                           AIDS NEWS SERVICE
                      Michael Howe, MSLS, Editor
                        AIDS Information Center
                   VA Medical Center, San Francisco
                        (415) 221-4810 ext 3305
                           December 23, 1994

                 Safer Sex: Information for Counselors
                              (Part XIV)

                 References - Behavior and Counseling
                       (Arranged Alphabetically)

AU  - Bolton R ; Vincke J ; Mak R ; Dennehy E
TI  - Alcohol and risky sex: in search of an elusive connection.
AB  - 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.
SO  - Med Anthropol. 1992 May;14(2-4):323-63.

AU  - Booth R ; Watters J
TI  - Factors associated with safer sex and needle hygiene among
drug users in eight USA cities.
AB  - 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. 
SO  - Int Conf AIDS. 1993 Jun 6-11;9(2):707 (abstract no.
PO-C15-2943).

AU  - Boucher EC ; Krijnen P ; van den Hoek JA ; Coutinho RA
TI  - Bisexuality and safe sex practice in homosexual men in
Amsterdam, The Netherlands.
AB  - 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.
SO  - Int Conf AIDS. 1992 Jul 19-24;8(2):C273 (abstract no. PoC
4173).

AU  - Costigliola P ; Di Bari MA ; Fulgaro C ; Coronado O ; Ricchi
E ; Chiodo F
TI  - Sexual behavior after safe sex counseling in stable
heterosexual partners of HIV+ subjects.
AB  - 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.
SO  - Int Conf AIDS. 1993 Jun 6-11;9(2):689 (abstract no.
PO-C11-2830).

AU  - Crosby GM ; Paul J ; Barrett D ; Midanik L ; Stall R
TI  - Gay male substance abusers who only have safer sex.
AB  - 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.
SO  - Int Conf AIDS. 1993 Jun 6-11;9(2):696 (abstract no.
PO-C12-2873).

AU  - Davies PM
TI  - Safer sex maintenance among gay men: are we moving in the
right direction? [editorial]
SO  - AIDS. 1993 Feb;7(2):279-80.

AU  - de Vroome EM ; Sandfort TG
TI  - Full-, selective-, and no safe sex among a cohort of Dutch
gay men.
AB  - 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.
SO  - Int Conf AIDS. 1993 Jun 6-11;9(2):818 (abstract no.
PO-D06-3605).

AU  - DeBrow ME
TI  - Practicing safer sex.
SO  - Imprint. 1989 Feb-Mar;36(1):55-6.

AU  - DeBrow ME
TI  - Safer sex.
SO  - Imprint. 1988 Feb-Mar;35(1):33-6.

AU  - DiIorio C ; Parsons M ; Lehr S ; Adame D ; Carlone J
TI  - Knowledge of AIDS and safer sex practices among college
freshmen.
AB  - 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.
SO  - Public Health Nurs. 1993 Sep;10(3):159-65.

AU  - Dowsett GW
TI  - Sustaining safe sex: sexual practices, HIV and social
context.
SO  - AIDS. 1993;7 Suppl 1:S257-62.

AU  - Ekstrand M ; Stall R ; Kegeles S ; Hays R ; DeMayo M ; Coates
TI  - Safer sex among gay men: what is the ultimate goal?
[editorial]
SO  - AIDS. 1993 Feb;7(2):281-2.

AU  - Frosner GG
TI  - How efficient is safer sex in preventing HIV infection?
SO  - Infection. 1989 Jan-Feb;17(1):1-3.

AU  - Frutchey C ; Blankenship W ; Stall R
TI  - Ability to envision a future predicts safe sex among gay men.
AB  - 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. 
SO  - Int Conf AIDS. 1993 Jun 6-11;9(2):815 (abstract no.
PO-D06-3585).

AU  - Gomez CA ; Marin BV
TI  - Can women demand condom use? Gender and power in safe sex.
AB  - 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.
SO  - Int Conf AIDS. 1993 Jun 6-11;9(2):801 (abstract no.
PO-D03-3502).

AU  - Gotzsche PC ; Hording M
TI  - Condoms to prevent HIV transmission do not imply truly safe
sex.
AB  - 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.
SO  - Scand J Infect Dis. 1988;20(2):233-4.

AU  - Gruer I ; Cowan L ; Elliott I ; Farrow K ; Henderson A ;
Sloan D
TI  - A safer sex campaign at an international airport.
AB  - 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.
SO  - Int Conf AIDS. 1993 Jun 6-11;9(2):781 (abstract no.
PO-C34-3384).

AU  - Hart GJ ; McClean J ; Boulton M ; Dawson J ; Fitzpatrick R
TI  - Maintenance and change in safer sex behaviours in a cohort
of gay men in England.
AB  - 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.
SO  - Int Conf AIDS. 1991 Jun 16-21;7(2):422 (abstract no.
W.D.4139).

AU  - Hernandez-Avila M ; DeCaso L ; Rocha A ; Gortmaker S ; Avila
C ; Mueller N ; Sepulveda A
TI  - Sexual behavior modification by means of safe sex workshop
in HIV/AIDS prevention.
AB  - 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. 
SO  - Int Conf AIDS. 1991 Jun 16-21;7(2):414 (abstract no.
W.D.4106).

AU  - Hobfoll SE ; Jackson AP ; Lavin J ; Britton PJ ; Shepherd JB
TI  - Safer sex knowledge, behavior, and attitudes of inner-city
women.
AB  - 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. 
SO  - Health Psychol. 1993 Nov;12(6):481-8.

AU  - Jones L
TI  - Unsafe sex & other risky behavior. Why?
AB  - 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.
SO  - Int Conf AIDS. 1992 Jul 19-24;8(3):214 (abstract no. PuD
9091).

