References - Behavior and Counseling

(Arranged Alphabetically)

Alcohol and risky sex: in search of an elusive connection.

Since the publication of the 1986 article by Stall, McKusick, Wiley, Coates and Ostrow, the conclusion that drinking alcohol prior to or during erotic encounters increases the probability of engaging in high-risk sexual behavior has been widely accepted, despite some contradictory findings from research on this hypothesis. This paper presents the results of tests of the alcohol/risky-sex hypothesis in a cohort of gay men in Flanders, Belgium. Failing to find evidence to support the hypothesis of a general effect of alcohol on sexual risk taking, we argue that previous conclusions on this matter must be viewed with extreme caution, especially in light of the implications that this failure to replicate has for AIDS prevention programs. Cultural, social, and methodological factors that could account for this failure to replicate are discussed in the context of a review of the literature on this hypothesis.

Factors associated with safer sex and needle hygiene among drug users in eight USA cities.

OBJECTIVES: To identify factors associated with safer sex and safer needle hygiene. METHODS: Targeted samples of drug injectors and crack smokers (N = 397) were surveyed in street settings in eight USA cities. Separate logistic models were developed to identify independent factors associated with sex risk and needle risk. Unprotected sex with multiple partners was unsafe. Needle risk was any needle sharing without first disinfecting. TABULAR DATA, SEE ABSTRACT VOLUME. CONCLUSION: These findings suggest: a) exchange relationships and high risk drug use patterns appear to be barriers to safer sex behaviors; b) social bonds to non-IDU society tend to support safer needle use.

Bisexuality and safe sex practice in homosexual men in Amsterdam, The Netherlands.

OBJECTIVES: To describe bisexuality, and sexual techniques and safe sex practice with women in a cohort of homosexual men with high risk for acquiring HIV and to estimate the role of this group of men in the spread of HIV into the female population. METHODS: Between April and October 1991, a questionnaire concerning sexual practices and safe sex with female and male sex partners during the previous six months was administered to 660 homosexual men participating in a since 1984 ongoing prospective HIV-study in Amsterdam, The Netherlands. RESULTS: Of this group of homosexual men with a mean age of 40 years, and of which 34% were HIV positive, 27% described themselves as bi-sexually or heterosexually inclined. Only 23 men (3%) had sexual contact with women in the previous six months (total number of female partners was 30). 18/23 (78%) had one female partner only (in 16/18 this was a steady partner). In the 23 men with heterosexual contact, vaginal sex was the most common practised sexual technique (91%). Four men (18%) also had anal contact with women. Unsafe sex with women (vaginal and/or anal contact without consistently using condoms), was reported by 12 men (55%), all of them HIV negative. Most bisexual men in this sample (95%) also had male sex partners during the previous six months (median 5, range 1-25), of whom 24% had unprotected insertive and/or receptive anal contact (18% of the HIV positives and 50% of the HIV negatives). CONCLUSIONS: Although 27% state to be bi-sexually inclined, heterosexual contact is rare in this cohort of homosexual men. The role of the bisexual men in our study, who know they are infected with HIV, in the spread of HIV infection among women will probably be limited, as all of them reported safe sex with their female partners. A HIV positive test result apparently promotes the consistent use of condoms with women by this group. However, the HIV negative bisexual men in this group could be a source of transmission to women during the period preceding the seroconversion visit, since unsafe sex with both male and female partners is common among these men.

Sexual behavior after safe sex counseling in stable heterosexual partners of HIV+ subjects.

