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

12th World AIDS Conference

Abstracts 23129-23133 367

23129 Understanding HIV risks of drug-using men who have
sex with men
Fen Rhodes1, S. Deren2, R.G. Carlson3, L. Cottler4, M.J. Stark5, E.Y. Lambert6,
R.T. Trotter II7. 1CSULB Center For Behav Research & SVCS 1090 Atlantic
Avenue, Long Beach, CA; 2National Development & Research Inst., New York
NY; 3 Wright State University, Dayton; 4 Washington University, Saint Louis MO;
5Multnomah County Health Department, Portland OR; 6National Institute on
Drug Abuse, Washington DC; 7Northern Arizona University, Flagstaff AZ, USA
Background: Drug-using men who have sex with men (DU-MSM) are at elevated
risk for HIV infection as a consequence of both high-risk sexual activities and
direct and indirect risks associated with drug use. DU-MSM have been shown to
be at substantially higher risk for HIV than persons who report either risk behavior
alone. In addition, a substantial percentage of DU-MSM are behaviorally bisexual
and may serve as a bridge for transmission of HIV to and from a variety of other
populations. Research is needed to understand the context and dynamics of risk
behaviors engaged in by DU-MSM and their implications for developing effective
HIV prevention interventions.
Methods: Individual structured interviews and focus groups were conducted
in six cities with 98 predominately street-recruited MSM who smoked crack or
injected drugs. Interviews assessed demographics, drug use, sexual activity, private/public sexual identity, and personal relationships. Focus groups explored the
context of and relationship between drug and sexual activities, and addressed
pertinent HIV prevention issues.
Results: 42% of DU-MSM identified publically as gay/homosexual; 35% identified publically (21% privately) as heterosexual. 51% had one or more female
sex partners in the past year. There was a high frequency of unprotected sex
during drug use and a distinct preference for having sex when high. Individuals
reported associating primarily with other drug users, usually MSM, and had limited
contact with non-drug users and with the traditional gay community. Among all
participants, drug use rather than sexual orientation formed the core of
Conclusions: These results confirm that there is a compelling need for specific
behavioral interventions to reduce the high level of HIV risk among street-based
DU-MSM. This is especially true in light of their ongoing sexual and drug-related
interactions with members of other populations. Such interventions must recognize the heterogeneity of DU-MSM in terms of drug use and sexual orientation
as well as the primacy of drug use in defining personal identity and their relative
isolation from the mainstream gay community.
23130 Improved antiretroviral treatment does not affect sexual
decision-making among the majority of men who have
high risk sex with men
James Dilley1, W. Woods2, W. Mc Farland2, J. Sabatino1, J. Rinaldi1, B. Adler1,
T. Lihatsh1. 1Univ CA San Fran AIDS HLTH PROJ; Box 0884 San Francisco CA;
2Center AIDS Prevention Studies, San Francisco CA, USA
Background: Recent advances in antiretroviral (ARV) treatments of HIV infection
have prompted concern that individuals at risk may reduce their commitment to
safer sex practices.
Methods: 93 men were recruited for a counseling intervention study when they
phoned to schedule an anonymous HIV antibody test. Participants were non-IDU,
had at least one previous negative HIV test, and had unprotected anal intercourse
(UAI) with another male within the last 12 months. The entire sample completed
a structured interview and a randomly selected subgroup (n = 47) was enrolled
in a counseling intervention that focused on cognitions at their last incident of
unprotected anal intercourse.
Results:
Table 1: Responses with regards to the availability of new ARV treatments

