Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

218 Abstracts 14177-14181

12th World AIDS Conference

Concordant Discordant
UAI with primary partner 56% 37%
UAI with non-primary HIV-/? partner 15% 28%
partners. For example, a respondent said, "I go outside of my relationship to
have sex, well, the way I li<e it." Another stopped using condoms with his primary
partner saying, "...I felt like I was some sort of specimen or something, that I had
to be covered in certain areas, to protect this person."
Conclusion: Risk for HIV transmission from HIV+ men in discordant relationships to their primary and non-primary HIV-/? partners is substantial. Sex with
HIV-/? partners is likely stressful for HIV+ men and may lead some men to rely on
dangerous prevention strategies. Prevention programs that target couples must
address risk with non-primary partners as well as risk within the relationship.
14177 1 The importance of social and family networks on safer
sex practices based on age
Roger Le Clerc, J. Otis, R. Lavoie, B. Turmel, R. Noel, M. Alary, A. Dufour.
'Cohorte Omega, 4205 Saint-Denis, 320 Montreal, Canada
Objectives: 1. Establish a link between the social and family network on safer
sex practices, 2. see the variations of these network's support based on age.
Methods: The Omega Cohort is an ongoing study aiming to assess HIV incidence and associated psycho-social determineants among MASM in the Montreal
area. Enrollment started in Octover 1996. Men complete a questionnaire and are
tested for HIV every six months. As November 30, 1997, 810 baseline interviews
(TO) and 431 first follow-us interviews (T1) had been conducted.
Results: With regular partners, safer sex practices are related with a less family
link*, a stronger family's confort with homosexuality", with a less soutien for the
family* and with the feeling that links with friends are important**. With casual
partners, safer sex practices are related with the feeling that quality links with the
family are importante*, with the fact that family is a stronger emotional et material
support**. There is no significative difference with friends.
Base on age, there is ro significative difference in the family's confort face to
homosexuality. Social network is more important than family network***. Family
is a more importante ressource (affective and utilities) for <29 than >30. <29
are used more often as confident by social network***, <29 wanted more support
(affective** and material*") from social network. <29 have the perception that
their social network is more confortable with homosexuality*.
Conclusion: The social and family network's influence on safer sex practices
is different regarding casual or regular sexual partners. Networks could play different role on safer sex practices on regard of the age. This point will be discuss
at the Conference.
14178 Sexual practices of HIV-infected persons at initial primary
care presentation and six months later
Jeffrey Samet', R. Hingson', J.B. Savetsky', L.M. Sullivan', M.D. Stein2.
SBoston University School of Medicine, Suite 200, 91 East Concord Street,
Boston, MA; 2Brown University School of Medicine, Providence, RI, USA
Purpose: Addressing unsafe sexual behavior is one role of primary care physicians. We examined the use of condoms among patients at both the time of
initiation of HIV-related primary care and 6 months later and determined factors
associated with unsafe sexual behaviors at follow-up.
Methods: We interviewed 203 consecutive outpatients on initial HIV primary
care presentation at two urban hospitals between 2/94 and 4/96, and reassessed
72% (146/203) six months later. Characteristics assessed at entry into care
included sociodemographic, clinical, substance use, social support and health
beliefs. At both baseline and follow-up interviews, we assessed sexual behavior
with the following questions: "Have you had sex with anyone within the last 6
months?" and "When you had sex with your partner(s), how often did you use a
condom?" We defined unsafe sex as having had sex within the past six months
and not always using condoms; safe sexual behavior was defined as not having
sex or having sex and always using condoms. Bivariate analyses were conducted
to assess predictors of unsafe sexual behavior at 6-month follow-up.
Results: Patient characteristics included: 26% women; 44% black, 29% white,
25% Hispanic, 2% other; 73% with highest yearly income <$16,000; 47% injection drug users; 20% gay/bisexual men; and median CD4 count 280/l. At
presentation, 49% of patients reported unsafe behavior and 51% safe behavior.
At 6-month follow-up, 20% reported unsafe behavior (29/146) and 80% safe behavior (117/146). No patient characteristic was significantly associated (p < 0.05)
with unsafe sexual behavior at follow-up including: age, gender, race, education;
HIV risk factors; substance abuse; social support or stress (Duke Social Support
and Stress Scales); depressive symptoms (CES-D); and CD4 count.
Conclusion: Unsafe sexual behavior occurred in half of HIV-infected patients at
initial primary medical care presentation and in one-fifth 6 months after initiation of
care. As no patient characteristic predicted subsequent unsafe sex, assessment
of sexual behavior should occur among all patients at follow-up.