OBJECTIVE--The aim of the study was to evaluate the adoption of sexual preventive measures by heterosexual partners after a specific counselling. METHODS--Background: from 1985 to 1992, we have examined 306 heterosexuals which have had a stable relationship with a subject discovered to be HIV Ab + ve. All subjects at the time of HIV serology received a counseling on safe sex measures, and 145 (50 males and 94 females) were interviewed about sexual behaviors before and after the knowledge of the HIV infection of the partner and the counseling. RESULTS--A reduction of the frequency of sexual contacts per week was seen for 48.8% of male partners (MP) and 51.9% of female partners (FP). Moreover, 18.5% females had used IUD before but 86.7% of them stopped to use it after the counseling. About sexual practices, 50% of MP and 57.1% of FP stopped to have the vaginal contacts during menses, 17.6% of MP and 26.1% of FP the fellatio, and 37.5% of MP and 40% of FP the anal contacts. An overall condom use before the counseling was reported by 15.8% of interviewed partners and its use increased to 75.5% of partners after counseling (M:22.4%-71.4%; F:12.2%-77.8%). However, condoms were used primarily in vaginal contacts (78.7%) and a large amount of partners who decided to continue to have high-risk conctacts practiced them without using condoms (notably anal sex [72.8%] and fellatio [93.1%]). Age over thirty is related to an higher rate of cessation the fellatio (50% vs 16.5%; Fisher P < .01). A relationship lasting more than 48 months was the main variable linked to the use of condoms (84.8% vs 66.2%; Mantel-Haenszel chi2 P < .05), and to the cessation of anal sex (75% vs 10%; MH chi2 P < .0001), of fellatio (38.3% vs 10.9%; MH chi2 P < .001), of cunnilingus (28.8% vs 9.5%; MH chi2 P < .01), of vaginal sex during menses (72.7% vs 44.7%; MH chi2 P < .05). No differences were found by considering gender of partners. CONCLUSIONS--The counseling for the adoption of safe sex measures is the main way to prevent HIV transmission in stable couples. In addition, sex counselling should be also addressed to younger partners and in couples with shorter length of relationship.

Gay male substance abusers who only have safer sex.

OBJECTIVES: To better understand the differences between gay male substance abusers who only have safe sex and gay men who only have risky sex while under the influence of alcohol or drugs. METHODS: Gay men entering substance abuse treatment in San Francisco (n = 455) were recruited to complete surveys and interviewed using the Timeline Followback Method (TL) on sexual behavior, substance use and related variables. The TL procedure uses a blank calendar form and a series of questions to cue recall of drinking, drug use and anal intercourse over a 30 day period. Two groups were compared. Safe: men who only had protected anal intercourse (n = 43); Unsafe: men who only had unprotected anal intercourse (n = 89). Both groups always had anal sex while under the influence of alcohol or drugs. FINDINGS: The safe group was more likely than the unsafe group to report perceiving safe sex as the community norm (p < .001), encouragement from friends to practice safe sex (p < .001), future intentions to have safe sex (p < .001), better impulse control (p < .008), and were more likely to be HIV negative (p < .02), if HIV antibody status were known. No differences were found with regard to demographics, relationship status, number of sexual partners, problems related to alcohol or drugs, alcohol or drug use expectancies, psychological variables (depression, hostility, anxiety, loneliness, and self-esteem), coping strategies, or the amount of alcohol or drugs used while engaging in sex. CONCLUSIONS: These findings suggest that one of the goals for risk-reduction efforts may not simply be to avoid sex while under the influence of alcohol or drugs, but to continue to assist individuals at risk by helping them control impulses, negotiate safer sex, and develop social support which encourages a safer sex lifestyle.

Safer sex maintenance among gay men: are we moving in the right direction? [editorial]

Full-, selective-, and no safe sex among a cohort of Dutch gay men.

OBJECTIVE. One of the strategies gay men use to reduce the risk of AIDS is to restrict unsafe sex (operationalized here as unprotected anogenital sex) to a steady partner. The objective was to explain the choice of this strategy by psycho-social predictors. METHODS. Three groups were compared with discriminant analysis: 1) safe with steady and casual partners (full safety, n = 49). 2) unsafe with steady but safe with casual partners (selective safety, n = 59). 3) unsafe with steady and casual partners (no safe sex, n = 35). This dependent variable was measured in 1989 among a cohort of Dutch gay men; predictors were measured from 1986 to 1989. RESULTS. The discriminant analysis revealed two dimensions: the first characterized the group no safe sex. Predictors loading high on this dimension were: lower AIDS knowledge; lower condom acceptability; more friends who have casual partners; using marijuana. the second characterized the group selective safety. Predictors loading high on this dimension were: lower age; not being active in the gay movement; ever having been marned; a depressive coping style; fewer friends who have casual partners; fewer friends who use condoms. CONCLUSION. The three groups do not differ in one dimension, e.g. according to degree of safety, but in two. Some suggestions to promote selective or full safety are to increase AIDS knowledge, to promote condom acceptability, to diminish depressive coping styles, to enhance condom promoting norms, and to stress the possible safer sex inhibiting effects of marijuana., specifically among younger gay men.