S23131 HIV prevalence and risk behaviour among male
transvestites in Jakarta, Indonesia
Imran Lubis', A. Manaf', S. Yasan', H. Abednego', S. Lazzari2. 1Directorate
General Communicable Disease Control & Environmental Health, Jakarta;
2World Health Organization, Jakarta, Indonesia
Objectives: To monitor changes in the prevalence of HIV-1 infection and to
identify risk factors for infection among male transvestites (waria) in Jakarta,
Indonesia.
Methods: A program of AIDS/STD peer education was conducted among waria
in several areas of Jakarta from 1993 to 1997 in an effort to reduce high-risk
behavior. As part of the program, demographic and risk factor information was
collected annually. A total of 15 waria leaders were trained to conduct behavioral
change activities. Every year, blood was collected unlinked anonymously from a
sample of participants and tested for HIV-1 (ELISA and WB) and syphilis (TPHA).
Results: An average of 500 waria (range 225-850) participated each year. The
mean age of participants dropped from 31 to 27 years during the study period.
Knowledge about HIV transmission did not change but perception of HIV risk
did, with 66% of participants perceiving themselves at risk in 1997 versus only
29% in 1993. Despite the more widespread perception of risk no reduction in
reported sexual behavior was reported: the proportion of waria reporting multiple
sexual partners remained stable at about 80%, the mean number of partners per
week increased from 2-4 to 5, with about 50% of them being foreigners, and
the percentage of those receiving payments during the last week increased from
66% to 84%. Only 29% of waria used condoms. The main reasons for not using
condoms were dislike and partner rejection. From 1993 to 1995, HIV prevalence
in a sample of participating waria remained low (from 0% to 0.3%). However, HIV
prevalence has increased to 3.1% in 1996 and 6% (90% C.I 3.3-8.7) in 1997.
From 1993 to 1997, the prevalence of syphilis increased from 35% to 52%.
Conclusions: Male transvestites in Jakarta report the highest risk sexual
behavior of any group in Indonesia and their HIV and syphilis seroprevalence
levels, the highest documented of any group in Indonesia, reflect this. There is
no evidence that existing AIDS/STD educational activities have been effective
in reducing their high risk behavior, although interpretation of survey findings is
complicated by the high turnover of participants. Additional specific and targeted
intervention programs are urgently required to prevent further spread of HIV in
this group.
27*/23132 Differential effects of multiple loss on safe sex
intentions and behavior in gay men
Theogm Sandfortt, E.M.M. Devroomel, J.B.F. Dewit2, W. Stroebe2, G.J.P. Van
Griensven3. Utrecht University; Gay & Lesbian Studies, Box 80140; 3508 TC
Utrecht; 2Utrecht University; Social & Organizational Psychology, Utrecht;
3Amsterdam Municipal Health Service, Amsterdam, Netherland
Objectives: Clinically, it has been suggested that the multiple losses within the
gay community might impair the motivation to have safe sex and promote sexual
risk behavior. The aim of this study is to see whether there is any empirical
support for this hypothesis in various subgroups of gay men.
Methods: Data collection via written questionnaires in 444 gay men (61% HIVand 39% HIV+, mean age 45), participating in the Amsterdam Cohort Study. Amsterdam is the epicenter of the AIDS epidemic in the Netherlands. Hypotheses
were tested in the total group, as well as specifically among men with only casual
sex partners and men with two or more symptoms of severe depression (GHQ).
The differential effect of HIV status was studied as well.
Results: Of the total sample of men, only 13% did not lose any friend or steady
partner to AIDS, while 35% lost 9 or more friends and/or steady partners. Degree
of loss is positively related to intrusive thoughts about AIDS. In the whole sample,
degree of loss is not related to safe sex intentions but negatively to actual risk
behavior, indicating that a higher degree of loss results in less sexual risk behavior
(r = -.11, p <.05). This effect is even stronger in the depressed group (n = 205;
r = -.16, p <.05), regardless of HIV status.
Among men with casual partners there is a differential effect of loss: among
HIV- men (n = 122) degree of loss is negatively related with the intention to use
a condom with casual partners (r = -.29, p <.001). Among HIV+ men (n = 33)
degree of loss is positively related to the intention to use a condom with casual
partners (r =.33, p <.06).
Conclusion: On a general level, multiple loss does not seem to promote unsafe
sex, directly nor indirectly via intentions to have safe sex. Overall, multiple loss
even seems to promote safe sexual behavior; in these cases multiple loss might
function as a cue to action. However, in HIV- men, multiple loss seems to weaken
the intention to use condoms with casual partners, which might result in unsafe
sex at a later stage.
26*/23133 Are youth and drug use risk factors among German
gay men?
Michael Bochow. Intersofia Kottbusser Damm 79 10967 Berlin, Germany

Objectives: Youth and drug use are often held to be responsible for risk behavior
among gay men. In light of the results of a survey conducted among gay men in
Germany, these hypotheses were reviewed.
Methods: In 1996, ten of the most important gay magazines in Germany circulated a self-administered questionnaire to their readers. A total of 3048 men
participated (17% from eastern Germany, 83% from western Germany). Risk

General Attitudes/Intensions
(n = 93)
I am much less concerned about
becoming HIV+
I am much more willing to take a chance
of getting infected when having sex
I have already taken a chance of
getting infected
I am less likely to get infected from a guy on the
new treatments than from a guy is not on them

% Cognitions at Last UAI
% (n = 7)
New treatments make
18 HIV manageable
I knew his viral load
8 was low
A guy on treatment is
11 unlikely to infect me
I'll take new treatments to
8 prevent my infection

The men whose behavior had been affected by the new treatments did not
report a greater number of partners, more past STD, less education, nor were
they more likely to report a primary partner who was HIV+.
Conclusions: The initial success of new ARV treatments has not reduced
concern about infection or the perception of risk of infection among the majority of
these men and most have not changed their sexual behavior as a result of recent
treatment successes. However, recent treatment advances are currently effecting
the sexual decision making for some men who have high-risk sex. Prevention
efforts must address the changes in risk perception that result from improvement
in the medical management of HIV disease.