Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Mo.D.1714 - Mo.D.1718

Mo.D. 1714
HIV RISK AMONG LOW-INCOME WOMEN:A CASE FOR ADDRESSING GENDER
ISSUES IN PREVENTION INTERVENTIONS
Crumble, Denise A.,* Wagstaff, D.,* Kelly J.,* Sikkema, K.,* Solomon, L.,* Anderon, E..*
Norman, A.,*" Mercer M.,*** Heckman,T,* Perry M.* *Medical Collee of Wisconsin,
Milwaukee, WI, USA;" Univ. ofVermont; **Virginia Tech; **Univ. ofWashington; *
Case Western Reserve
Objective: This study identified HIV risk factors related to characteristics of the sexual relationships of low-income urban women and related psychosocial factors.
Methods: Anonymous questionnaires were administered to 1268 adult women living in 18
inner-city housing developments in five US cities. Based on their self-reported behavior during the preceding two months, women were assigned to one of four risk categories: women
with multiple partners, women with one partner they believed or knew had engaged in
risky behavior (i.e., other partners or injected drugs), women with one partner they knew
or believed had not engaged in risky behavior, and women who had not had sex.The four
groups were compared with respect to the respondents condom use and related HIV risk
factors.
Results: Seventy-one percent were Afican-Aerincan, the mean age was 33.8. and on average the women had 3 children. Overall, 59% of the women were sexually active: 14% had
multiple sexual partners, 21% had a single risky partner, 38% were mutually exclusive, and
25% were riot sexually active. More than half of the women had been involved with their
primary partner for one or more years.Twelve percent had been treated for an STD within
the past two months. Condom use during the past two months was less frequent among
women with one risky partner than among those with multiple partners. In all, only 5% of
the women perceived that they were at considerable risk for HIV infection.
Conclusion: This study points to the need to consider the extent to which low-income
women may be at risk for HIV because of the behavior of a partner with whom they have
a long-standing relationship. Prevention programs for these women and their sexual partners need to pay attention to partner issues and focus on partner dynamics and imbalances
of power
Denise Crumble, CAIR, Medical College of Wisconsin, 1201 N. Prospect Avenue,
Milwaukee,Wl 53202, U.SA.Telephone: [phone], Fax: [phone]
Mo.D. 1715
PSYCHOSOCIAL DETERMINANTS OF HIV RISK REDUCTION BEHAVIORS AMONG
MEN WHO FREQUENT BATHHOUSES
Elwood, William N.,* Williams, M.L.,* Bowen, A.M." *NOVA Research Company Bethesda,
MD, USA; *University of Wyoming, Laramie, WY USA
Objectives: To describe the relationships between psychosocial determinants of sexuality
and the willingness to engage in HIV sexual risk reduction behaviors among men who have
sex with men and firequent bathhouses.
Methods: Forty-five men were recruited to participate in the study Participants were
required to have had sex at least once in a bathhouse during the six months prior to
recruitment. Candidates were recruited through advertisements in local newspapers and by
referral from men already participating. Initial screening for eligibility was conducted during
phone conversations. Data were collected using in-depth interviews and focus group sessions. Data were examined using a subective-objective analytical strategy
Results: Men who possess less salient AIDS risk reduction information and more negative
perceptions, attitudes, and beliefs about engaging in sexual behaviors that reduce the risk of
HIV infection are more likely to have recently engaged in risky sexual behaviors in bathhouses.The degree to which an individual was integrated into a social group as well as the
type of social bond (i.e., sexual versus friendship) were directly related to their attitudes,
knowledge, and beliefs about sexuality and HIV risk avoidance.The more socially isolated an
individual, the less likely he was to possess salient HIV risk reduction information, perceive
himself to be at risk, have positive attitudes about risk avoidance, or believe that infection
could be avoided. Furthermore, analysis showed that perceptions of sexuality were related
to willingness to practice risk reduction behaviors. Men for whom sexuality was a basis for
creating interpersonal relationships were more likely to possess salient risk reduction information and positive perceptions, attitudes, and beliefs about HIV risk avoidance.
Conclusions: Descriptions of HIV risk reduction behaviors engaged in by men who have
sex with men in bathhouses show a strong relationship between psychosocial determinants
and willingness to engage in risk behaviors. Men who are able to comfortably integrate sexuality into their self-perceptions or for whom sexuality was the basis for structuring relationships with others, were more likely to avoid high risk sexual behaviors or consistently
use condoms.The context of the bathhouse as a place for anonymous sexual activities was
found to strongly influence the HIV risk reduction behaviors of some men. Information
gained in this study can provide the basis for the development of HIV risk reduction interventions that target men who have sex with men in bathhouses.
WN. Elwood, 402 Tuam Avenue, # I, Houston, TX 77006, USA Telephone: [phone]
Fax: 301 I-986-4931 email: [email protected]
Mo.D.17 16
HIV/STD HIGH RISK BEHAVIOR SURVEYS - WHERE ARE THE GAPS AND WHAT
NEEDS TO BE DONE
B rackbill, Robert M., Anderson J E, Wald M. National Centers for Disease and Control and
Prevention, Atlanta, GA, USA.
Objective:To summarize the sampling methods, periodicity and data elements of behavioral
surveys of high risk HIV/STD populations and to identify gaps in the surveillance network. In
contrast to general population surveys, this report focusses on surveys that targeted high
risk populations, e.g. men who have sex with men (MSM), street youth, and drug users.
Methods: A search produced over 170 currently available published survey articles on
HIV/STD related sexual and drug-use risk behaviors. A flexible and updatable relational data
base of article contents, that included information on survey sampling, methodology scope,
and data elements, permits a comparative analysis.
Results: Ninty-four percent of surveys were local and 52% one-time (except for MSM), less
than 40% were i-epresentative.