Practicing safer sex.

Safer sex.

Knowledge of AIDS and safer sex practices among college freshmen.

We assessed knowledge of the acquired immunodeficiency syndrome (AIDS) and of safer sex practices among college freshmen. A second purpose of the study was to assess this knowledge among black as well as white students. Students attending classes at three private colleges in a large southern city were asked to participate in the study. Respondents completed the modified AIDS information survey, the knowledge of safe sex practices questionnaire, and a demographic data sheet. A total of 689 questionnaires were received from single college freshmen. The results indicated that respondents were knowledgeable about the cause and transmission of AIDS but were less knowledgeable about medical aspects. Most knew that condoms are effective in preventing the spread of AIDS, but fewer could differentiate between the effectiveness of latex and nonlatex condoms. These findings are useful to health educators in improving AIDS education programs.

Sustaining safe sex: sexual practices, HIV and social context.

Safer sex among gay men: what is the ultimate goal? [editorial]

How efficient is safer sex in preventing HIV infection?

Ability to envision a future predicts safe sex among gay men.

OBJECTIVE: As the AIDS epidemic continues in large epicenters, heavily impacted groups--such as gay men--are reporting feelings of fatalism and/or the inevitability of infection with HIV. This report describes the association between the ability to conceive of a personal future during the midst of the continuing health crisis and recent high risk sexual activity. METHODS: A large convenience sample (n = 1046) was surveyed at a San Francisco AIDS Foundation booth during the Gay Freedom Day Parade Celebration in June, 1992. The instrument included scales measuring perceived norms for safe sex, condom use commitment, self efficacy, and value of the gay community to the individual (alphas ranging from .57 to .85). Sense of having a personal future was measured with a set of items assessing future goal orientation, overwhelming grief, feeling on hold until the epidemic is over and ability to imagine a personal future (alpha = .51). FINDINGS: Mean scores (6 point scale) for each of these items are: (all p values .05) TABULAR DATA, SEE ABSTRACT VOLUME. CONCLUSIONS: These data indicate that the ability to envision a personal future during the course of the AIDS epidemic is related to safe sex behavior. AIDS prevention activities may need to support the sense of personal and community survival in heavily-impacted communities as a means of maintaining consistent safe sex.

Can women demand condom use? Gender and power in safe sex.

SIGNIFICANCE. The rapid increase of HIV infection among women in the U.S. has been attributed mainly to heterosexual contact. Up to 20% of married men and 60% of unmarried men report multiple sexual partners increasing the likelihood that a woman's partner may put her at risk for HIV infection. This study assessed barriers to condom use with male partners among Latino and non-Latino white women. METHOD. A total of 697 women (513 Latino, 184 non-Latino white) who reported having a male partner in the previous year were taken from a larger population-based sample of 2221 telephone interviews with adults, aged 18-49 years. Multiple regression analysis was used to assess barriers to condom use. RESULTS. Most women never use condoms with their primary partner (67% of Latino and 60% of non-Latino white). Those who do use are more likely to be unmarried (p < .05) and younger (p < .01). Barriers to condom use with a primary partner include: partner's anger at condom use request (p < .001), other birth-control used (p < .001), less self-efficacy to use condoms (p < .001), negative attitude towards use (p < .001), and having fewer friends who use (p < .001). Barriers are the same for Latino and non-Latino white women (R = .58). CONCLUSION. The sexual behaviors recommended to prevent HIV infection present difficult and complex issues for women. Women must often rely on their ability to require their male sexual partner to use a condom, or engage in non-penetrative sex even when other forms of contraception are being used. Many women encounter resistance from a primary partner and, consequently, are less likely to demand condom use. HIV prevention strategies should target heterosexual couples and address gender-power norms.

