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

362 Abstracts 23105-23110

12th World AIDS Conference

they will continue to get infected at alarming rates and risk transmitting HIV and
HBV to a variety of sexual and injection partners. Prevention programs for highest
risk youth should provide effective risk and harm reduction strategies that address
same-sex and opposite-sex sexual risks (regardless of stated sexual orientation),
injection drug use, and STD prevention.
25* / 23105 Negotiated safety and agreements between men in
relationships: Are all agreements equal?
June Crawford, P. Rodden, S. Kippax, P. Van De Ven. National Centre in HIV
Social Research, MacQuarie University, sydney NSW, Australia
Objectives: To assess agreements between men in regular relationships with respect to (a) the extent to which behaviour both inside and outside the relationship
is in accordance with the agreement and (b) the extent to which the agreement
and behaviour expose men and their partners to risk of HIV.
Methods: An Australian national phone-in survey of homosexually active men
conducted in late 1996. Sample size was 3039.
Results: Three groups were identified out of 1147 men in regular relationships
of longer than six months. Group 1 seroconcordant HIV negative (n = 787);
Group 2 discordant serostatus (n = 59); Group 3 unknown concordance (n =
310). Group 2 were older, and with lower income. Compared with Groups 1 and
2, Group 3 were less likely to live together; less likely to have agreements (65%
compared with 87%) and more likely to have casual partners (62% compared with
56.5%). Among men in Group 1, 68% had agreements representing 'negotiated
safety', 2.4% agreements representing safe sex always and only 13.5% had no
agreements. In Group 2, agreements were less likely and less likely to be 'safe'.
In Group 3, 47.5% had 'unsafe' agreements, only 26.9% had 'safe' agreements
and 25.6% had no agreements. Most behaviour (around 90%) was as safe as
or safer than that agreed to. Unprotected anal intercourse with casual partners
(UAIC) varied according to both Group and type of agreement. In Group 1, 5.6%
of those with 'negotiated safety' agreements reported UAIC compared with 15%
of those with no 'safe' agreement. Higher levels of risk practice both inside and
outside the relationship were found for men in Groups 2 and 3.
Conclusion: Men who know their own and their partner's serostatus are likely
to have agreements representing 'negotiated safety' and to act in accordance
with those agreements. Among serodiscordant couples risk behaviour within the
relationship is of concern; among those in relationships where serostatus of one
or both partners is unknown, risk behaviour outside the relationship appears
higher. The fact that such risk behaviour appears in many cases to be sanctioned
by an agreement suggests that these men may need to be targeted.
644* /23106 New therapies for HIV and sexual risk behaviour
among gay men in London, UK
Jonathan Elford1, Graham Bolding1, L. Sherr1, M. Maguire2. 1Dept. Primary
Care and Population Sciences, Royal Free Hospital School of Medicine,
Rowland Hill St., London; 2Lamden Isungton Community Health Services NHS
Trust, London, UK
Background: Concern has been expressed that highly effective combination
therapies for HIV may induce complacency among gay men regarding safer sex.
To investigate this we conducted a survey among gay men to examine their
beliefs about the impact of new drug therapies on infectivity and prognosis. and
the frequency of unprotected anal intercourse.
Methods: In September 1997, a baseline questionnaire was completed by
gay men attending one of 4 gyms in central London before the introduction of
an HIV prevention inititative (4 gym project). Men were asked if they had had
unprotected anal intercourse (UAI) in the previous 3 months, the HIV status of
their UAI partner and to what extent (a) they were less worried about HIV now
that treatments had improved (b) they believed new drug therapies made people
with HIV less infectious.
Results: Of 941 men participating in the survey, more than one third (338,
36%) were less worried about HIV infection since treatments had improved (298
"somewhat"; 40 "a lot"). Men who said they were less worried about HIV since
treatments had improved were more likely to report UAI (34%, 114/338) than
men who did not share this view (21%, 129/603) (p < 0.001). Knowledge of HIV
status of UAI partner did not differ between these 2 groups. Although 19% (180)
of men believed that new therapies made people with HIV less infectious (133
"somewhat", 47 "a lot"), this was not associated with frequency of UAI (26%,
243/941 overall)
Conclusion: More than one third of gay men said they were less worried about
HIV infection since treatments had improved. Those who said they were less
worried about HIV were more likely to report unprotected anal intercourse (UAI)
in the previous 3 months than those who did not share this view. Among gay men
beliefs about new HIV therapies may influence their sexual risk behaviour.
|23107 Condom usage by homosexual and heterosexual
relationships by bisexual men in Rio de Janeiro, Brazil

Monica Souza',2, R.F. Lago2, R.I. Moreira2, P.H.P. Longo2, J. Portella2,
N.M. Fernandes2, S.N.B. Silva2. 1Rua Presidente Dominiciano 150, Inga Niteroi
- Rio De Janeiro - CEP:2410-271; 2Projeto Praga Onze/HIVNET UFRJ Niterdi
RJ, Brasil
Objective: To investigate frequency of condom use in homosexual and heterosexual relationships by bisexual men participating in a HIV seroincidence study.

