 1 31
Vaginal Intercourse
Main Partner 64 56 33 5 0 6
Other Partners 117 38 34 14 2 12
Conclusions: Dependent on the type of partner and sexual practices, safe-sex behavior (defined as either
action or maintenance) occurs in less than 30% of this group of men. Since MSM are highly closeted,
community-based Interventions may be the only way to effectively change their sexual behavior. Given the
high percentage of MSM in pre-contemplative and contemplative stages, intervention strategies in our MSM
communities must focus on contemplative and ready-for-action messages.
Cornelis A. Rietmeijer, M.D., M.S.P,H.
605 Bannock Street
Denver, CO, 80204-4507 USA. TE1 [phone] Fax [phone]
TuD 0546 REACHING OUT TO GAY BARS AND DISCOTHEQUES AS A MEAN OF AIDSPREVENTION: THE SAFE SEX PROMOTION TEAMIS. Stoppelenburg, Eric;
Stichting Aanvullende Dienstverlening, Amsterdam
Issue/Problem: In gay bars and discotheques distribution of printed material such as
posters or leaflets, as a prevention strategy has its limitations. Are there ways to
affirm the social norm of having safe sex more effectively? And is it also possible
to give gay men peer support about the coping strategies necessary for keeping up
safe sex?
Project description: In bars, discotheques and also gay saunas the four different
Safe Sex Promotion Teams present a theatrical performance which stresses the importance of having safe sex. After the performance the teammembers have conversations
with the visitors about the safe sex guidelines and the situations in which it can
be difficult to keep up safe sex. Leaflets, condoms and lubricant are distributed as
promotion material.
search. In 1991 the second, more professional, version of the promotion teams had its
premiere. Until february 1992 there had been 117 performances. The teammembers had
had 1550 conversations with visitors about safe sex. They had distributed over 8000
packets of promotion material. The far majority of gay men experience the perfommances and the talks as informative and supportive.
Lessons learned: The professional quality of the performance is essential to stimulate safe sex as positive and appealing. It is also very important to match a team
with the locations at which it is aimed. For instance: an erotic team for the
leather scene and a trendy team with a dance act for discotheques.