14179 Feelings of attachment, alcohol and drug use in safe and
unsafe sexual encounters of bisexual men in Ontario,
Canada: An event-based analysis
Ted Myers, D. Allman, S. Bullock, C. Strike, L. Calzavara, M. Graydon,
M. Millson. HIV Studies Unit, University of Toronto 3rd Fl. 12 Queen's Park Cres
West, Toronto, Canada
Objectives: To compare the influence of personal characteristics, and contextual
aspects of the sexual encounter on safe and unsafe sexual events, across four
sexual partner types reported by behaviourally bisexual men.
Design: Cross-sectional telephone survey, purposive sample.
Methods: Behaviourally bisexual men (N = 1,314) were recruited to participate
in a province-wide 1-800 free-call telephone survey. Respondents were asked
questions about their personal characteristics, sexual identity/orientation, as well
as details of their sexual behaviour, feelings of attachment, attraction and alcohol
and drug use in safe and unsafe sexual episodes with regular and casual female
and male sex partners. Bivariate analyses using Chi-square and t-tests were
conducted prior to heirarchical linear modeling of these data.
Results: Of the 1,157 bisexual men who completed the event-based questions
1,023 reported at least one sexual event in the previous year. A total of 3,546
episodes were described (39% regular female, 15% casual female, 24% regular
male and 22% casual male sex partners; and of these 48%, 22%, 20% and 11%
respectively were unsafe). Age and sexual identity showed no association with
risk behaviour. Increased feelings of attachment were associated with decreased
safety in episodes with regular female (p =.001), regular male (p =.004) and
casual male sex partners (p =.01). Drug use had no influence in episodes with
female partners but was associated with decreased safety in sexual episodes
with regular male (p =.005) and casual male sex partners (p =.01). Alcohol
use was associated with an increased likelihood of safe events only with regular
female partners (p =.003). With casual female sex partners no the variables were
found to reflect differences in risk behaviour.
Conclusions: Findings suggest bisexual men exercise discretion in their sexual risk-taking. Feelings of attachment appear to contribute to unsafe sex across
both male and female partnerships, drug use operates to elevate risk behaviour
with male partners, whereas alcohol has little influence on behaviour. The findings
related to drug use in this study of bisexual men are not consistent with results
reported in previous event-based analyses that have been conducted with other
populations.
14180 1Recreational drug use among gay men in Sydney,
Australia: The normative role of drug use in gay social
and sexual identity
Stephanie A. Knox', Susan Kippax', P. van de Ven', G. Prestage2. 'National
Centre in HIV Social Research Macquarie University, Sydney NSW 2109;
2University of New South Wales, Sydney, Australia
Objectives: To examine the prevalence and patterns of recreational drug use
among gay men in Sydney, particularly the relationship of recreational drug use
to sexual practice and gay identity.
Method: 697 men from the Sydney Men and Sexual Health (SMASH) cohort
study were interviewed in 1996. Men were recruited to SMASH on the criterion
of having had sex with men, not on the basis of drug use. Responses, therefore
to questions on recreational/non-prescription drug use in the six months prior
to interview, provide some indication of the prevalence of recreational drug use
among gay men in Sydney.
Results: 78.3% of the men had used recreational drugs in the six months
prior to interview and 10.6% of all men reported injecting drugs. 54% of men
reported using one of the psychostimulants (eg. speed, ecstasy, cocaine), only
2.2% reported using heroin. Men who had recently used drugs were more likely
to be in full time employment than men who had not recently used (p =.004) and
60% of those who reported recent drug use were in managerial or professional
positions, compared with 50% of those who had not recently used drugs (ns). Men
who sought sexual partners at gay venues, dance parties and sex venues had
a significantly greater level of recreational drug use than those who did not seek
partners at such venues (p <.001). In contrast, there was no relationship between
level of drug use and seeking partners at parks, other public places or through
sex workers. Both the use of amyl nitrite and speed were positively correlated with
anal and esoteric sexual practices. Speed, however was specifically correlated to
seeking sexual partners at gay venues and events, (r=.23, p <.01), while amyl
nitrite was not related to seeking partners through gay venues and events (r =
03, ns).
Conclusion: A large majority of Sydney gay men have recently used drugs
and it appears that drug use is the norm for these men. The high socio-economic
status enjoyed by those men who have recently used drugs suggests that their
drug use is not associated with marginalisation. In fact drug use, particularly the
'party drugs' (eg. speed, ecstasy), appears to be related to sexual practice and
sexual involvement in gay community. This indicates that drug use is part of gay
sexual and social identity for many gay men in Sydney.

S14181 The importance of life skills in HIV/AIDS prevention
among young people and adolescents
Ronald Kamara. PO. Box 2886, Kampala, Uganda
Issue: The level of information and knowledge about HIV/AIDS in Uganda is ove
90%. Most people, including the youthand adolescents, know about HIV/AIDS,