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

12th World AIDS Conference

Abstracts 23111-23114 363

this difference remained (in a logistic regression) after age differences between
the cities were taken into account.
Number of gay men who reported various practices with regular or casual partners

No such partner
No anal intercourse
100% protected anal intercourse
Any unprotected anal intercourse

Regular Partners
Singapore Sydney
148 (28.8%) 601 (37.4%)
76(14.8%) 115(7.1%)
124 (24.1%) 411 (25.5%)
166 (32.3%) 482 (30.0%)

Casual Partners
Singapore Sydney
178 (34.6%) 500 (31.1%)
121 (23.5%) 269(16.7%)
98 (19.1%) 584 (36.3%)
117(22.8%) 256 (15.9%)

Conclusion: Between Singapore (emerging, low HIV prevalence gay community) and Sydney (established, higher HIV prevalence gay community), there are
similarities and differences in gay men's sexual risk practices. Men in Singapore
are more likely than their Sydney counterparts to have any unprotected anal
intercourse with casual partners, both overall and based on those who have anal
intercourse. The difference remains after controlling for age effects, with clear
messages for sexual health and HIV prevention programs.
231111 Trends in high risk behavior in an open cohort of 600 men
who have sex with men in Sao Paulo, Brazil
Maria Amelia Veras1, J.R. Carvalheiro2, M.J. Spink3, A.D. Grangeiro2,
R.D. Stall4, E.S. Hudes5, N. Hearst5. 'Health Department of Sao Paulo, Rua
Cayowaa 2251 Apt. 112, Sao Paulo, SP 01258-011; 2lnstitute of Health, Sao
Paulo, SP; 3Pontificial Catholic University of SP, Sao Paulo, SP; 4Institute of
Health, Sao Paola, SF Brazil; 5University of California San Francisco, San
Francisco, CA, USA
Objectives: To examine patterns of AIDS risk behavior among a population of
men who have sex with men (MSM) in Sao Paulo, Brazil, and to compare trends
over time as measured by two methods.
Design: Open cohort analyzed in two ways: longitudinal follow-up of participant
enrolled in the first year; and serial cross-sections of new enrollees at baseline
from the same community.
Methods: "Projeto Bela Vista" began recruiting MSM from the metropolitan
Sao Paulo area into an open cohort with semiannual follow-up in August 1994.
Additional men were continually recruited from the same population using the
same recruitment methods to join the study; their baseline data thus constitute
a serial cross-sectional sample of the same population. Identical face-to-face
interviews and HIV serology were performed at each wave. Men who were HIV+
or injecting drug users were excluded from further follow-up and are not included
in baseline data presented here.
Results: By either method used, high risk behavior remained frequent in this
population. Reported rates of unprotected anal intercourse (UAI) were higher for
men followed in the cohort study who entered 8/94 (N = 77) or 2/95 (N = 103) than
for new recruits at baseline (p <.012 at 2/96). In contrast, temporal changes in
mean numbers of partners (not presented here) were similar using either method.
Cohorts connected by lines
Seria1 cross-sectlons marked by dots
60 -o
0 -
3o3
Aug94- Feb95- Aug95- Feb96- Aug96 -Percentage Practicing UAI
Conclusions: Differences may be due to greater willingness to disclosure
of stigmatized behaviors after repeated interviews, behaviors responses to new
knowledge of "safe" HIV status of partners, or other factors. Observed trends of
risk behavior in other populations may be similarly sensitive to the study design
used. Generalizations from any single design to the broader population must be
made with caution.
23112 HIV prevention programs must address environmental
influences to reduce risk behavior among young Asian
men who have sex with men
Kyung-Hee Choi, E. Kumekawa. Center for AIDS Prevention Studies 74 New
Montgomery St. #600 San Francisco CA 94105, USA
Objectives: To explore environmental issues affecting HIV risk among young
Asian men who have sex with men.
Methods: We conducted in-depth interviews with 51 individuals who were
knowledgeable about young Asian men who have sex with men (e.g., providers
from health departments and community-based organizations, bartenders, shopkeepers, gay Asian community leaders and members) using the Community
Identification Process, an ethnographic technique designed to identify hard-toreach populations and to develop HIV prevention programs for these populations.
The interviews were conducted in San Diego, Anaheim-Garden Grove, Oakland-Berkeley, and Seattle during May-September 1997. Study participants were
asked about the influence of the family, the general Asian community, and the
mainstream gay community on sexual risk among young Asian men.
Results: We found 6 environmental factors related to sexual risk among young
Asian men who have sex with men:

