Sexual scripts’ help MSM discuss safer sex

Intervention study conducted at 13 sites

Project Community Intervention Trial for Youth (CITY), funded by the Centers for Disease Control and Prevention (CDC), is studying a prevention project that teaches young men who have sex with men (MSM) how to discuss and negotiate safer sex. How at-risk MSM communicate with partners about sex is an important part of an intervention strategy because some preliminary findings indicate that young MSM do not consistently include safer-sex negotiations and behavior in their sexual script, a term that researchers use to indicate patterns of behavior that lead to sex.1

"When interviewing young MSM about their needs and safer-sex behavior, we asked if they had ever had anal sex with or without condoms and oral sex with condoms," says David Seal, PhD, associate professor at the Center for AIDS Inter-vention Research at the Medical College of Wisconsin in Milwaukee. "If they said, Yes,’ we had them tell us about the last time they did that behavior. We were trying to understand the context of how these interactions unfolded for the young people," he explains.

So investigators asked the men these types of questions:

  • Who were your partners?
  • What were your motivations?
  • How were you aroused?
  • Was safer sex discussed?
  • Did you know your partner’s serostatus?
  • What were your motivations in these interactions?
  • Were you seeking intimacy or driven by passion?
  • Was the sex coercive?

Interestingly, researchers found that when the man was motivated by emotional intimacy and feelings of love, trust, and feeling close to a partner, he was more likely to engage in anal sex without a condom, Seal says. Alternatively, when men reported being motivated by passion and were engaged in casual sexual encounters with partners they didn’t know well, they were more likely to engage in oral sex with a condom, he adds. "The findings that were most troubling for us were that 5% of the narratives involved anal sex in what we would consider rape or highly coercive," Seal says.

Through this preliminary research, investigators began to understand what needed to be addressed in an intervention. Prevention strategies were created to address different scenarios with the goal of helping at-risk men make decisions that will make their sex safer, he says.

The CITY project, conducted at 13 sites nationwide, includes comparison groups at half of the sites. Sites using the intervention model have five components:

1. Community health advocate training. Participants are trained to be community health advocates through political or safe-sex education work. Training helped to build their HIV-prevention knowledge and skills, manage risk triggers, and find strategies for talking about HIV risk reduction with peers.2

2. Marketing campaigns. Marketing campaigns include fliers of safer-sex practices to distribute at bars and coffee shops.

3. HIV social events. Dances and other events are sponsored with safer sex incorporated into the social program.

4. Group workshops. Small group workshops involving peer networks are held in a traditional fashion.

5. Community capacity development. This involves working with youth organizations that have not previously worked with MSM youth. "We worked with an African-American provider to develop a training institute on MSM of color," Seal says. "We planned and hosted a conference of 100 people devoted to MSM of color and had national speakers come in, as well as local presentations."

None of these interventions are new, Seal notes. "But we hope for a synergistic effect."

Some of the capacity building already under way has resulted in training workshops and new services directed toward gay or lesbian populations. One project involved a drag queen show in which the performance was followed by safer sex education. "You’re reaching people for HIV prevention information in a relaxed, non-HIV way," Seal says. "There’s also a youth group called Project Q that is totally youth-driven, and we hold joint events, [such as] dances with a safer-sex theme, with them," he says. Through each of these programs and interventions, the objective is to encourage at-risk youth to change their current sex script for a sex script that naturally leads to safer sexual behavior.

The project’s goal is to obtain measurable improvements in risk reduction among young MSM in the communities where the intervention project is employed, Seal says. "Big studies in the last couple of years show that HIV seroprevalence rates are rapidly rising among young MSM, particularly in communities of color, and for all of us who work with the population that certainly is a cause of concern," Seal says. "We’re hoping to see a reduction in risk behavior in the project’s surveys."

References

1. Stevenson LY, Seal DW, Peterson JL, et al. Sexual and safer sex scripts among young men who have sex with men. Presented at the 14th International AIDS Conference. Barcelona, Spain; July 2002. Abstract: TuOrE1241.

2. Stevenson LY, Seal DW, Coley BI, et al. Presented at the 14th International AIDS Conference. Barcelona, Spain; July 2002. Abstract: MoPeD3541.