Condoms to prevent HIV transmission do not imply truly safe sex.

30 female prostitutes and 16 persons from the hospital staff each tested 10 latex condoms by vaginal intercourse. Six dropped out. Condom rupture occurred at least once for 7/40 persons (95% confidence interval 7-33%). Total condom rupture rate was 5%. Although encouragement to condom use is prudent in an epidemiological scale, truly safe sex with an HIV-positive partner using condoms is a dangerous illusion.

A safer sex campaign at an international airport.

Single young adults departing for holidays abroad may be at increased risk of acquiring HIV and other STDs A health promotion campaign was launched to tackle this issue. METHOD: Two teams of three trained workers were based in the international departure lounge at Glasgow Airport for four weeks during July and August 1992, a peak holiday period in Scotland. The focus of the campaign was a large visual display and an HIV safer sex crossword competition using crosswords printed on beer mats. Winners were awarded designer safer sex T-shirts. Participants were offered free condoms and leaflets on safer sex and health travel. Interviews were also conducted to assess knowledge and attitudes about the campaign and its acceptability. RESULTS: About 66,000 people passed through the departure lounge during the campaign. Over 10,500 crosswords were completed: 53% by women and 65% by people aged under 30; 2,500 T-shirts were given out as prizes; about 33,500 condoms were issued to about 5,500 people. Only 6% of passengers surveyed did not understand the aim of the campaign. There were no objections to any of the campaign materials and 85% of respondents agreed that health authorities should make free condoms available to people going on holiday. Most other comments were favourable. CONCLUSION: The campaign provoked a high level of interest and participation by the target age group. It also proved acceptable to the general travelling public, suggesting that it would adapt well for use in other airports.

Maintenance and change in safer sex behaviours in a cohort of gay men in England.

OBJECTIVE: To investigate the extent to which a sample of gay men in England have begun, maintained or stopped safer sex behaviours over a one year period, and to study the reasons for unsafe sex. METHODS: Men were recruited from community and clinic sources in 4 cities and interviewed regarding sexual behaviour in the previous month and year (T1). Nine-12 months later (T2) they received a questionnaire regarding sexual behaviour in the last month and the period since interview. RESULTS: From January 1988 - July 1989, 502 men with a mean age of 31.6 years (range 16-67) were recruited from gay bars/organisations (283; 56%), clinics (123; 25%) and through snowball sampling (96; 19%). Postal questionnaires were returned by 369 (74%) at T2. Comparing sexual behaviour in each of the months prior to T1 and to T2, it appeared that 213 (58%) had only had safe sex (no penetrative sex or consistent condom use), 38 (10%) had begun safer sex, 52 (15%) became unsafe and 60 (17%) had remained unsafe at both T1 and T2. However, a further 34 (16%) of those safe at T1 and T2 reported unsafe sex during the intervening period, giving a 'relapse' rate of 24%. Unsafe sex was associated with regular partners; 58% of those with regular partners (120/207) at T1 and T2 as compared to 38% of those with non-regular partners (57/149) reported unsafe sex. CONCLUSION: Comparing sexual behaviour in one month periods over time will underestimate level of unsafe behaviours; it is important to establish sexual activity in intervening periods. Reasons for so-called 'relapse' will be considered, and the value of this term questioned.

Sexual behavior modification by means of safe sex workshop in HIV/AIDS prevention.

OBJECTIVE: To estimate changes in sexual behavior among a male homosexual/bisexual population who attended workshops promoting safe sex practices, and identify predictors of reduction in risky behavior. METHODS: In a prospective design, seronegative at-risk males attended a safe sex workshop. A self-administrated questionnaire concerning knowledge, attitudes and behavior was filled out by participants at baseline and one month follow-up. Knowledge, attitudes toward condom use, and risk perception scales were constructed, and exhibited good reliability (coefficient alpha=0.69 and 0.79). Using multivariate regression we examined predictors of behavioral change toward safer sex practices. RESULTS: As of November 1990 a total of 230 were followed-up after one month. No differences were found in the follow-up group versus those not followed with respect to age, education, number of partners or receptive anal sex. More of those followed-up practiced insertive anal sex (p less than .002) TABULAR DATA, SEE ABSTRACT VOLUME. In multivariate regressions, age, education, and styles of sexual practices did not predict differences in behavior change after controlling for baseline behavior. CONCLUSION: These result demonstrate the short-term effectiveness of an inexpensive safe-sex workshop in reducing risky behavior, and improving condom use among high risk seronegative homosexual/bisexual males. The workshop appears similarly effective for various age, sexual practice, and educational groups.