AU  - Kaplan MH ; Farber B ; Hall WH ; Mallow C ; O'Keefe C ;
Harper RG
TI  - Pregnancy arising in HIV infected women while being
repetitively counseled about safe sex.
AB  - 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. 
SO  - Int Conf AIDS. 1989 Jun 4-9;5:222 (abstract no. M.B.P.4).

AU  - Madhok R ; McCallum AK ; McEwan R ; Bhopal RS
TI  - Students' knowledge and behavior concerning safer sex: a UK
study.
AB  - 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.
SO  - J Am Coll Health. 1993 Nov;42(3):121-5.

AU  - Messiah A ; Bucquet D ; Mettetal JF ; Larroque B ; Rouzioux
TI  - 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. 
AB  - 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. 
SO  - Sex Transm Dis. 1993 Jan-Feb;20(1):51-8.

AU  - Moore S ; Rosenthal D
TI  - The social context of adolescent sexuality: safe sex
implications.
AB  - 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.
SO  - J Adolesc. 1992 Dec;15(4):415-35.

AU  - Morales R ; Luna F
TI  - Safer sex among men who have sex with men.
AB  - 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.
SO  - Int Conf AIDS. 1992 Jul 19-24;8(2):C363 (abstract no. PoC
4721).

AU  - Moss G ; Clemetson D ; D'Costa LJ ; Maitha GM ; Reilly M ;
Ndinya-Achola JO ; Plummer FA ; Kreiss JK
TI  - Despite safer sex practices after counselling, seroconversion
is high among HIV serodiscordant couples in Nairobi, Kenya.  
AB  - 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. 
SO  - Int Conf AIDS. 1991 Jun 16-21;7(2):325 (abstract no.
W.C.3119).

AU  - Nostlinger C ; Wimmer-Puchinger B ; Barth M ; Bauer E
TI  - Promoting safe sex and sexual health to socially
disadvantaged young women and girls.
AB  - 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.
SO  - Int Conf AIDS. 1992 Jul 19-24;8(2):D461 (abstract no. PoD
5446).

AU  - O'Leary A ; Goodhart F ; Jemmott LS ; Boccher-Lattimore D
TI  - Predictors of safer sex on the college campus: a social
cognitive theory analysis.
AB  - 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. 
SO  - J Am Coll Health. 1992 May;40(6):254-63.

AU  - Parish KL ; Mandel J ; Thomas J ; Gomperts E
TI  - Prediction of safer sex practice and psychosocial distress
in adults with hemophilia at risk for AIDS.
AB  - 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. 
SO  - Int Conf AIDS. 1989 Jun 4-9;5:421 (abstract no. Th.B.P.33).

AU  - Pollak M
TI  - Homosexual rituals and safer sex.
SO  - J Homosex. 1993;25(3):307-17.

AU  - Raisler J
TI  - Safer sex for women.
AB  - 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. 
SO  - NAACOGS Clin Issu Perinat Womens Health Nurs. 1990;1(1):
28-32.

AU  - Reale D ; Cavallari C ; Czeresnia I ; Ferreira A ; Torres L
TI  - Safer sex in drug users: how to get it?
AB  - 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.
SO  - Int Conf AIDS. 1992 Jul 19-24;8(3):225 (abstract no. PuD
9156).

AU  - Schilling RF ; el-Bassel N ; Schinke SP ; Nichols S ; Botvin
GJ ; Orlandi MA
TI  - Sexual behavior, attitudes toward safer sex, and gender among
a cohort of 244 recovering i.v. drug users.
AB  - 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.
SO  - Int  J Addict. 1991 Aug;26(8):859-77.

AU  - von Konsksy BR
TI  - A computer model to demonstrate the effectiveness of safe
sex.
AB  - 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.
SO  - Int Conf AIDS. 1991 Jun 16-21;7(2):419 (abstract no.
W.D.4124).

AU  - Weiss SH ; Weston CB ; Quirinale J
TI  - Safe sex? Misconceptions, gender differences and barriers
among injection drug users: a focus group approach.
AB  - 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.
SO  - AIDS Educ Prev. 1993 Winter;5(4):279-93.


                      CONDOM DEMONSTRATION MODELS

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Kimball, Skokie, IL 60076. (800) 621-7500.

Ansell Medical Products, P.O. Box 1252, Dothan, AL 36302. (800)
327-8659.

Exodus Trust, 1523 Franklin Street, San Francisco, CA 94109. (415)
928-1133.

Health Edco, P.O. Box 21207, Waco, TX 76702-1207. (800) 299-3366.

Malibu Sales, P.O. Box 4371, Los Angeles, CA 80078. (213) 871-
1225.

                     AMA Given Contract to Develop
                    Physicians' HIV Prevention Kit

      A physician HIV prevention kit to assist primary care
physicians in changing behavior techniques among their patients is
to be developed by the American Medical Association (AMA) under a
$75,000 grant from the Centers for Disease Control and Prevention
(CDC).
      According to CDC, the kit and materials "will encompass a wide
range of information and behavior change support for patients." 
It is to include information on behavioral techniques for the
sexually active and for the abstinent, brochures, a condom
demonstration item, and a behavior change diary.
      The one-year project, expected to begin September 30, 1994,
is the result of an unsolicited proposal by the AMA and will be
conducted through a yet-to-be selected state medical society.  The
demonstration is to train 100 to 200 primary care physicians in the
use of the kit.
      Information on the project is available from Elizabeth M.
Taylor, grants management officer, Grants Management Branch, CDC,
255 East Paces Ferry Road N.E., Room 305, Mailstop E-16, Atlanta,
GA 30305; (404) 842-6640.  Refer to Announcement No. 399. (AIDS
Policy & Law, 1994 September 16;9(17):7.)
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