Mary Boulton

Regular partners and risky behaviour: Why do gay men have unprotected intercourse?

Studies in both the UK and the USA continue to show that gay and bisexual men put themselves at risk of exposure to HIV through unprotected intercourse, most often with regular partners. As part of a larger study of homosexually active men, 310 men who had had unprotected anal intercourse with a man in the previous year were asked to describe the last occasion on which this had happened. The majority of men had had unprotected intercourse with a regular partner and did not perceived it as risky, although most did not know the HIV status of their partner. Regular and non-regular partners were perceived differently. Men were more likely to be emotionally involved in regular partners and to perceive unprotected penetrative sex with a regular partner as not risky. Future health education initiatives must take into account mens emotional involvement in regular partners and their perception of unprotected intercourse with such partners as not risky.

Gay men's accounts of unsafe sex

This paper provides a qualitative analysis of the explanations given by a sample of 78 gay men in England of the most recent occasion on which they engaged in anal intercourse without a condom. Explanations are analysed and interpreted from the sociological perspective of accounts: that is, they are not viewed as exact descriptions of the real motives for behaviour but are seen as a powerful resource that can illuminate the knowledge, assumptions and values that inform behaviour. Four distinct types of accounts were identified from the mens descriptions of the circumstances and motivations surrounding their most recent unsafe sexual encounter. These related to: (i) their emotional needs and drives; (ii) the calculus of risk; (iii) issues of trust; and (iv) lapses of control. Each of these types of account is described and the implications of the typology are considered, both for our understanding of the meanings, considerations and constraints surrounding high-risk sexual behaviour and for developing more relevant health education interventions.

A new approach to the measurement of patients' understanding of what they are told in medical consultations.

Quest-ce-que les patients retiennent dune consultation medicale? Que comprennent-ils de ce que le medecin leur a dit? Quels sont les processus de cette comprehension? Autant de questions dun interet clinique et theorique considerable. Neanmoins la recherche empirique sur cette comprehension est bridee par linadequation des instruments de mesure peu a la hauteur des theories socio-anthropologiques visant a rendre compte de la consultation medicale, et qui du meme coup, deviennent inapplicables. Une methode de comparaison des contenus fondee sur le principe de lecoute par un tiers est proposee pour definir cet univers dinformation

Awareness of sexual partners' HIV status as an influence upon high-risk sexual behaviour among gay men.

ObjectiveTo evaluate the extent to which high-risk sexual behaviour is influenced by awareness of partners HIV status among gay men. DesignStructured interviews and collection of saliva samples for anonymous linked testing for HIV-1 antibodies. SettingGenitourinary medicine clinics and the gay community. SubjectsMen (n = 677) who reported sexual contact with another man in the last 5 years. ResultsThe majority of respondents (63%) had had an HIV-antibody test. Analysis of data showed that in 15% of the respondents 1380 partnerships, HIV status was known by both parties. However, the majority of partnerships involved only safe sex. Only 26% of the partnerships in which unprotected penetrative anal sex had occurred involved mutual knowledge of HIV status and was most likely to occur with regular rather than non-regular/casual partners. Logistic regression revealed that this latter association could not be explained in terms of mutual HIV status knowledge. ConclusionsDespite widespread HIV testing, the majority of gay men engaging in high-risk sex are unaware of their partners HIV status.

Gay men, social support and HIV disease: A study of social integration in the gay community

As part of a large study of the effects of HIV and AIDS on gay male sexual behaviour, we investigated the extent to which gay men in the UK have access to social support and informal care at times of illness. The study sample (n = 502) demonstrated high levels of willingness to disclose sexuality to others, sociability and social integration. Over 90% reported that they had access to people whom they could turn for practical help at times of temporary incapacity. Between 42% and 46% have known a person, or persons, with HIV symptomatic disease, AIDS or someone who has died of AIDS, although men recruited in larger towns and cities were more likely to know people at every stage of HIV infection and AIDS than those from smaller towns. Twenty-five per cent had provided practical help and support to at least one person with AIDS; men in this situation were more likely to have had a close friend, lover or former lover who had died of AIDS. It is argued that it is not possible to expect the gay community to provide fully for the non-medical care of its members and, whilst some needs can be fulfilled on an informal care basis, the demands of long-term serious illness are such that adequate support services should be available in the community.

The sexual behaviour of bisexual men in relation to HIV transmission.

Relatively little is known about the behaviour of bisexual men which may help in assessing their role in HIV transmission. A sample of 60 behaviourally bisexual men were asked about their sexual behaviour with male and female partners and their perceptions of risk of HIV infection. Only a minority of men engaged in unprotected anal sex with their male partners while two thirds had unprotected vaginal sex with their female partners. This asymmetrical pattern of sexual behaviour reflects a differential perception of risk of HIV infection with male and female partners. A quarter of the men had unprotected penetrative sex with both male and female partners in the previous year. The pattern of risk behaviour varied amongst men living in gay, heterosexual or bisexual contexts.

Thinking Prevention: Concepts and Constructs in General Practice

General Practitioners (GPs) often report that it is difficult to “think” preventively in the context of their routine consultations with patients; the immediate complaints of the patient are given priority in a clinical encounter and this is reinforced by a long tradition in which being “responsive” to patients’ expressed needs is highly valued. Evidence from recent studies of the content of general practice consultations (Boulton and Williams 1983; Tuckett et al. 1985) shows that prevention does not figure prominently in these transactions, although some have since argued that this overlooks an increasing trend among GPs to raise preventive issues in the consultation (e.g. Stott 1986).1 These findings are at variance with the current ideology of general medical practice in Britain which places considerable emphasis on the notion of anticipatory care as an integral feature of the service GPs provide to patients, and which portrays general practice as a key locus for such activity in the primary care sector (see Royal College of General Practitioners 1981 and 1983).

