Predictors of Unprotected Anal Intercourse Among HIV-Positive Latino Gay and Bisexual Men

This study examined sexual behaviors in a sample of 155 HIV-positive Latino gay and bisexual men. Nearly half the sample had engaged in unprotected anal intercourse in the past 12 months; unprotected anal intercourse was more likely when the partner was also HIV-positive. Separate regression models predicted the number of receptive and insertive partners for unprotected anal intercourse. Participants reported both more unprotected insertive and receptive partners if they had sex under the influence of alcohol or drugs. Older participants and those with lower levels of Latino acculturation reported having more partners with whom they took the receptive role during unprotected anal intercourse, whereas those with higher levels of depression reported having more partners with whom they took the insertive role. Hierarchical set logistic regression revealed that the dyadic variable of seroconcordance added to the prediction of unprotected anal sex with the most recent male partner, beyond the individual characteristics. Results show the importance of examining both individual and dyadic characteristics in the study of sexual behavior.     

Seroadaptation in a Sample of Very Poor Los Angeles Area Men Who Have Sex with Men

Data from 635 very poor men who have sex with men (MSM) were used to identify seroadaptation with 1,102 male partners reported between 2005 and 2007 in Los Angeles as part of the Sexual Acquisition and Transmission of HIV Cooperative Agreement Program. The mean age of the sample was 41.7 years; 53 % had experienced homelessness in the past year. Condoms were reported in 51 % of sexual events involving anal intercourse. HIV seroconcordance was reported in 41 % of sexual partnerships among HIV-positive participants. HIV-positive men were more likely to have oral-only or unprotected receptive anal intercourse and less likely to have unprotected insertive anal intercourse with HIV-negative or unknown partners compared to HIV-positive partners. Even in the face of poverty, HIV-positive MSM report mitigating risks of HIV-transmission though seroadaptation in the context of modest rates of condom use.     

Comparison of sexual behaviors, unprotected sex, and substance use between two independent cohorts of gay and bisexual men

OBJECTIVE: To compare demographic characteristics, sexual practices, unprotected receptive and insertive anal intercourse, substance use and rates of HIV-1 seroconversion between two prospective cohorts of HIV-negative men who have sex with men. DESIGN: Comparative analysis of two independent cohorts. METHODS: Between May 1995 and April 1996, 235 HIV-negative Vanguard Project (VP) participants were enrolled and between January and December 1985, 263 HIV-negative participants in the Vancouver Lymphadenopathy AIDS Study (VLAS) completed a follow-up visit. The VP participants were compared with VLAS participants with respect to self-reported demographic variables, sexual behaviors, unprotected sex, substance use and rates of HIV-1 seroconversion during follow-up. RESULTS: In comparison with the VLAS participants the VP participants were younger (median age, 26 versus 34 years; P< 0.001), more likely to be non-Caucasian (75 versus 97%; P< 0.001), and were less likely to have attended university/college (35 versus 46%; P = 0.014). The VP participants reported a higher mean number of male sex partners in the previous year (15 versus 12; P= 0.026) and a higher mean number of regular partners (1.7 versus 0.6; P < 0.001). The VP participants were more likely to report engaging in receptive (92 versus 60%; P< 0.001) and insertive (90 versus 69%; P < 0.001) anal intercourse with regular partners and receptive anal intercourse with casual partners (62 versus 38%; P< 0.001). The VLAS participants were more likely to report never using condoms during insertive and receptive anal intercourse with both regular and casual partners. The VP participants were less likely to report using nitrite inhalants (34 versus 43%; P= 0.033), but more likely to report the use of cocaine (30 versus 8%; P< 0.001), LSD (21 versus 3%; P < 0.001), amphetamine (11 versus 1%; P< 0.001), heroin (3 versus 0%; P= 0.010) and methyldiamphetamine (17 versus 10%; P= 0.034). The VLAS participants were nine times more likely to report high-risk sexual behavior, after controlling for differences in age, ethnicity, substance use, and method of recruitment between cohort members. After adjustment for differences in demographics, sexual behaviors, and level of substance use, the risk ratio for seroconversion among VLAS participants remained significantly elevated compared with VP participants. CONCLUSION: These data provide evidence that men who have sex with men who were enrolled in the VP were more sexually active than their VLAS counterparts were 10 years ago as measured by self-reported numbers of regular and casual partners and frequency of anal intercourse with these partners. However, condom use appears to be significantly higher among VP participants, which has contributed to a lower rate of HIV-1 infection.     