Safer sex knowledge, behavior, and attitudes of inner-city women.

Sexual behavior, knowledge of HIV transmission and prevention, perceived risk of AIDS, and safer sex behavior were studied in a sample of 289 single, pregnant, inner-city women. African-American and European-American women were equally represented. Women had poor AIDS knowledge. Sexual behavior placed women at risk for HIV infection due to the lack of condom or spermicide use. Women did not perceive themselves at risk for the AIDS virus, although they did recognize that heterosexuals were at risk. Their lack of risk perception was partly based on their having a single sexual partner. They did not regard their partner's current or past behavior as placing them at risk. Recommendations for intervention and cultural differences were discussed.

Unsafe sex & other risky behavior. Why?

ISSUE/PROBLEM: Three out of four Teens and young adults still practice unsafe sex. Low self-esteem, feeling unworthy and years of emotional neglect are primary reasons. The individual is so hungry for love. The need to stop the pain so great, they will put themselves at risk and worry about AIDS later. DESCRIPTION OF TREATMENT MODALITY: Assist the client in identification of the problem. Self-esteem and character building through the group process. Validate the clients survival skills to enhance reception of new skills. Use of visualization techniques to protect the clients psyche as painful past experiences are uncovered. Self acceptance and emotional stability are achieved through meditation and relaxation therapy that is non-sexual yet nurturing. RESULTS: One year after being introduced to this treatment modality. The clients express greater feeling of empowerment. A much improved sense of self and the strength to face the future. LESSONS LEARNED: Even the most severe cases of sexual assault, physical battering and parental neglect can find relief beyond expectation with continued implementation of these recovery tools.

Pregnancy arising in HIV infected women while being repetitively counseled about safe sex.

OBJECTIVE: To study the epidemiologic features of women who became pregnant after learning their HIV+ status METHODS: 151 women who were of child bearing age have been followed after they were found to be antibody + to HIV-1. A registry has been maintained of women who become pregnant after knowledge of their antibody status and after discussions about safe sex. RESULTS: Of 80 surviving women from 88 IVDU's, 6 became pregnant one time and 1 2x. Of 43 surviving women from 46 women who acquired disease heterosexually, 3 became pregnant 1 time. No women of 11 surviving women from 17 who acquired disease from other means (6 transfusional, 3 Caribbean, 8 unknown male) became pregnant. 4/11 of women became pregnant even though they were taking zidovudine and were counseled several times about safe sex. One patient's pregnancy was ectopic, 2 delivered full term children, one is carrying the pregnancy to term. 7 had termination of pregnancy. Pregnancy occurred even with low helper cells (less than 200 cells/mm3) in 5. CONCLUSION: Pregnancy continues to occur frequency (11/134) even after women learn about their HIV status. Improved techniques about safe sex must be developed.

Students' knowledge and behavior concerning safer sex: a UK study.

Most students in institutions of further and higher education in the northeast of England who responded to a 1989 survey dealing with sexual behavior and safer sex were heterosexual and had been sexually active or intended to have sexual intercourse. Many students, however, believed that safer sex implied having no sex at all or were unaware of the role of nonpenetrative sex in preventing human immunodeficiency virus (HIV) infection. They did not use condoms, in spite of having positive attitudes about condom use, and they engaged in one or more sexual activities that increased the risk of acquiring HIV infection. In view of the increasing incidence of acquired immunodeficiency syndrome (AIDS), the authors assert, these findings are cause for concern and require concerted action by health educators and society to encourage safer sex practices and to prevent the spread of HIV infection.