Monday, July 8, 1996
Target popu, i,
% local
% one time
% representative seii,,

Adult Adoles
90
58
56

scentlouth MSM Drug users
83 100 100
75 22 62
25 44 29

All
94
52
39

Conclusion: Fo: the iost part, published data on high risk populations lacks methodological
rigor that would be reqr i:ed for monitoring HIV/STD iehavioral risks. Researchers need to
be made aware otf the importance of using sampling strategies that effectively increase survey representativeress. A national strategy is warranted for consistent survey collection to
develop an HIV/STD behavior surveillance network.
Robert M. Brackbill, CDC, I 600 Clifton Rd. E-44 Atlanta, GA 30329
Telephone: [phone] Fax [phone]; robl@acpsstd I.em.cdc.gov
Mo.D.1717
HIV-I INFECTION RISK AND BEHAVIOR CHANGE IN A COHORT OF THAI MEN
DURING AND AFTER MILITARY SERVICE
Renzullo, Philip I, Nelson K2, Celentano D2, Beyrer C2, Eiumtrakul S3, Garner R4, McNeil J 1
Khamboonruang C5.!WRAIR, Washin, Ion, DC; 2Johns Hopkins University, Baltimore, MD;
aRoyal Thai Army Chiang Mai,-hailand; SFATechnoloyres, Falls Church.VA; 5Chiang Mai
University Chiang MaiThailand.
Objective: To determine the seroconversion rate (SR).hanges in risk behavior and risk factors among male conscripts in the Royal Thai Army (R-A) during and after completion of
their mandatory two-year service.
Methods: The cohort was selected f6om among conscrpts who participated in a study of
HIV infection risk while in the RTA.Those who agreed to participate and returned for follow-up visits after discharge comprised the Ex-Service Cohort. Demographics, medical history STDs, and sexual history were surveyed at 6-month intervals during service and at 3,
9, and I5 months after discharge. HIV ser-conversion rates and 95% confidence intervals
were calculated over the 3 year period, during service and after discharge. Multiple regression techniques for repeated measures were used to determine relationships between
potential risk factors and seroconversion. Change in risk was evaluated based on deviations
from expected distributions of risk categories for sentinel behaviors. Differences were
assessed with chi-square analyses.
Results: A total of 546 (96.4%) men agreed to participate in the ex-service study Of these,
380 returned for visits after discharge from the RTA. No significant differences wereseen in
demographic, medical and behavioral variables between Ex-Service participants and nonparticipants. A total of 23 men seroconverted during the follow-up period, I 6 during military service and 7 after discharge.The overall SR and 95% confidence interval (CI) for the
cohort was 2.14/100 person--years (py) (Cl= 1.36-3.2 I1).The SR and 95% Cl for within and
ex-service periods were 2.56/100 py (1.46-4.15) and 2.01/1 00 py (0.8 -4. 13). Greatest
change in risk over time was seen with I) condom use with CSWs, girlfhiends and wives
and 2) alcohol use.
Conclusions: HIV seroconversion rates duinng and after service were not significantly different. Despite the similiar SR, significant increases in risk were reported with the use of condoms with sex partners and with alcohol use. Longitudiral studies can provide important
information on the maturing HIV infection epidemic in Taland, as well as on the evaluation
