NYC study of gay men offers outreach, education

HIV rate is low, and safer sex is status quo

A recent study in New York City of the sexual behavior of gay and bisexual men shows that communities can successfully combine data-collecting efforts with outreach services and education to target a specific population for HIV prevention.

The survey was administered on New York City streets by a large group of volunteers with the Gay Men’s Health Crisis (GMHC), a New York City-based AIDS advocacy group. Called the GMHC HIV Prevention Department 1998 Gay and Bisexual Men Sexual Health Survey, it included self-reports of sexual behavior by 7,065 men.

This type of grass-roots survey could be modified for use among minorities, teen-agers, injecting drug users, and other at-risk populations for which more data are needed before communities launch new prevention campaigns.

The GMHC survey results brought good news to the HIV/AIDS community: 89% of the men surveyed said they had taken an HIV test, and only 13% of the men surveyed said they had tested positive for HIV.

While it was the first large-scale study of its kind in New York City, previous surveys conducted in cities like San Francisco in the 1980s have placed the percentage of HIV-positivity among gay men at 50%.

Also, the survey showed that 78% of men reported using a condom during their first anal intercourse, which is more than double the 34% who reported the same practice in 1985.

While newspaper reports of the survey focused on the fact that 39% of the men said they had engaged in unprotected anal intercourse within the past year, researchers say this doesn’t tell the whole story with regard to safe-sex practices.

Only 11% of the men surveyed reported having unprotected anal intercourse with a person whose HIV status was different from their own or whose HIV status was unknown, says Tracy Mayne, PhD, director of epidemiology and surveillance for the New York City HIV/AIDS Prevention Plan ning Group. Mayne was a prin cipal investigator for the survey.

"What’s really important is even if we look at the 39%, we find that these men are more likely to be having unprotected intercourse with a single partner," Mayne says. "So if two men get together and form a monogamous relationship, and they’re both sero-negative, should we call that risky if they’re having unprotected intercourse?" Mayne compares that type of behavior to married couples who don’t use condoms during sexual intercourse.

Gay men report having fewer partners

And the New York gay men reported having fewer sexual partners than gay men have reported in previous studies. About 60% of white gay men reported having five or fewer partners in the past year, while 80% of black men reported having five or fewer partners, and 75% of Latinos reported the same. Gay men reporting having zero or only one partner in the past year were 30% for whites, 36% for blacks, and 37% for Latinos, Mayne says. (See story on the survey’s results, p. 104.)

The survey even compared the prevalence of HIV-positive men choosing to be receptive partners during unprotected anal intercourse, and found that even when practicing unprotected anal intercourse, men are choosing positions that are less likely to transmit HIV, Mayne says.

"There are definitely cultural norms about safer sex that exist now, and those norms certainly have changed [since AIDS]," Mayne says. "We have better success in getting people to use safer sex practices than we do to get people to floss their teeth."

The GMHC survey served dual purposes, both collecting data that could be used to track trends and direct HIV prevention efforts and providing outreach and education to gay men. Nearly 93% of the men who turned in a survey had filled it out entirely and correctly.

"The fact that we had over 7,000 men fill out that survey is remarkable, and, in itself, groundbreaking," says Bob Bergeron, CSW, director of HIV prevention for GMHC.

"Research done in New York for gay men has not always been helpful for us in HIV prevention because of limitations of research size and difficulties getting to diverse populations," Bergeron says. "We reached what researchers have labeled difficult-to-reach populations, and we have a diverse scope in the survey by race and age, with our youngest person surveyed age 12 and the oldest 88."

The survey demonstrates that AIDS prevention efforts targeted at gay men have been successful in the United States, says Ron Stall, PhD, an associate professor at the University of Califor nia-San Francisco and a researcher at the Center for AIDS Prevention Studies in San Francisco.

"When you compare the disease trajectory among gay men in New York or San Francisco to that of the heterosexual populations in Asia, Africa, or India, the difference is striking," Stall says. "In those other countries, the HIV prevalence rates over the past 15 years have doubled and doubled, while the prevalence rates among gay men [in the United States] have gone down."

Another important aspect of the GMHC study is that because of its size, it will be very useful for researchers who want to conduct analyses of very specific groups of gay men, such as minority populations, Stall says.

"The usual sample size is, if you’re lucky, 500 to 1,000 gay men, and it’s impossible to do subanalyses of Asian/Pacific Islanders or other groups," he explains.

The survey included 225 Asian/Pacific Islander men, a larger sample size than most studies have found when specifically targeting this group.

A volunteer effort

Here’s how GMHC conducted the survey and provided outreach and education to the target population:

GMHC enlisted more than 2,000 volunteers to distribute the survey in neighborhoods, at bath houses, parties, clubs, and other places frequented by gay men between June 1, 1998, and Nov. 1, 1998. They also attended Gay Pride parades and festivals held in each of New York City’s boroughs. Volunteers included HIV-positive and negative gay men, and GMHC tried to match volunteers’ ethnicity to their target population, sending black and Hispanic volunteers to neighborhoods populated by their ethnic groups. About 5% of the surveys were written in Spanish.

Volunteers worked in teams of three, with one person carrying a box in which surveys could be placed. They wore T-shirts identifying themselves as part of the GMHC "Beyond 2000 Sexual Health Survey" initiative. When volunteers passed out the one-page, one-sided, 8-inch by 14-inch anonymous survey, they asked men to "take three minutes to answer 20 questions."

Volunteers handed survey respondents pencils and cardboard to write on so they could continue to stand. The pencils had GMHC’s phone number, and the men were asked to keep the pencil. Also, volunteers carried a tool belt of HIV prevention items including condom packs.

The survey’s questions concerning sexual activity used graphic street vernacular. According to volunteers, the surveys themselves often sparked discussions about safe sex and HIV, Bergeron says. "We provided consciousness-raising about their behaviors through the survey."

The survey included validity questions asking for the same information in different ways to ensure consistency. The survey also included questions about drug use, race, education, condom use at first intercourse, and other topics.

One of the survey’s chief limitations is that it targeted areas and gay events where men were likely to identify themselves as gay, so it didn’t include a large representation of men who have sex with men but don’t call themselves "gay" or "bisexual." Also, more than one-third of the surveys were completed in locations where an admission was charged or where it’s expensive to visit, such as the community of Fire Island, so the survey also is likely to underrepresent lower socioeconomic classes.

"We tried to go to a wide range of events that allowed us to reach a large representation of gay men," Bergeron says. "That was a priority to us, to reach a diverse group of gay men."

GMHC will continue the survey, which will give researchers a comparison study. And the 1999 survey will ask even more detailed questions regarding safe-sex practices. For example, one new question will be a follow-up to the question about the HIV status of the gay man’s partners.

"We’re asking them, "How do you know? Did you ask them their HIV status? Did you have a test together, or did you see the test report?" Mayne says.