Factors correlated with homosexually acquired human immunodeficiency virus infection in the era of safer sex. Was the prevention message clear and well understood? Alain Brugeat Physician Group.

A cross-sectional survey was conducted between November 1986 and January 1988 among 246 homosexual/bisexual patients by consulting physicians promoting human immunodeficiency virus (HIV) infection prevention, to determine factors correlated with HIV infection a few years after the launch of safer sex recommendations. After adjustment for numbers of sexual partners and frequency of unprotected receptive anal intercourse, seropositive subjects, compared to seronegative ones, had significantly higher frequencies of: (1) receptive anal intercourse using condoms and extraneous lubricants, (2) anorectal douching before or after intercourse, (3) past history of syphilis, and (4) nitrite inhalations. The first three factors remained significant after multivariate analysis. Eighty-three percent of the subjects practicing receptive anal intercourse with condoms plus lubricants used inappropriate lubricants. Some factors identified in our study are well established risk factors for homosexually acquired HIV infection, suggesting that safer sex recommendations still are not followed by all. Our results also elicit additional factors that independently increase the risk. Two of them, extraneous lubrication of the condom for anal receptive intercourse and anorectal douching, may result from a misunderstood notion of safer sex, or from practices thought by mistake to protect against HIV.

The social context of adolescent sexuality: safe sex implications.

This study was an examination of the sexual worlds of 153 adolescents aged 15 to 18 years through the content analysis of interviews on the topics of love, romance, relationships between the sexes, sexual values and sexual behaviors. The aim was to develop more detailed descriptions of the dimension of adolescent sexuality and relate these dimensions to sexual risk, that is, the tendency to engage in unprotected intercourse, an activity which increases vulnerability to AIDS and other sexually transmitted diseases. To this end, seven themes were isolated from the interview scripts, these being permissiveness, double standards, belief about sexual control (the Id Factor), romance, regrets about permissiveness, sexual aggression, and questioning. Measures of four of these themes were constructed, and sex and sub-group differences explored, as were the relationships between themes and sexual risk. The implications of different pathways to sexual risk-taking were discussed.

Safer sex among men who have sex with men.

ISSUE/PROBLEM: Unsafe sexual practices among regular customers at bisexual cantinas and bars in urban areas of Mexico are a common place. This sexual behavior is mainly due to problems in AIDS campaigns which are insufficient on several levels. DESCRIPTION OF PROJECT: Through in-depth interviews and a general survey our work team has tried to find out a correlation between customers and the place of social encounters, underlying the approach to other men in order to get sex. RESULTS: Two years later and after characterizing 6 types of men safer sex among men who have sex with men presents 6 different types where the main variables are: AIDS comprehension, lover or friends of a PWA/HIV, alcohol and exhibitionism. LESSONS LEARNED: Natural leaders of the social groups and explicit information on AIDS are the key material to promote safe sex among men who have sex with men.

Despite safer sex practices after counselling, seroconversion is high among HIV serodiscordant couples in Nairobi, Kenya.

OBJECTIVE: To identify factors associated with heterosexual transmission of HIV among couples serodiscordant for HIV infection. METHODS: At a Nairobi STD clinic, HIV+ individuals and their HIV- spouse were followed prospectively with a questionnaire, physical exam and HIV serology. RESULTS: Of 65 couples, the index case was a man in 38 and was a woman in 27. During a mean follow-up period of 9.3 months (range 0.5-34.0), the frequency of sex per month decreased from 9.9 to 4.5 per month (p less than .0001) and condom usage increased from less than 5% to 54% (p less than .0001). Despite these practices, HIV seroconversion occurred in 9 individuals (6 women and 3 men) for a crude seroconversion rate of 18% per year (19% for women and 16% for men). Seroconversion was not significantly associated with sexual activity, condom usage, sexually transmitted diseases, lack of circumcision in men, cervical ectopy in women, pregnancy, presence of HIV associated symptoms or beta-2 microglobulin levels in the index case. DISCUSSION/CONCLUSIONS: In this cohort of HIV serodiscordant couples, condom use was significantly increased after counselling. However, the seroincidence among HIV negative spouses was 18% per year.

