David W. Lyter

Factors related to seroconversion among homo- and bisexual men after attending a risk-reduction educational session.

Thirteen homosexual men, volunteers in a study of the natural history of HIV, who seroconverted to HIV after participating in an educational program on HIV prevention, were interviewed about the circumstances leading to their seroconversion. Six men had participated in unprotected anal intercourse with at least one partner whom they believed was HIV-negative. Four men attributed their conversion to mental health problems or to drug and alcohol use. Two mens seroconversions could not be ascertained and one man attributed seroconversion to a condom break. Most men who had learned how to avoid infection, and had successfully done so for a time, had knowingly engaged in unsafe behaviors because of strong emotional responses to certain partners or because of mental health or drug and alcohol-related problems. Skills training for dealing with partners who pressure men to behave unsafely is needed, as is mental health and drug and alcohol counseling for men at risk for HIV infection.

The effect of group education on improving attitudes about AIDS risk reduction

Four hundred sixty-four homosexual and bisexual men, recruited from a cohort of 1,700 men enrolled in a study of the natural history of acquired immunodeficiency syndrome (AIDS), participated in a peer-led, small-group educational session promoting AIDS risk reduction. Although levels of knowledge about AIDS and human Immunodeficiency virus (HIV) transmission were uniformly high prior to intervention, at least 60% of the men reported having engaged in unprotected, receptive anal intercourse with more than one partner in the preceding six months. Prior to intervention, a substantial number of the men had mixed feelings about AIDS risk reduction or endorsed negative attitudes about AIDS risk reduction. After attending the session, attitudes improved significantly in five of the six areas surveyed.

Marketing strategies for recruiting gay men into AIDS research and education projects

Recruiting gay and bisexual men into AIDS-related research and education programs will become increasingly common as federal, state and local funds become available. The Pitt Mens Study, a study of the natural history of Human Immunodeficiency Virus (HIV) infection, developed a recruitment strategy based on marketing principles. These techniques allowed the study to target particular gay and bisexual groups for inclusion. 1718 gay and bisexual men were recruited. Non-whites and unemployed men were targeted and recruited in numbers comparable to their representation in the larger community.

Applying the criteria for the development of health promotion and education programs to AIDS risk reduction programs for gay men

As a result of the AIDS (Acquired Immune Deficiency Syndrome) epidemic, many community health agencies are faced with the task of planning and implementing programs to prevent or reduce the risks of HIV (Human Immunodeficiency Virus) infection. Furthermore, the urgency of AIDS will force community groups to develop prevention programs prior to an analysis of substantial data relating to intervention efficacy. By using the five criteria for the development of health promotion and education programs enumerated by the American Public Health Association, planners can benefit from the experience of past health promotion initiatives, and insure a comprehensive approach to planning. The authors describe, using specific examples, how these criteria were used to develop and implement an AIDS risk reduction program for gay and bisexual men.

VIROLOGIC, IMMUNOLOGIC, AND EPIDEMIOLOGIC ASSOCIATIONS WITH AIDS AMONG GAY MALES IN A LOW INCIDENCE AREA a

The Pittsburgh tri-state area is presently a low incidence area for AIDS and AIDSrelated complex (ARC). There are only six confirmed cases of full-blown AIDS using the Centers for Disease Control criteria. The first case occurred in 1980, the second appeared in 1982, and four were discovered in 1983, which is two cases per million in the Pittsburgh area. This is lower than the 5 to over 30 cases per million noted in such cities as Los Angeles, San Francisco, Miami, Houston, and New York. We estimate that there are only about 20 known cases of ARC in Pittsburgh. We have confirmed 10 of these in our study using the definition of noncontiguous, extrainguinal lymphadenopathy persistent for more than three months, without any association with known, non-AIDS-related causes. All cases of AIDS and ARC have been in non-Haitian gay males with no history of intravenous drug abuse. We began our pilot study earlier this year to examine the basis for this low incidence of AIDS. There are two major hypotheses that could explain the low incidence. First, the putative infectious agent or agents causing AIDS and ARC may not be widely introduced into our gay population. Second, and not necessarily exclusive from the first, is that various lifestyle, virologic, and immunologic characteristics that have been associated with AIDS differ between gay males in Pittsburgh and those in high incidence areas. Our study population consisted of 57 gay male volunteers who were healthy by physical exam and history. These subjects were all white and were predominantly in their 20s and 30s. The healthy subjects began having gay sex in their late teens. They were relatively sexually active as evidenced by an average of over 30 different sex partners in the year preceding our study. About one-third of our subjects participated in sex at gay baths. Those studied were also sexually active as shown by a relatively high level of self-reported episodes of sexually transmitted diseases (mean of 3) and history of hepatitis (26%). Over 60% participated as the passive recipient in anal intercourse.