Determinants of High Risk Sexual Behavior: The Advocate Study of Gay Men

AIDS has become a ubiquitous disease of catastrophic proportions. In this 'sex study' included as part of the Advocate magazine in 1994, attitudes and sexual activities of 13,000 gay men nationwide were surveyed. A set of research hypotheses were made, these were: that there would be a relationship between various sociodemographic, intepersonal and relational, substance use, sexual, experiential, and health care variables and high-risk sexual behavior. Some of these hypotheses were confirmed, while others were not. The particular value of this study is that it was nationwide, contained large numbers of participants and large numbers of variables, included all sizes of metropolitan areas, and specifically defined high-risk sexual activity.

While many of the results confirm previous studies, the constellation and clustering of results perhaps points to issues larger than HIV and high-risk sexual behaviors alone, issues that are fundamentally societal. It is hoped that basic societal changes in attitudes towards gay men and women will reduce the isolation, loneliness, and feelings of being different that may well underlie the high rates of drug use and the meaning of the nature of sexual activity that is often present in gay community. It is at this fundamental societal level that progress against AIDS will need to proceed.

Abstract: AIDS has become a ubiquitous disease of catastrophic proportions, which directly or indirectly affects all humans. In this 'sex study' included as part of the Advocate magazine in 1994, attitudes and sexual activities of 13,000 gay men nationwide were surveyed. The literature strongly suggests that age, specifically younger age, is a risk factor for unsafe sex in United States. Regarding disclosure of being gay to others, the data are somewhat inconclusive. Income may relate to unsafe sex. If anything, those who are HIV-seropositive appear to practice safe sex more often than those who are not. Racial variables appear significant, with Blacks and Latinos becoming a substantially higher percentage of new HIV cases than those who are White. Those who were more highly educated appear to take fewer risks. Certain occupational groups may also have a higher incidence of risk-taking behaviors. Religion or spirituality perhaps do not appear to relate to high-risk behavior. Size of metropolitan area, small towns specifically, has been shown to be a substantial risk factor. The use of drugs and alcohol is clearly related to the incidence of high-risk sexual behavior. Abuse or coercion may be a factor in unsafe sex, but at the same time many of those in this category also have problems with substance abuse and selling sex for drugs or money. The relationship issue is a very complex one. Those in relationships who have a primary partner have a higher incidence of unsafe sex, even though both may not be monogamous, and may not be aware of the HIV serostatus of their partner. Connection to the gay community has had many different definitions, but it may be that those who have more contact with the gay community may also have more opportunity to engage in sex and a higher incidence of unsafe sexual behavior. There is too little data on masturbation to determine if it is an ameliorating factor regarding high-risk sexual activity. Attitudes towards condom use are a powerful predictor of high-risk sexual activity. Prostitution is often linked with substance abuse and sexual abuse and unquestionably leads to a higher level of risk-taking activities.

The particular value of this study is that it was truly nationwide, contained large numbers of participants and large numbers of variables studied, included all sizes of metropolitan areas, and specifically defines high-risk sexual activity as anal sex to the point of ejaculation inside the rectum without the use of a condom. While many of the results confirm previous studies, the constellation and clustering of results perhaps points to issues larger than HIV and high-risk sexual behaviors alone, issues that are fundamentally societal. These issues have to do with individuation, development of ego strength, feelings of self-esteem and self-worth, and the safety of youth to self identify both privately and publicly as gay. It is hoped that basic societal changes in attitudes towards gay men and women will reduce the isolation, loneliness, and feelings of being different that may well underlie the high rates of drug use and the meaning of the nature of sexual activity that is often present in gay community. It is at this fundamental societal level that progress against AIDS will need to proceed.