Promoting safe sex and sexual health to socially disadvantaged young women and girls.

ISSUE/PROBLEM: How to introduce HIV/AIDS-prevention for lower-class, socially disadvantaged adolescents is controversial, given the high degree of social problems and difficulties with reaching this target-group. Information/prevention has to be intensive. PROJECT: Based on intensive research in selected shelters fo adolescents (by the city of Vienna; N = 50, by in-depth-interviews were assessed demographic profile, sexual and contraceptive behavior, psychosexual development, HIV/AIDS-concerns and preventive behaviors, sexual scripts and attitudes towards sexuality, AIDS, PWAs and AIDS-policies and prevention-needs) it has been recognised that a specific HIV/AIDS-intervention has to be designed to respond to the particular needs of these adolescents. The aim is to increase AIDS-awareness, safe-sex behaviors and condom-use in particular and self-empowerment, personal skills and body-feeling in general in the target-group of adolescent girls. RESULTS: In the target-group there is a high occurrence of sexual and physical abuse, drug and alcohol abuse, teenage-pregnancy and unemployment. Starting the intervention, it had to be recognised that HIV/AIDS-prevention was not the girl's top-priority confronted with so many social problems. Using the method of peer-group education some aspects of self-efficacy and self-responsibility can be given back to the young girls. A flexible six-step HIV/AIDS, contraception, and sexual health-program, mostly developed by the adolescents and supervised by health-psychologists is the outcome of this project. LESSONS LEARNED: Participants learn successful strategies for communication about sexuality and develop personal skills for sexual situations. The pilot-project can be transferred to similar institutions. Supervisors learn that the personal skills and the knowledge of young people is a valuable tool for designing sexual health promotion programs, that can reach adolescents in need for HIV/AIDS-prevention where traditional programs fail.

Predictors of safer sex on the college campus: a social cognitive theory analysis.

In April and May 1989, the authors surveyed a sample of students enrolled on four college campuses in New Jersey (N = 923) concerning their HIV transmission-related behavior, knowledge, and a variety of conceptual variables taken primarily from social cognitive theory that were thought to be potentially predictive of safer sexual behavior. Analyses of sexually active, unmarried students' responses indicated that men expected more negative outcomes of condom use and were more likely to have sexual intercourse while under the influence of alcohol or other drugs, whereas women reported higher perceived self-efficacy to practice safer sex. Regression analyses indicated that, among the factors assessed, stronger perceptions of self-efficacy to engage in safer behavior, expecting fewer negative outcomes of condom use, and less frequency of sex in conjunction with alcohol or other drug use significantly predicted safer sexual behavior. Enhanced self- efficacy to discuss personal history with a new partner was associated with a greater number of risky encounters. Implications of these findings for intervention efforts with students are discussed.

Prediction of safer sex practice and psychosocial distress in adults with hemophilia at risk for AIDS.

OBJECTIVE: To determine which behavioral factors are predictive of consistent condom use and psychosocial distress in hemophilic adults at risk for AIDS. METHODS: A self-administered questionnaire was sent to all 975 identified persons with hemophilia in California in 1987-88. Items were designed to identify factors associated with decreasing transmission of HIV to partners and with psychosocial distress levels indicative of need for intervention. RESULTS: Analyses of data from 351 respondents indicate that only one-third report consistent condom use during vaginal intercourse. Predictors to consistent condom use were discussion of safer sex with partner, knowledge of HIV test results, and postponement of childbearing; these factors produced a cumulative R2 of .44. 24% of respondents indicated experiencing significant distress. Predictors to psychosocial distress were worrying about transmitting HIV, perceived chance of developing AIDS oneself, recreational drug use, and knowledge of HIV test results, again with a cumulative R2 of .44. CONCLUSION: Awareness of HIV+ sero-status appears to be linked both to safer sex practice and psychosocial distress, emphasizing the need for ongoing support to these individuals and their families. Couple communication and perceived risk of AIDS for self and others are key factors in coping with AIDS. A better understanding of the impact of the AIDS threat on partners and couple functioning, in order to facilitate communication and shared responsibility for risk reduction in couples, is needed.

