Condom Use and Sexual Identity Among Men Who Have Sex With Men -- Dallas, 1991

Safer sex practices intended to reduce the risk for human immunodeficiency virus (HIV) infection have been vigorously promoted among men who are homosexual or bisexual (i.e., men who have sex with men). Such efforts have emphasized personal responsibility and protection of partners, and many of these men appear to have adopted risk-reducing behaviors (1). However, it is unknown whether these safer sex practices and norms have been adopted by men who have sex with men but conceal their sexual orientations or do not self-identify as homosexual or bisexual (2- 7). To characterize the relation between the adoption of safer sex practices among men who have sex with men and sexual self-identity, as well as HIV information-seeking, exposure to the homosexual or bisexual community culture, and comfort in disclosing sexual identity, the Dallas County (Texas) Health Department (DCHD) conducted a survey among men who have sex with men. This report summarizes survey findings for men who reported having had sex with men and who visited DCHD clinics for anonymous HIV counseling and testing from January through June 1991.

During the survey period, a self-administered questionnaire was provided to all men who were waiting to see a counselor. Only those men who reported ever having had anal sex with a man (n=229 {42%} of 540) were included in this analysis. Reported condom use was assessed by one question regarding frequency of condom use while engaging in anal sex. The questionnaire also addressed respondents' self-perceived sexual identity (i.e., "straight" {i.e., heterosexual}, homosexual, or bisexual), frequency of seeking information on HIV/acquired immunodeficiency syndrome (AIDS), exposure to print media addressing homosexual issues (i.e., reading specific magazines), and comfort in disclosing having had sex with a man to family members.

The mean * score for frequency of reported condom use for men who had anal sex with men and self-identified as homosexual or bisexual (mean {M}=2.7; 95% confidence interval {CI}=2.5-2.9) was significantly higher than for men who had anal sex with men and self-identified as straight (M=0.9; 95% CI=0.4-1.5) (p<0.0001). The percentage of men who reported never using condoms was 64% for those self-identified as straight (11% of the sample, n="25)" compared with 16% for those self-identified as homosexual or bisexual (89% of the sample, n="203)" (p<0.001). The mean score for reported frequency of condom use for men who indicated that they often sought HIV/AIDS information in newspapers, brochures, or leaflets (M="2.8)" was significantly higher than for men who did not seek such information (M="2.3)" (95% CI for the difference between means="0.1-0.9," p<0.01).

Respondents' reported comfort ** in disclosing to family members that the respondents have had sex with a man correlated negatively with the consistency of condom use (r=-0.16, p<0.02) (i.e., men who felt more uncomfortable disclosing to family members tended to use condoms less consistently). Men indicating that they read materials dealing with homosexual issues used condoms more frequently (M="2.8;" 95% CI="2.6-3.1)" than those who reported not reading such materials (M="2.1;" 95% CI="1.9-2.4)" (p<0.001).

Reported by: AC Seibt, MEd, AL McAlister, PhD, Univ of Texas Health Science Center at Houston, Center for Health Promotion Research and Development. AC Freeman, MSPH, MA Krepcho, PhD, AR Hedrick, R Wilson, MFA, Dallas County Health Dept, Dallas. Behavioral and Prevention Research Br, Div of Sexually Transmitted Diseases and HIV Prevention, National Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: The findings in this report suggest that men who have anal sex with men but do not identify themselves as homosexual or bisexual are not adopting behaviors to reduce their risk for HIV infection with the same frequency as men who self-identify as homosexual or bisexual. Specifically, men who were clients of the DCHD and who sought information on HIV/AIDS and materials relating to homosexual issues (which may also reflect a connection to homosexual or bisexual culture) used condoms more consistently compared with men who did not seek this information. Consequently, men who had sex with men but did not self-identify as homosexual or bisexual may have been at greater risk for HIV infection than were men who were openly homosexual or bisexual.

Because the data in this report are based on a survey in a single facility and because of the limited sample size for self-identified straight men (n=25), these findings may not be generalizable. These findings do emphasize, however, that to reduce HIV transmission among men, public health officials may need to develop innovative outreach and risk-reduction strategies aimed at men who have sex with men but who do not self-identify as homosexual or bisexual. Surveys to further characterize the risk for HIV infection among this population are being conducted in Dallas; Denver; Long Beach, California; and Seattle (8).

References

1. Becker MH, Joseph JG. AIDS and behavioral change to reduce risk: a review. Am J Public Health 1988;78:394-410.

2. Beckstein DL. AIDS prevention in public sex environments. Santa Cruz, California: Santa Cruz AIDS Project, 1990.

3. Doll LS, Petersen LR, White CR, Johnson ES, Ward JW, The Blood Donor Study Group. Homosexually and non-sexually identified men who have sex with men: a behavioral comparison. The Journal of Sex Research 1992;29:1-14.

4. Humphreys L. Tearoom trade: impersonal sex in public places. New York: Aldine de Gruyter, 1970.

5. Kinsey AC, Pomeroy WB, Martin CE. Sexual behavior in the human male. Philadelphia: WB Saunders, 1948.

6. McKusick L, Coates TJ, Morin SF, Pollack L, Hoff C. Longitudinal predictors of reductions in unprotected anal intercourse among gay men in San Francisco: the AIDS Behavioral Research Project. Am J Public Health 1990;80:978-83.

7. Myrick F. Attitudinal differences between heterosexually and homosexually oriented males and between covert and overt male homosexuals. J Abnorm Psychol 1974;83:81-6.

8. O'Reilly KR, Higgins DL. The AIDS Community Demonstration Projects for HIV prevention among hard-to-reach groups. Public Health Rep 1991;106:714-20.

• Possible answers were: "never"=0, "almost never"=1,

"sometimes"=2, "almost every time"=3, "every time"=4 to the question, "When you have anal sex with a man, how often is a condom used?" ** Disclosure comfort was measured on a scale ranging from 1 to 5, where 1="very comfortable" and 5="very uncomfortable."

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