OUTCOMES OF A 16-CITY RANDOMIZED FIELD
TRIAL OF A COMMUNITY-LEVEL HIV RISK REDUCTION INTERVENTION. Kelly,
Jeffrey A.*; Sikkema, K.J.*; Winett, R.A.**; Solomon, L.J.***;
Roffman, R.E.****; Kalichman, S.C.*; Stevenson, L.Y.*; et al. *Med.
College of WI,**VA Polytechnic Inst.,***U of Vermont,****U of Wash.
Obiectives: This project reports on a randomized, multicity field trial of a community-level HIV
prevention model shown promising in earlier research for producing population-wide risk behavior
change. Gay men in 16 small, isolated U.S. cities were studied, and the intervention tested a diffusion of
innovation/peer influence model to change community risk-taking norms.
Methods: Baseline risk behavior surveys were conducted with about 4,500 men patronizing gay bars in 16
small cities throughout the United States. Baseline results confirmed high initial levels of risk behavior,
with 40% of respondents reporting unprotected anal intercourse in the past 2 months. The cities were then
randomly assigned to intervention and comparison conditions. In each of the 8 intervention cities, small
cadres of persons well-known, liked, and popular with gay men in their city were identified, trained over
a 2-month period, and then enlisted to talk to friends and serve as risk reduction encouragers, endorsers,
and trend-setters. In the comparison cities, AIDS education materials only were widely disseminated in
gay clubs. Large-scale population surveys of bar patrons were repeated in all 16 cities three months
following completion of the intervention in the experimental cities.
Results: In the 8 cities which received the experimental intervention, there were systematic reductions in
population risk behavior from baseline to postintervention; decreases from baseline averaged -20% to
-25% in the proportion of men who had any high-risk sex, with corresponding reductions in frequency of
risk behavior. Little change occurred over the same time period in the comparison city populations.
Conclusions: Peer influence and diffusion intervention models appear effective for inducing or
accelerating population-wide risk behavior change. This cost-effective approach seems useful for
community level interventions with other populations including those in developing countries.
Kelly, Jeffrey A., Dept. of Psychiatry & Mental Health Sciences,
Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee,
WI 53226. Telephone: [phone], FAX: (414) 287 - 4683
TuD 0545 SUSTAINING SAFE SEX OR RELAPSE: GAYMEN'S
RESPONSE TO HIV. Kippax, Susan, Dowsett, G.W., Davis, M., Rodden, P.
and Crawford, J. Macquarie University AIDS Research Unit, School of
Behavioural Sciences, Macquarie University, NSW 2109, Australia
Issue/Problem: The sustaining of safe sexual behaviour is of concern with respect to
the prevention of HIV. This issue is explored with reference to a volunteer sample
of men who have sex with men who took part in a longitudinal study.
Description of Project: The sexual practices and safe sex strategies of the men were
investigated in 1986/87 and again in 1991. The accuracy of the men's knowledge of
HIV transmission, the degree of their contact with the AIDS epidemic and their
attachment to and engagement in gay community, as well as their HIV antibody status
were also noted.
Results: The data indicate that the majority of men sustained the changes they had
made to their sexual practices in 1986/87 in response to the threat of AIDS. In
general, their sexual behaviour was safer in 1991 than in 1986/87. Although men
occasionally engaged in unsafe practices, this does not necessarily indicate relapse
Unprotected anal intercourse was practised regularly by some men, but in almost all
cases with partners of the same HIV antibody status. The predictors of a variety of
safe sexual strategies are discussed with reference to notions of "relapse" and
"maintenance".
Kippax, Susan, Macquarie University AIDS Research Unit, School of
Behavioural Sciences, Macquarie University, NSW 2109, Australia.
Telephone (61) (2) 805 8059; Fax (61) (2) 805 8112

TuD 0547 uP, us 9 uina.liao sai aue u
6"lY JUl, -UIT'Y I..I"Lcu.,,I;l.,. iKavi, Ashok-:ow,
Jhair-pcrson, Editorial Coliective,:omnbay iost.
Issue: The howosexual co.imunity in Bombay has tasen an initiative in
developing a safer-ex ednucatioal inteievenion utin2 peert ioup
counselling services.The paper ad-resses the groblems in a country
where homosexuality is officially decried:aid the condom is heavily
prooioed as a faily planning device.
Description: In 1989, a 100 honos xuals in ooauay/s-une were surveyed
for their awareness of HIi/AlDS and safer-sex. A 24-page quarterly
newsletter/magazine titled 'owsbay nost' s tated publication in June
1990 with a circulation of 2,000. it was published in _nglish and
Hindi. *orkshops were held in local hotels.It was found that most imien
had problems with condoms. hlence educational c1a.Jaign to sensitise
the com;munity. Through rass-o3ot experiments, condom-use flaps were
pre-tested and appropriate one Oveioped for Indian sensitivity.!he
educational cmampaign discovered that existing condoms were unsuitable
for wale-male sex. Condoms which aere thicker and with more lubricant
were pre-tested and developed.
Results: The ongoing experience indic.tes ahat prograrnimes must be
comm::unity-based interventions to be effective. It also suggests that
special condoms way be necessary for male-nale sex and discusses a
practical process throu h which a grass-roots intervention amongst
homosexuals in Asian countries can be daveloped.

Stoppelenburg, Eric, Stichting Aanvullende Dienstverlening
le Helmersstr.17, 1054 CX A'dam: 020-6853331 Fax:[phone]

havi, Ashok-Row. &hair-person,.oabay host.
i'lat 10, niviera soop HousinG Society. 15th.ioad,:oantacruz(,,est), B.BAY 400W,0511.; 646 3590
91. 2.6L40.01 28

Tu36