Sexual Risk Behaviors of STD Clinic Patients Before and After Earvin "Magic" Johnson's HIV-Infection Announcement -- Maryland, 1991-1992

During the human immunodeficiency virus (HIV) epidemic, media and public interest have been captured periodically by accounts of persons infected with HIV. However, the effect of these stories on HIV/acquired immunodeficiency syndrome (AIDS) awareness and sexual behaviors is largely unknown. On November 7, 1991, Earvin "Magic" Johnson announced at a press conference he was infected with HIV and would be retiring from professional basketball. This report summarizes findings on the self-reported sexually transmitted disease (STD)/HIV sexual risk behaviors of patients of an STD clinic in a Maryland suburb of Washington, D.C., during the 14 weeks before and the 14 weeks after Johnson announced he was infected with HIV.

The announcement occurred during the 15th week of a 29-week cross-sectional study comparing STD/HIV risk factors reported by STD clinic patients on self-administered questionnaires to those reported in face-to-face interviews. All patients eligible for the study attended a public STD clinic in suburban Maryland for STD-diagnostic and STD-treatment services. A random sample of patients was asked to participate in the study. To examine the effect of the announcement on reported sexual behavior, face-to-face interview data were analyzed because they were available for all study participants.

Of the 283 study participants, 186 (66%) were interviewed during the 14-week preannouncement period (July 29-November 1, 1991), and 97 (34%) during the 14-week postannouncement period (November 11, 1991-February 14, 1992). Overall, participants were predominantly male (170 {60%}) and black (206 {73%}) and had at least a high school diploma (240 {85%}); the mean age was 25.1 years. Overall, 87 (31%) had had one or more STDs during the previous 12 months; 220 (78%), two or more sex partners during the previous 12 months; and 157 (55%), 10 or more sex partners during the previous 10 years. STD clinic patients interviewed before and after the announcement showed no substantial differences in the demographic characteristics, self-reported STD histories, or sexual behaviors measured over longer periods.

To compare reported STD/HIV sexual risk behaviors during the preannouncement and postannouncement periods, self-reports of four sexual behaviors were analyzed (Table 1). No significant differences occurred in patients' reports of condom use during vaginal sex either with their steady or with nonsteady sex partners during the previous 3 months. However, significantly fewer patients in the postannouncement period than in the preannouncement period reported having had either "one-night stands" (20% versus 31% {chi-square=4.1; p=0.04}) or three or more sex partners of the opposite sex (21% versus 32% {chi-square=4.2; p=0.04}) during the previous 3 months. For both of these behaviors, the percentages of patients reporting them was lower during the last 2 weeks of the postannouncement period (i.e., a full 3 months or more after the announcement) than during the first 12 weeks of the postannouncement period.

The trend toward fewer sex partners in the postannouncement period occurred for both sex and race groups (Figure 1). However, the difference in the number of sex partners between the postannouncement and preannouncement periods occurred only for the older patients (i.e., aged 25-48 years) (8% versus 31%, respectively {chi-square=9.7; p=0.002}). For younger patients (i.e., aged 16-24 years), no significant behavioral difference occurred between the two periods (35% versus 33%). The trend toward fewer "one-night stands" in the postannouncement period was present for all race, sex, and age groups.

Reported by: B Boekeloo, PhD, L Schiavo, D Rabin, MD, Georgetown Univ School of Medicine, Washington, DC. C Jordan, MPH, JR Matthews, Montgomery County Health Dept, Silver Spring, Maryland. Behavioral and Prevention Research Br, and Clinical Research Br, Div of Sexually Transmitted Diseases and HIV Prevention, National Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Johnson intended that his announcement would alert the U.S. public, particularly young persons, about the dangers of unsafe sex (1). If differences in reported sexual behaviors between the preannouncement and postannouncement periods resulted from the announcement, the greatest impact seems to have been on the number and type of sex partners rather than on condom use.

This survey is subject to several limitations. First, the patients were asked questions about sexual behaviors they had practiced "during the last 3 months." Only 24 of the 97 patients in the 14-week postannouncement group actually were asked the questions a full 3 months or more after the announcement. However, these 24 patients had a lower frequency of having "one-night stands" or having three or more sex partners than the 73 patients interviewed during the first 3 months after the announcement. Second, findings are based on self-reported sexual behaviors; the patients may have reported, but not actually practiced, safer sexual behaviors. However, the lack of substantial differences in self-reported condom use suggest that this limitation was minimal. Third, the study population comprised STD clinic patients who likely engaged in sexual risk behaviors. As a result, any difference in risk behaviors between the preannouncement and postannouncement periods would be expected to be minimal. However, these data show significant differences in two of four sexual risk behaviors.

Other studies suggest Johnson's announcement increased HIV/AIDS awareness (2), HIV/AIDS concerns (3), intentions to adopt or maintain safer sexual behaviors (4), demand for HIV-antibody testing (5), and telephone calls to CDC's National AIDS Hotline (6). However, this is the first published report showing the potential effect of an HIV/AIDS media story on reported sexual behavior. These data suggest that messages about HIV risks stemming from the HIV-infection announcement of a highly visible person were associated with reductions in certain sexual risk behaviors in this STD clinic population.

References

1. Atlanta Journal/Atlanta Constitution. A portion of the transcript of Magic Johnson's news conference on November 7, 1991, as recorded by the Associated Press. Atlanta: Atlanta Journal/Atlanta Constitution, November 8, 1991.

2. Kalichman SC, Hunter TL. The disclosure of celebrity HIV infection: its effects on public attitudes. Am J Public Health 1992;82:1374-6.

3. Rapkin B, Mantell JE, Tross S, Ortiz-Torres B. Do you believe in Magic?: the public health consequences of Magic Johnson's announcement for inner-city women {Abstract}. Vol 1. VIII International Conference on AIDS/III STD World Congress. Amsterdam, July 19-24, 1992:Th70.

4. Rugg D, Banspach S, Short L. Changes in behavioral intentions among adolescents following HIV disclosure by a national sports celebrity {Abstract}. Vol 1. VIII International Conference on AIDS/III STD World Congress. Amsterdam, July 19-24, 1992:Th70.

5. Gellert G, Weismuller P, Higgins K, Maxwell R. Disclosure of AIDS in celebrities. N Engl J Med 1992;327:1389.

6. CDC. HIV/AIDS prevention fact book, FY 1992. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, Office of Director, HIV/AIDS, March 1992:024.

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