Use and Cost of Hospital and Community Service Provision for Children with HIV Infection at an English HIV Referral Centre

AbstractObjective: To describe the use of hospital and community services for children infected with HIV and estimate the cost per patient-year by stage ofHIV infection during the era of antiretroviral monotherapy.n Design: Data on the use of hospital services were collected from case notes; the use of statutory and nonstatutory community services was recorded through diaries and interviews. Total cost estimates were calculated from unit costs from relevant hospital departments and community organisations.n Setting: Children managed at St. Mary’s Hospital (London, England) between 1 January 1986 and 31 December 1994, some of whom used statutory and nonstatutory community services in South East England between 1 November 1994 and 31 May 1996.n Patients and participants: 118 children with positive HIV antibody status.n Main outcome measures and results: Mean inpatient days, outpatient visits, tests and procedures performed, drugs prescribed, community services used, associated unit costs and average cost estimates per patient-year by stage of HIV infection (1995/1996 values), and lifetime costs.Service provision during the study period was predominantly hospital-based. The use of services increased for different stages of HIV infection and increased with increasing severity of HIV infection. A shift from an inpatient-based to an outpatient-based service was seen between the periods 1986 to 1991 and 1992 to 1994. As symptoms evolved, children used more hospital inpatient services, with an accompanying shift in the use of community services from general services, such as schooling, to increased use of nurses, social care and home help. The estimated total cost of hospital and community carewas £18 600 per symptomatic non-AIDS patient per year and £46 600 per AIDS patient per year. Similar estimates for children with indeterminate HIV infection and asymptomatic infection amounted to £8300 and £4800 per patient-year, respectively. Nondiscounted lifetime costs for hospital care amounted to £152 400 (£44 300 to £266 800) compared with discounted lifetime costs of £122 700 (£42 000 to £182 200); nondiscounted lifetime costs for community care amounted to £24 300 (£7900 to £41600) compared with discounted lifetime costs of £21 000 (£6800 to £32 000).n Conclusions: The continued emphasis on the use of hospital services may be due to the small number of children infected with HIV, most of whom lived in the London metropolitan area where specialist carewas concentrated in a few centres. Ashift from an inpatient- to an outpatient-based service was observed over time; the advent of the use of combination antiretroviral therapy in this population may further facilitate a shift in service provision and promote shared care between specialist centres, local hospitals and community-based services.n

Predictors of high risk sexual behaviour in gay and bisexual men

SummaryEvidence of high risk sex between gay men continues to be reported, as does a range of sexual behaviour. Three hundred and sixty-nine homosexually active men from different areas of England were each assessed twice at an an interval of 9 months in order to examine the extent to which a number of social-psychological factors predicted subsequent high risk sexual behaviour. Few of the variables were significantly related to unprotected receptive anal sex in the way that the Health Belief Model predicted, except for some perceptions of costs and benefits of safer sex. However, whether or not men were involved in a regular relationship with a partner was strongly associated with high risk behaviour. The implications of these results are that health education interventions should focus on alerting all men to the social context in which high risk sex is more likely to happen: the regular partnership.RésuméCertaines indications font penser quune partie des homosexuels continuent à avoir certains comportements sexuels à haut risque. 369 homosexuels actifs de différentes régions dAngleterre ont été interrogés deux fois dans un intervalle de 9 mois; le but de lenquête était dexaminer si certains facteurs sociopsychologiques prédisaient un comportement sexuel à haut risque. Peu de variables avaient une relation significative avec une attitude anale réceptive non protégée, analysée selon le «Health Belief Model» des exceptions concernaient quelques perceptions concernant les coûts et les bénéfices de la sexualité sûre. Dautre part, lexistence dune relation avec un partenaire stable était fortement associée avec un comportement à haut risque. Ces résultats impliquent que les campagnes déducation devraient sadresser à tous les hommes chez lesquels une sexualité à haut risque est la plus répandue, à savoir ceux vivant un partenariat régulier.ZusammenfassungNoch immer finden sich Hinweise auf ein sehr risikoreiches Sexualverhalten homosexueller Männer, wie das Festhalten an gefährlichen Sexualpraktiken. Zweimal im Abstand von neun Monaten waren 369 homosexuelle geschlechtlich aktive Männer aus verschiedenen Gebieten Englands befragt worden, um zu untersuchen, in welchem Ausmass sozio-psychologische Faktoren mit einem risikoreichen Sexualverhalten verbunden sind. Nur wenige dieser Variablenwaren in statistisch signifikanter Weise mit der Praxis des ungeschützten Analverkehrs verbunden, so wie das “Health Belief Model” es hätte vermuten lassen. Eine gewisse Ausnahme bildete die Beurteilung von Aufwand und Nutzen des “Safer Sex”. Die Tatsache, dass der Befragte einen regelmässigen Sexualpartner hatte, war statistisch positiv mit einem Hochrisikoverhalten korreliert. Präventionskampagnen sollten darum die Männer auf die Situation hinweisen, in der auf “Safer Sex” am ehesten verzichtet wird, nämlich eine stabile Partnerbeziehung.

Health education and prevention in general practice- the views of GP trainees

THIS paper presents the results of a questionnaire given to 118 general practice trainees, to provide baseline data for the development of new teaching materials on health education for use in general prac tice vocational training. The questionnaire looked at their knowledge of anticipatory care, as well as at their attitudes to the practice of health education in their own consultations. The results suggest that, while trainees have a sound knowledge of most pre ventive and health education issues, the attitudes of the majority to these issues may act to keep them from putting their knowledge into practice. New education materials for general practice vocational training may therefore be usefully directed towards the trainees attitudes, orientations and perceptions about their work, which constrain and circumscribe their practice of prevention and health education.