of interventions aimed at curbing the epidemic
Philip O. Renzullo, Preventive Medicine,WRAIR, I Taft Ct./Suite 250, Rockville, MD 20850
Telephone: 30 I -294- I 888 FAX 301-294- I 898 email: [email protected]
Mo.D. 1718
CHILDHOOD SEXUAL ABUSE PREDICTS HIV RISK SEXUAL BEHAVIOR IN ADULT
GAY AND BISEXUAL MEN
Jinich, Samuel, Stall R, Acree M, Paul J, Kegeles S, Hoff C, Coates TJ. Center For AIDS
Prevention Studies (CAPS), University of California, San Francisco; USA
Objective: I) To explore the prevalence of childhood sexual abuse with significantly older
partners among adult gay and bisexual men in two western cities in the United States. 2) To
compare the current sexual behaviors and HIV status of adult gay and bisexual men who
experienced sexual abuse as children to the sexual behaviors among men who did not
experience childhood sexual abuse.
Methods: Adult gay and bisexual men (n= I933) from two household-based and two bar
based samples were interviewed by telephone or by mai.Two methods were used to sample adult gay/bisexual men in Portland and Tucson in 1992: (I) a randomized time period
technique to recruit male patrons of gay bars; (2) a list-frame telephone sample of households to screen for households with resident gay/bisexual men.
Results: 32% of the men (n=626) reported childhood sexual abuse prior to age I 6 with
someone at least 5 years older than them.Those who experienced sexual abuse during
childhood were more likely to report riskier sexual behaviors as adults than those who
were not abused: 30% (vs. 20%, p<.000 I) reported unprotected anal intercourse in the last
30 days and 13% (vs. 8%, p<.01) reported unprotected oral sex to ejaculation with a nonprimary receptive partner Among those abused, 34% reported they had not been coerced,
while 31% were mildly coerced and 34% strongly coerced or physically forced. Whereas
21% of nonabused men and 25% of abused/not coerced men engaged in unprotected anal
intercourse with a nonprimary partner in the past I 2 months, a significantly higher proportion of men who experienced mild coercion (32%) and strong coercion or physical force
(36%) engaged in this practice, X2 (3, 1368) = 21.4, p<.O001. Men who were sexually
abused were more likely to be HIV + than those not abused (24% vs. 19%, p<.05).
Conclusions: The prevalence of sexual abuse in this popu ation was considerably higher
than studies have reported for the general male populaticn. Childhood sexual abuse contributes to the continued high-risk sexual behavior of gay rnd bisexual men particularly
among men who recall their experience as coercive.The next generation of HIV preventive
interventions requires that we develop interventions whica identify target, and support
young sexually abused gay and bisexual adolescents in order to focus on the psychosoal
impact of the childhood sexual experience and to provide psychoeducational experiences
to focus on underlying processes which, if not addressed, could lead to higher rinsk for HIV.
S. Jinich, 74 New Montgomery Street, Suite 600, SF, CA 941105, U.S.A.Telephone: [phone] Fax [phone] email: [email protected]

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