Homosexual rituals and safer sex.

Safer sex for women.

This article focuses on safer sex counseling for the clinical practitioner. Current knowledge about the sexual transmission of HIV is summarized. High-risk sexual practices are identified, and safer sex guidelines are proposed. Suggestions are offered for counselling clients about risk assessment and safer sexual practices. Barriers to changing sexual behavior are identified, and strategies for addressing them in the clinical setting are proposed.

Safer sex in drug users: how to get it?

OBJECTIVES: Establish educational strategies to increase the adoption of safe sexual practices in a group of drug users--D.U.--from Sao Paulo city, from the identification of theirs beliefs, concepts and behavior patterns. METHODS: Two outreachworkers--ORWs--previously selected and trained identified 70 D.U. of alcohol and other drugs in one district of Sao Paulo city in 5 months, of continuous activity. Three places, such two bars and a leisure and cultural centre, were chosen to be the meeting point between the group of D.U. and the ORWs. In the 2nd month of the out reach work it started the analysis of the qualitative data, by the researches (2 psychiatrists, psychonalysts), which were supervising the ORWs from the beginning, and an anthropologist, based on: 1) the anthropologist 40 hours field work 2) analysis of the daily written reports from the ORWs 3) analysis of 17 D.U. life histories reported by the ORWs and the anthropologist 4) analysis of 22 written reports of the psychological supervision RESULTS: 6 aspects were selected as significant to identify the population in study: patterns of behavior in distinct subgroups, beliefs about death, AIDS and health care patterns of sexual behavior meeting points, appealing leisure activities and sociability behavior patterns related to work concepts and values related to drugs and drug use. DISCUSSION AND CONCLUSION: The specific educational strategies were: a music festival and the performance of a theater play, both capable to introduce deep discussions about sexual behavior in an atmosphere where entertainment and work are linked.

Sexual behavior, attitudes toward safer sex, and gender among a cohort of 244 recovering i.v. drug users.

Heterosexual contact with drug users is a major route of AIDS transmission. This study of 135 male and 109 female methadone maintenance patients described subjects' sexual behavior, preventive practices and attitudes toward safer sex; explored ethnic-racial differences in high risk sexual behavior and attitudes; and examined the relationship between attitudes toward safer sex and frequency of condom use for men and women. Reported condom use was low, and it correlated with attitudes toward safer sex. Men tended to report higher rates of sexual risk-taking, although women reported more frequent sex with IV drug users. Study findings have implications for developing intervention strategies to reduce risk behavior associated with HIV transmission.

A computer model to demonstrate the effectiveness of safe sex.

A simple computer model for use by health care workers, educators, public health planners and epidemiologists, which demonstrates the importance of practicing safe sex, is described. Users of the model estimate the average percentage of time the population practices safe sex, resulting in a computer generated plot of the size of the HIV-, HIV+, and AIDS populations over time. By plotting the difference in population sizes for varying values of this estimate, users are presented with strong visual evidence that practicing safe sex 100% of the time is necessary, as small variances produce large differences in the progression of the simulated epidemic. TABULAR DATA, SEE ABSTRACT VOLUME.

Safe sex? Misconceptions, gender differences and barriers among injection drug users: a focus group approach.

Heterosexual transmission is one factor involved in the spread of the human immunodeficiency virus (HIV) within the injection drug use (IDU) population and between IDU and non-IDU individuals. Insufficient information is currently available to reduce this heterosexual transmission. As a basis for designing a questionnaire aimed at the IDU population, we conducted 5 focus groups to collect information on knowledge of and attitudes toward safe sex as held by male and female IDUs in methadone treatment. We identified misconceptions related to HIV infection, condoms, and sexual behavior. We also found gender-based differences in knowledge and learning style. Also, while individuals felt a responsibility to prevent HIV transmission, they lacked sufficient control to do so. The wide range of responses on questions concerning sexually transmitted diseases (STDs), condoms, reproductive decisions, and methods of promoting safe sex provides a basis for developing a questionnaire designed to identify and target specific subgroups for educational intervention.