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

12th World AIDS Conference

Abstracts 23405-23409 423

cent of HIV+ women with negative partners and uninfected women with positive
partners report patterns of inconsistent condom use despite repeated HIV counseling. Prevention interventions should target the specific barriers to condom use
encountered by these serodiscordant couples.
23405 Sexual behavior among HIV seropositive
men-who-have-sex-with-men who frequent public and
commercial sex environments
Jeffrey Parsons1, P.N. Halkitis1, M.J. Stirratt1, A. O'Leary2. 1Jersey City State
College, 2039 Kennedy Blvd. Jersey City, NJ; 2Rutgers University, USA
Background: To examine sexual risk behavior in a sample of HIV seropositive
men-who-have-sex-with-men (MSM), and its relationship to frequency of going to
public sex environments (PSEs) and commercial sex environments (CSEs).
Methods: A sample of sexually-active, ethnically diverse, HIV seropositive
MSM residing in New York City or San Francisco were recruited from a variety
of venues to participate in the Seropositive Urban Men's Study funded by the
Centers for Disease Control. Participants were administered a quantitative survey
assessing frequency of looking for sex partners in PSEs (outdoor cruising areas
and parks) and CSEs (sex clubs and bathhouses), HIV sexual risk behaviors, and
alcohol/drug use during the past three months, as well as measures of sexual
sensation seeking and sexual compulsivity.
Results: Of the 235 men, 50% (n = 117) reported looking for sex partners
in PSEs and 44% (n = 103) reported looking for sex partners in CSEs at least
once during the past three months. Ethnic differences were identified, with Whites
more likely than Latinos or African-Americans to have looked for sex partners
in CSEs, (p =.002), but not PSEs. Significant differences in the frequency of
unprotected insertive anal sex with HIV+ partners with (p =.000) and without (p =.04) ejaculation were identified between those who had and had not frequented a
CSE. Similar differences in the frequency of unprotected insertive anal sex without
ejaculation with HIV- (p =.001) and HIV status unknown (p =.002) partners were
identified based on CSE experience. Trends were noted for differences in the
frequency of unprotected insertive anal sex with ejaculation with HIV- (p =.063)
and HIV status unknown (p =.057) based on CSE experience. No differences in
frequency of sexual risk behaviors were noted between those who had and had
not frequented a PSE. Those who report frequenting PSEs or CSEs also report
more use of alcohol (p =.026) and recreational drugs (p =.031) than do those
who do not frequent PSEs/CSEs. Men who report going to PSEs scored higher
on a sexual compulsivity scale (p =.012) and those who report frequenting CSEs
more than once a month scored higher on a sexual sensation seeking scale (p =.01).
Conclusions: Differences exist between HIV seropositive MSM who do and
do not frequent PSEs and CSEs to look for sex partners. Intervention strategies
targeting men who frequent CSEs should emphasize reducing unprotected anal
intercourse. The HIV risk reduction and education needs of these men requires
further study, but at a minimum, efforts should be made to recruit MSM for
intervention studies in PSEs and CSEs.
23406 1 The relationship between sex, drugs, and condom use
among men who have sex with men and also inject drugs
(MSM-IDU) in Denver
Sheana Bull, P. Piper, C. Rietmeijer. Denver Public Health 605 Bannock St.
Denver CO, USA
Objectives: MSM-IDU are currently the group at highest risk for HIV transmission in Colorado; little is understood about drug use and its relationship to sexual
behavior and condom use in this population. We conducted a survey among
MSM-IDU in Denver to better understand these behaviors and develop targeted
HIV prevention interventions in this population.
Design: Community-based survey in a purposive sample of MSM-IDU in Denver.
Methods: Survey data on sexual and drug risk behaviors were collected
through interviews with MSM-IDU; eligible participants had sex with men and
injected drugs within the past six months.
Results: Of 85 men interviewed to date, 46% report to have been high on drugs
for half or more of their sexual encounters. Different drugs appeared to be used
for different activities. For example, cocaine was preferred by 29% and methamphetamines by 20% as the drug of choice for "partying", while 40% identified
cocaine and 34% methamphetamines as the drug of choice for having sex; heroin
was not cited as a preferred drug for either of these activities. Over half (57%)
of the men indicated that sex used to be most important to them and they used
drugs to enhance the experience; only 35% of the sample indicate that this is still
the case. Conversely, 34% of the sample indicate that drugs used to take priority
over sex, or they always combined the two, and almost half (48%) of the sample
describe their current perspective on the relationship between sex and drugs in
this manner. Men most frequently indicated that they utilized condoms less while
high with non-main male partners; 43% of these men suggest that while they are
high they forget about condoms, and 36% state drugs allow them to overcome the

guilt they would feel for not using condoms. Despite inconsistencies in condom
use, 37% of men indicate that they believe needle sharing is placing MSM-IDU
at risk for HIV transmission; further exploration of data indicate this perception
is fostered by increased frequency of needle use necessitated by cocaine and
methamphetamine injection.
Conclusions: These data show that there is an important overlap between
sex and drugs for MSM-IDU that may not be as pronounced for other MSM

