UCSF Researchers Seeing Increased Rates Of Unprotected Sex Among San Francisco Gay Men

June 30, 1998

Geneva, Switzerland -- Half of the young gay men who participated in a University of California San Francisco study were engaging in high-risk sex activities, many with a partner of differing or unknown HIV status.

Research findings showed unprotected anal intercourse among young gay men has increased by 50 percent since 1992, said Maria Ekstrand, PhD, a research scientist with the UCSF Center for AIDS Prevention Studies, in a presentation today (June 30) at the 12th World AIDS Conference.

In a related presentation today, Dennis Osmond, PhD, UCSF associate professor of epidemiology and biostatistics, reported that this increased risk behavior has not yet led to increased rates of infection. The rates are high enough, however, to lead to substantial numbers of infected gay men as they get older. Both presentations are based on an ongoing research project called the San Francisco Young Men's Health Study. Osmond is the principal investigator.

As part of this project, Ekstrand, Osmond, and their colleagues annually surveyed 510 gay or bisexual men from 1992-97. All the men were between the ages of 18 and 29 in 1992. The men responded to questions about their HIV status, sexual behaviors, alcohol and drug use, their thoughts and feelings about the AIDS epidemic and their last instance of unprotected intercourse. The researchers found that in 1996, 51 percent of respondents had either insertive or receptive unprotected anal intercourse, up from 37 percent in 1992.

"We found these increases very alarming," Ekstrand said. "We didn't start out looking for this. Usually when a group of men is followed over time their risk goes down, because the questionnaire itself is an intervention, causing the respondents to reflect on their sexual behavior on a regular basis."

Less than a third of the men reported having no instances of unprotected anal intercourse since 1992. The researchers found that men who reported unprotected anal intercourse with a partner of different or unknown HIV status had significantly more sex partners, were more likely to be drinking, and were more likely to report being "too turned on" to stop and find a condom. Those having unprotected sex only with partners of the same HIV status were significantly more likely to say they had unprotected sex because they were "in love." The researchers first noticed an increase in unprotected sex as they looked at the responses to the 1995 questionnaire.

Ekstrand speculated on several reasons for the increases. Men might be burning out, she said, and getting tired of years of practicing safe sex. They may feel the AIDS epidemic is over, or that if they got infected there would be a cure available before they got sick. Lack of condom use also might be due to a desire to trust the partner, she noted.

In 1996, the researchers added questions to the survey to determine the reasons for increased unprotected sex. One explanation for this behavior is that men were choosing to have unprotected sex only with partners they think are the same HIV status as themselves, a process known as "negotiated safety."

Research findings showed, however, that about half of the men having unprotected sex--22 percent of the total respondents--were doing so with a partner of unknown or different HIV status.

"It's not negotiated safety," said Ekstrand. "If there is any negotiation going on, it's negotiated danger."

Osmond's data showed that 32 men became infected with HIV during the five-year course of the study. The infection rate in 1994 was 2.6 percent, but the rate has been around 1.5 percent per year since then.

Osmond speculated on several reasons why the researchers are not seeing rates of infectivity increasing with more unprotected sex. He said many infected San Franciscans are combating HIV with multi-drug therapies, and may be less infectious than those untreated. The infection rate has been declining in San Francisco and the men in the study are possibly less likely to encounter an infected sex partner.

"A rate of 1.5 percent may seem low. In fact, it is lower than in the first year of the study," said Osmond, "but it's still high enough to maintain an epidemic. By the time these men reach their 40s and 50s, we're talking about 20 to 30 percent of them being infected with HIV."

Although there have been extraordinary gains for safe sex made in the gay community, Ekstrand emphasized that the war is not yet won. "We can't sit back and get lulled into a sense of security," Ekstrand said. "Twenty-two percent of gay men having unprotected anal sex is an unacceptably high number. It is extremely risky and will eventually lead to increased infections."

Study co-investigators from UCSF CAPS are Ron Stall, PhD, MPH, associate professor of epidemiology and biostatistics; Jay Paul, PhD, research psychologist in epidemiology and biostatistics; Kim Shafer, PhD, post-doctoral fellow; and Edwin Charlebois, MPH, and PhD-candidate in epidemiology and biostatistics.

Thomas Coates, PhD, director of the UCSF AIDS Research Institute, is also a co-investigator.

The UCSF ARI is an institute without walls that encompasses all UCSF AIDS programs under a single umbrella. It includes a dozen research institutes, a wide range of clinical, behavioral science, and policy programs, and nearly 1,000 investigators.

University of California - San Francisco

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