(a) cultural expectations of the parents (parental pressure to get married, have
children, carry on the family name and traditions, and not bring shame on the
entire family);
(b) family silence about sex (little communication about homosexuality because
of its personal, private, and sexual nature);
(c) stigmatization of homosexuality in the Asian community;
(d) the contrast between self-image and the ideal image of male beauty in the gay
community (e.g., a "glamour[ous], chiseled, healthy-looking White image"; the
"young, [with] blond hair with buff bodies");
(e) negative stereotyping of Asian men in the gay community (e.g., monogamous,
subservient, being the receptive partner in anal sex, and at low risk because
of the perceived low incidence of HIV in the population); and
(f) related emotional difficulties experienced by Asian men including negative
identity, low self-esteem, self-image, and self-worth, alienation, and depression.
Conclusions: The data suggest that future HIV prevention strategies must
consider the strong influence of environmental factors. These strategies should
be directed at the family, the Asian community, and the gay community with
programs such as family counseling, support groups for families with gay children, mass media campaigns to educate the community about sexual and ethnic
diversity, and forums to discuss homophobia and negative stereotyping of Asian
men.
123113 1 Application of a cognitive escape theory to a high-risk
drug use and sexual setting
Mark L. Williams', A. Bowen2, W. Elwood2. 1University of Wyoming Laramie
WY; 2Behavioral Research Group, USA
Objectives: To investigate the applicability of a cognitive escape theory to HIVrisky sex among men who have sex with men and frequent public bathhouses.
Methods: Thick descriptive data were collected from men who reported having
sex with men in a public bathhouse at least once in the past 6 months. In-depth
interviews and focus group data from 45 men in a large southern US city were
examined using an objective analytical strategy. Data were content coded by
categories derived from a cognitive escape model: perception of extremely high
performance standards; desire to engage in HIV-risky sexual behavior; stress
related to dissonance between desired behavior and perceived high performance
standards; releasing stimuli or settings; enactment of sexual scripts that include
risky behaviors; reinforcement of risky behavior; and episodic risky behavior.
Results: Data suggest that men who frequent public bathhouses perceive
extremely strong community norms prescribing unprotected anal intercourse and,
to a lesser extent, oral sex. Stress was evidenced as a heightened fear of succumbing to HIV disease; fatalism regarding ability to avoid infection; and doubts
regarding ability to completely forego penetrative sex or to continually employ
preventative measures. Cognitive disengagement from self-awareness of HIV
risk was achieved through alcohol and drugs use and/or by frequenting settings
that encourage sexual encounters. In an extension of the theory, men were able
to cognitively disengage from self-awareness by transference of responsibility or
through self-differentiation from perceived risk groups. Engaging in risky sexual
behaviors was found to be episodic, further supporting the relevance of a cognitive
escape model of HIV-risky behavior.
Conclusions: Men's decisions to engage in HIV-risky sexual behaviors while
visiting public bathhouses can be explained by a cognitive escape theory of
HIV-risky sexual behavior. Furthermore, it is suggested that, among groups
with strong, prescriptive social norms regarding HIV-risky behaviors, a cognitive
escape model may prove extremely useful for understanding the continued occurrence of HIV-risky sexual behaviors in the face of extensive HIV prevention
knowledge.
23114 Effect of HIV infection on the natural history of anal
human papillomavirus infection
Cathy Crit Chlow, S.E. Hawes2, J.M. Kuypers2, G.M. Goldbaum2,
K.K. Holmes2, C.M. Surawicz2, N.B. Kiviat2. UW HPV Research Group, 6
Nickerson St., STE 3 10 Seattle WA 98109; 2University of Washington, Seattle.
USA
Background: Human papillomavirus (HPV) is important in the etiology of anal
cancer and the immediate precursor lesions, high grade anal intraepithelial neoplasia. These lesions are common among men who have sex with men, especially
those with HIV or immunosuppression. Development of strategies for prevention
and treatment of these HPV-associated lesions requires an understanding of
the risk factors and natural history of HPV infection in these populations. We
undertook a study to identify risk factors for detection of prevalent and incident
anal HPV infection, and HPV persistence among a cohort of men with and without
HIV.
Methods: A longitudinal study was conducted among 287 HIV seronegative
(HIV-) and 322 HIV seropositive (HIV+) men attending a community based clinic.
Subjects regularly underwent an interview, examination, and specimen collection

for assessment of anal HPV and HIV DNA.
Results: Anal HPV DNA was detected at entry among 91.6% of men with, and
65.9% of men without HIV. HPV detection was associated with lifetime number
of sexual partners and recent receptive anal intercourse (HIV- men), decreased
CD4 count (HIV+ men), and recent anal warts (all men). Among HPV negative
men at entry, subsequent detection of HPV was associated with HIV, unprotected
receptive anal intercourse, and any sexual contact since the last visit (Odds Ratio