Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.
San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Tuesday, March 18, 1997 - Page A15
David Tuller, Chronicle Staff Writer
The study of 92 men suggests that those who engage in unprotected anal sex often do so not because of a lack of condoms or poor awareness of HIV but because of misguided assumptions about whether their partners are infected. Many of the gay men in the study often guessed at what a partner's HIV status might be based on such factors as his living conditions, physical appearance, whether HIV-related drugs were visible and whether he talked about his future.
"To ask or say whether you're sero-positive or sero-negative is to swim upstream in the gay male culture, and I think we in the gay community need to discuss why we have this difficulty," said Ron Stall of the Center for AIDS Prevention Studies (CAPS) of the University of California at San Francisco, which conducted the study.
The study also supports what many AIDS educators have been saying for several years: that one- dimensional safe-sex messages are not always effective in overcoming the complex emotional and social factors that affect sexual activity. Some AIDS prevention groups rely less on providing extensive information about condoms in favor of addressing deep-rooted psychological issues and encouraging open discussion among sexual partners.
The AIDS Foundation commissioned the study from CAPS last year. The study involved in-depth interviews with 92 gay and bisexual men from San Francisco and was designed to explore why some men still engage in unprotected anal sex despite the dangers.
The researchers found that gay men who reported having unsafe sex used condoms most of the time but occasionally did not. The unsafe episodes often occurred when the men were dealing with difficult personal issues, such as deaths of lovers and friends from AIDS, feelings of social isolation, a longing for intimacy and low self-esteem.
Sometimes, the study concludes, the need to alleviate psychological pain overwhelms rational judgment and leads men to engage in unsafe sex.
"The concern is not that many use sex to fulfill emotional needs but that when they do they are more inclined to engage in unsafe sexual practices," said MacArthur Flournoy, the AIDS Foundation's director of prevention. "More of those who placed themselves at risk were experiencing significant emotional difficulty and could not identify a way to deal with that pain in a manner that was not injurious to themselves."
AIDS educators estimate that up to half of the tens of thousands of gay and bisexual men in San Francisco are HIV-positive, and about 650 more are expected to become infected this year. While that represents a huge drop from the rate of new infections in the mid-1980s, it is much greater than the zero-infection rate that health officials want to see.
The AIDS Foundation and CAPS decided to release the results this week to coincide with the opening of the Ninth Annual AIDS Update Conference in San Francisco. The gathering begins today at the San Francisco Civic Auditorium and will include discussion panels on prevention, treatment, direct services and other HIV-related issues.
Another key focus of the study involved exploring why many men are able to practice safe sex consistently, over the course of a decade or more. In particular, said Stall, many HIV-positive men apparently maintain a strong sense of responsibility not to infect others.
"For some people, sex is about being out there on your own," he said. "For these men, it's about taking care of their partners and making sure that other people don't get hurt. They recognize that being sexually safe is a way of making sure that gay culture survives."
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