Trends in sexual behaviour and risk factors for HIV infection among homosexual men, 1984-7.

Abstract

To assess whether the spread of infection with HIV can be reduced by changes in behaviour among groups most at risk because of their sexual practices sexual behaviour was monitored among 1050 homosexual men tested for HIV infection at a genitourinary medicine clinic in west London from November 1984 to September 1987. Four cohorts, defined by date of presentation, were studied by questionnaire at their presentation, and blood samples were analysed.Between the first and last cohorts there was a considerable fall in the proportion reporting casual relationships (291/329 (88%) v 107/213 (50%)) and high risk activities, such as anoreceptive intercourse with casual partners (262/291 (90%) v 74/106 (70%)), with the greatest changes occurring before the government information campaign began in 1986. Nevertheless, half of the men in the last cohort studied reported having casual partners. Multiple logistic regression showed that behavioural risk factors for HIV infection most closely resembled those for hepatitis B and that previous sexually transmitted diseases (syphilis, hepatitis B, and anogenital herpes) were themselves independent risk factors. A history of syphilis ranked above anoreceptive intercourse as the strongest predictor of HIV infection. Actively bisexual men showed a much lower prevalence of HIV infection (3/57, 5%) than exclusively homosexual men (113/375, 30%).Sexual behaviour among homosexual men changed during the period studied, and the incidence of HIV infection fell, although more education programmes directed at homosexual men are needed to re-emphasise the dangers of infection.

A core group model for disease transmission

“…These changes include a reduction in average sexual activity, a decline in risky behavior, and a decrease of the rate of unprotected sexual contacts (see Baldwin and Baldwin [1], Curran et al [5], Fineberg [7], Evans et al [6], Martin [12], Saltzman et al [14], Shechter et al [15], van Griensven et al [17], [18], Wilkenstein et al [20], and Wiktor et al [19]). Changes in behavior have been observed also as the result of perceived environmental risks that are measured in terms of disease prevalence (see [7] and the references therein).…”

“…The core population may experience a significant reduction in size and sustained oscillations are possible. Our goal here is to look, in as simple setting as possible, at the role of partially effective disease management programs in communities where the level of disease prevalence is known (see Evans et al [6], Martin [12], McKusick et al [13], Shilts [16], Wiktor et al [19])…”

‘Relapse’ to unsafe sexual behaviour among gay men: a critique of recent behavioural HIV/AIDS research

“…Firstly there has been a reduction in all sexually transmitted diseases in gay men since the early years of the decade, indicating a general reduction in risk for infections which have similar transmission characteristics to HIV (Johnson and Gill 1989). Secondly, in the UK since 1986 there has been no increase in the level of HIV in men attending genito urinary medicine clinics, so avoiding the rapid incidence of infection seen in the early days of the epidemic in San Francisco or New York (Loveday et al 1989;Evans et al 1989). Finally, interview and questionnaire based studies relying on self-reports of behaviour change have consistently demonstrated a reduction in the primary risk behaviour for HIV infection in gay men (unprotected receptive anal intercourse), increasing use of condoms in penetrative sex, and a fall in the numbers of sexual partners reported .…”

Effects of treatment and prevalence-dependent recruitment on the dynamics of a fatal disease

“…Drastic changes in behavior have been observed in some homosexuallyactive populations as a result of the effects of the AIDS epidemic in these communities (see Baldwin and Baldwin 1988, Curran et al 1988, Fineberg 1988, Evans et al 1989, Martin 1987, Saltzman et al 1987, Shechter et al 1988, van Griensven et al 1989a,b, Wilkenstein 1988, McKusick et al 1985, Shilts 1987, and Wiktor et al 1990). The effects of these documented changes in behavior on HIV incidence, and the development of partially-effective drug treatments such as AZT, makes it even more difficult to forecast the timing and magnitude of this epidemic.…”