The number of gay men having unprotected anal sex is increasing dramatically,
according to researchers at the University of California, San Francisco.

A study of more than 500 young gay men in San Francisco revealed that the
prevalence of unprotected anal sex rose by a third to a half in just four
years.  Furthermore, about half of the men having unprotected anal sex had
partners of unknown or different HIV status.  The results are published in the
current issue of the journal AIDS.

“Occasional high-risk sex has now become pervasive among gay men in San
Francisco,” said Maria Ekstrand, PhD, research psychologist, UCSF Center for
AIDS Prevention Studies at San Francisco General Hospital Medical Center and
lead author of the study.  “It is apparent that many gay men find it difficult
to maintain safe sex practices over the long haul.  Prevention efforts must
address this problem.”

The researchers followed 510 gay men, aged 18 to 29, who were identified for
the San Francisco Young Men’s Health Study (SFYMHS) in 1992.  The participants
were tested for HIV and filled out a self-administered questionnaire on
numerous topics related to HIV and sexual behaviors during each study year
between 1993 and 1997.

During the first study year, 37 percent of the participants reported having
unprotected anal intercourse.  By the fourth study year, this number had
increased to one half.  Sixty-eight percent reported having unprotected anal
sex during at least one of the four years studied.

Men who didn’t know the HIV status of their partners or had a dissimilar status
were considered to be at high risk of transmission.  This group made up nearly
one fourth of the total sample during the last year of the study.  Compared
with men who had the same HIV status as their partners or who practiced safe
sex, the men in the high-risk group were significantly more likely to be HIV
positive, have greater numbers of sexual partners, and have more frequent sex,
said Ekstrand.  In addition, only 32 percent reported having disclosed their
HIV status to all of their anal sex partners.

“People who are sexually adventurous are pushing the envelope,” said Ekstrand. 
“They’re engaging in high-risk behavior and aren’t talking about their HIV
status with their partners.”

The reasons for having unprotected sex differed among the different
transmission risk groups.  Men who shared the same HIV status as their partners
were significantly more likely to say they had unprotected sex because they
were in love.  The high-risk group reported they had unprotected sex because
condoms were unavailable, they were turned on, or they had been drinking or
using other drugs.  This group was also more likely to use nitrate inhalants,
or “poppers,” to enhance their sexual experience.

“Sexual expression is highly valued in the gay community,” said Ekstrand.  “Gay
and bisexual men have had to curtail their sexual behaviors as a means of both
individual and community survival.  Compared to groups who have had to make
other health behavior changes, they have done a tremendous job.  But different
psychological and social issues make it difficult for them and as a result,
some men report feeling discouraged to the point of doubting that they’ll ever
be able to practice safe sex consistently.”

The researchers speculate that a need for sexual expression combined with the
effectiveness of protease inhibitors may have created a popular perception of
AIDS as a manageable chronic disease rather than a deadly epidemic.

“Gay men might think it’s not that bad to become infected with HIV these days,
but in spite of treatment advances, it’s still a big deal,” said Ekstrand. 
“Many of these young men have a lot to lose by getting infected.”
New combination therapy treatments don’t work for everyone, and for some men,
they result in terrible side effects, said Ekstrand.  The emergence and spread
of resistant strains of HIV is also a danger.

Although rates of new HIV infection in San Francisco have remained stable at
two percent a year among 18 to 29 year-old gay men, the researchers worry that
an increase in risky sexual behavior will result in higher rates of HIV
infection.  Already, several US cities have reported an increase in rectal
gonorrhea, including San Francisco.

“We want to go back to the community with our findings before HIV rates follow
suit,” said Ekstrand.  “Unless we can find ways to help gay men devise
practical and long-term HIV prevention strategies, ongoing HIV infection will
remain a permanent problem among gay male populations.”

In addition to Ekstrand, co-authors of the paper include Ron Stall, PhD, UCSF
associate adjunct professor of epidemiology and biostatistics; Jay Paul, PhD,
UCSF psychologist in medicine; Dennis Osmond, PhD, UCSF associate adjunct
professor of epidemiology and biostatistics; and Thomas Coates, PhD, director
of the UCSF AIDS Research Institute (ARI).  All authors are affiliated with the
UCSF Center for AIDS Prevention Studies of the UCSF ARI.