Methods: Projeto Praga Onze, the HIVNET site in Rio de Janeiro, Brazil, is
a prospective seroincidence study that started enrolment in July 1995. Inclusion
criteria for the study are male gender, age 18-50, HIV seronegativity and reported
homo/bisexual behavior. At each visit, participants are submitted to clinical and
laboratory evaluations, respond to questionnaires on sexual attitudes and receive
pre-and post-test counseling. The data analyzed in this abstract refer to answers
provided at the second (6 months) visit to the project site by participants who
referred having had sexual intercourse in the preceding six months with male and
female partners.
Results: Of the first 606 participants who returned for a second (6 months)
visit, 78 (12.9%) reported bisexual behavior. The table shows reported frequency
of condom usage during sexual intercourse with regular and casual male and
female partners according to sexual practice.
Sexual Practice Type of partnership
Regular Casual
Male partners
Oral 11% 55%
Active anal 58% 58%
Passive anal 7% 74%
Female partners
Oral 5% 4%
Anal 17% 20%
Vaginal 37% 76%
Discussion: These results indicate that despite intensive counseling and condom distribution, condom usage has not been incorporated into regular sexual
practice by the study population, particularly with their female sexual partners.
The development of educational strategies targeted to this population should be
a priority.
(Grant support FHI 01 - 35173-15)
1 23109 Increase in UAIC (unprotected anal intercourse with
casual partners) among Sydney gay men in 1996-97
Paul Van De Ven1, J. Crawford1, J. French1, S. Knox1, S. Kippax1,
G. Prestage2, A. Grulich2. National Centre in HIV Social Research, MacQuarie
University, Sydney; 2University of New South Wales, Sydney, Australia
Objectives: To examine current trends in UAIC among Sydney gay men.
Methods: Six monthly cross sectional surveys were conducted from February 1996. Gay men completed questionnaires at four locations (1 STD clinic,
3 gay venues). Questions were asked about practice of UAIC (with or without
ejaculation, and either insertive or receptive) in the six months preceding the
survey.
Results: The table below shows the total number of participants and the
percentages who reported any UAIC. Overall, there was a significant upward
trend (linear trend p < 0.001). Although the percentage of HIV negative men
who engaged in UAIC appears to have levelled out, a logistic regression analysis
provided no evidence for a significantly different trend according to serostatus.
Data from February 1998 will be presented.
Percentages of men who reported UAIC 'in the last six months'
Sample Feb 96 Aug 96 Feb 97 Aug 97
(N= 490) (N= 552) (N= 483) (N= 685)
Overall 14.9 19.9 24.0 26.1
(n= 161) (n= 114) (n= 147) (n= 204)
HIV positive 25.5 35.1 30.6 40.2
(n = 270) (n = 363) (n = 298) (n = 404)
HIV negative 9.3 16.3 21.8 20.6
Conclusion: In the period 1996-97, concurrent with the widespread adoption
of combination HIV therapies and viral load testing, there was a significant upward
trend in the percentages of Sydney gay men reporting engagement in any UAIC
'in the previous six months'. There were similar trends among both HIV positive
and HIV negative men. Data from February 1998 will be available to determine if
the trends continue at a fifth data collection point, into a third year.
23110 1 A comparison of HIV risk between gay men in Singapore
and Sydney
Paul Van De Ven1, G. Bishop2, R. Chan3, S. Koe3. 1National Centre in HIV
Social Research, MacQuarie University, Sydney, NSW, Australia; 2National
University of Singapore; 3Action for AIDS, Singapore
Objectives: To compare HIV risk between gay men in Singapore and Sydney.
Methods: During the first half of 1997, gay men completed similar short surveys
of sexual practices 'in the previous six months' at venues in Singapore (n = 514)
and Sydney (n = 1609).
Results: The men in Singapore ranged in age from 14 to 49 years (median =
27); those in Sydney from 15 to 79 (median = 34). As shown in the table below,

there were differences overall in the percentages of men who reported various
practices with regular (p <.001) or casual partners (p <.001), although there
was more missing data (coded as 'No such partner') for Singapore men. For the
reduced base of men who had anal intercourse, there were differences in risk
with casual (p <.001) but not regular partners (p =.33). A greater proportion of
Singapore men had any unprotected anal intercourse with casual partners, and