or other injection drug users. In addition, it appears that drug use increases in
importance over time in comparison to sexual desire. Such an overlap suggests
that HIV prevention strategies targeted at this group will have to develop effective
approaches to simultaneously reducing HIV risk from unprotected sex and drug
use.
123407 Fellatio continues to be associated with HIV infection
among female, streetbased sex workers with no history
of injecting drug use, in New York city
Joyce Wallace, J.I. Wallace, P.J. Alexander, S.R. Horn, A. Weiner, C. Montanez.
FROST'D: From Our Streets With Dignity, 369 Eight Avenue, New York, NY USA
Objective: To confirm the association between fellatio and HIV infection observed
in prior years.
Methods: Since 1989, FROST'D has counseled and tested more than 3,850
female sex workers for HIV, syphilis, and Hepatitis B. Counselors interview the
women about various aspects of their work and personal lives. Since 1991, we
have been offering food, clothes, sleeping bags, identification papers, and referrals for drug treatment, health care, public assistance, and shelter to our clients.
Since 1995, we have also been operating a needle exchange.
Results: In 1997, 50/404 women tested positive for HIV (12.4%), down from
36.2% in 1989. Injecting drug use continues to be an important risk tactor for
infection, and 21/128 (16.4%) of women with a personal history of injecting tested
positive, compared with 29/275 (10.5%) of non-injectors. 10/66 (15.1%) of women
with no history of injecting, but who had a lover who injected, tested positive,
compared with 2/38 (5.3%) of those who reported never having a lover who
injected. 7/52 (13.5%) with no history of injecting who mostly performed vaginal
sex at work tested positive, compared with 13/132 (9.9%) of those who performed
mostly fellatio, contradicting our data from 1989-1995 showing a greater risk from
fellatio (15.5% of those who performed mostly vaginal sex vs. 21.4% of those who
performed mostly fellatio tested positive). However, among women who mostly
performed fellatio at work in 1997, 8/97 (8.2%) of women who always used a
condom tested positive, compared with 5/32 (15.6%) of those who used condoms
inconsistently. Among those who always used a condom at work, 1/19 (5.3%)
who always used a condom with their lovers tested positive, compared with 5/52
(9.6%) of women who used condoms inconsistently with their lovers.
Conclusions: Performing fellatio without a condom continues to be associated
with HIV infection in our population. Programs that work with women who perform
fellatio on men infected with HIV, or whose HIV status is unknown, should strongly
encourage them to consistently use condoms for fellatio, as well as for vaginal
and anal intercourse, even when having sex with a lover.
23408 | AIDS risk among inner city pregnant and never pregnant
adolescents
Marie Talashek, A.C. Montgomery. University of Illinois at Chicago 845 S
Damen, M/C 802, Chicago, Illinois, USA
Objective: To compare pregnant teens and their never pregnant matched controls
on substance use, sexual practices, and violence.
Design: Longitudinal case control
Methods: Four cohorts of freshman girls in an inner city high school in the
USA were followed from 1 to 4 years to identify pregnancies. For each pregnant girl (183) a control (183) matched on age, cohort and ethnicity were also
interviewed. Developmental maturity and demographic and sociocultural control
variables were measured. Selected findings known to be associated with risk for
HIV will be presented. Subjects ranged in age from 14 to 19 years with a mean
age at conception of 15.8 years. Racial/ethnic backgrounds of the teens were
25% African American, 48% Puerto Rican, 20% Mexican, 2% Guatemalan, and
5% other Latino groups.
Findings: Pregnant girls were significantly more likely to have begun alcohol
use (13.6 vs. 14.5-yrs), drug use (14.2 vs. 15 yrs), and dating (13.5 vs. 14.2 yrs)
at an earlier age and to have boy friend gang members (31% vs. 16%) than were
never pregnant girls. Thirty-one percent of never pregnant girls were sexually
active. Pregnant girls were significantly less likely to have used condoms ever
(71% vs. 84%) or at first intercourse (44% vs. 63%) and more likely to have sex
without condoms (92% vs. 84%) than were never pregnant sexually active girls.
Conclusions: Findings indicate that inner city African American and Latino
females are at risk for HIV infection. While girls who have experienced pregnancy
have more risky behaviors many never pregnant adolescents are also at risk.
Programs are needed to decrease HIV risk among these high risk teens.
S23409 1 Correlates of risk behaviors among young and older men
who have affective and sexual relations with men (MASM)
in Montreal
Annie Dufour1, M. Alary2, J. Otis3, R. Parent4, R.S. Remis5, B. Masse2,
R. Lavoie6. 1CHA-Pavillion St-Sacrement 1050 Chemin Ste-Foy, Quebec, QC
G1S 4L8; 2Epidemilogy Group, Laval University Quebec QC; 3Department Of

Sexology, UQAM Montreal QC; 4Centre De Sante Publique De Quebec Quebec
QC; 5Dept. Public Health SC., U. Of Toronto Toronto ON; 6Action Sero-Zero
Montreal QC, Canada
Objective: To assess the characteristics associated with age (<30 y. vs > 30
y.) and risk behaviors during the previous six months (P6M) among MASM
participating in the Omega Cohort, Montreal, Quebec, Canada.