Correlates of sexual risk behaviors among HIV-positive men who have sex with men.

This study examines correlates of unprotected sexual risk practices of an ethnically diverse sample of HIV-seropositive men who have sex with men (MSM) from the New York City and San Francisco metropolitan areas. Participants completed a self-report survey that assessed sexual risk behaviors and potential correlates. A total of 367 men reported sex with a casual male partner in the previous 3 months. Participants were divided into three groups based on level of HIV-transmission risk with HIV negative or unknown-status partners: no unprotected anal sex (58.9%), unprotected receptive anal sex only (14.2%), and unprotected insertive anal sex (22.6%). Multivariate logistic regression analyses indicated that men reporting unprotected anal insertive sex perceived less responsibility to protect their partners from HIV. Men reporting no unprotected anal sex also reported less use of nitrate inhalants, lower temptation for unsafe sex, and fewer HIV-negative and unknown-status partners. Men reporting unprotected receptive anal sex were less anxious than the other two groups but also reported greater depression than those not reporting unprotected anal sex and greater loneliness than those reporting unprotected anal insertive sex. Implications for interventions with HIV-positive MSM are presented.     

Correlates of unprotected anal intercourse in HIV positive men attending an HIV/AIDS clinic in Sydney

We examined the impact of cognitive and biomedical variables on unprotected anal intercourse between HIV-1 infected men and casual sexual partners in a Sydney-based cohort. Participants answered questionnaires examining insertive and receptive intercourse with and without ejaculation. They completed a modified optimism-scepticism scale, a sexual beliefs scale and a clinical/demographics questionnaire. CD4 count, blood and semen VL were assessed. 43 of 109 reported anal intercourse with HIV+ partners, 33 with HIV- partners and 38 with partners of unknown status. With HIV+ partners past sexually transmittable infections were associated with receptive intercourse without ejaculation (p = 0.03) and insertive intercourse without ejaculation (p = 0.06) while sexual beliefs were associated with insertive intercourse without ejaculation (p = 0.038), receptive intercourse with ejaculation (p = 0.016) and insertive intercourse with ejaculation (p = 0.077). Sexual beliefs were found to have some association with unprotected receptive intercourse without ejaculation with HIV- partners (p = 0.071). With unknown serostatus partners, treatment-optimism (p = 0.026) had association with insertive intercourse with ejaculation while optimism (p = 0.002), sexual beliefs (p = 0.039) and recent VL (p = 0.059) had associations with insertive intercourse without ejaculation. Current STI had association with receptive intercourse with ejaculation with unknown status partners (p = 0.014). We found between-group differences in variables associated with different types of unprotected anal intercourse that may guide the development of prevention strategies.     

Longitudinal Modeling of Methamphetamine Use and Sexual Risk Behaviors in Gay and Bisexual Men

The purpose of the analyses was to examine the associations between methamphetamine and other club drug use with sexual risk taking across time in cohort of gay and bisexual men. Data were collected from a community-based sample. Assessments of unprotected anal intercourse with casual partners, and use of methamphetamine and other illicit drugs, were assessed at baseline, and at 4-month intervals over the course of a year, and were analyzed using hierarchical linear modeling. Methamphetamine use was related to the frequency of unprotected insertive and receptive intercourse with both HIV-positive and status unknown casual partners across time. The association between methamphetamine use and unprotected acts also was more pronounced for HIV-positive participants. These findings suggest that methamphetamine, and unprotected anal intercourse are co-occurring risk behaviors, that potentially heighten the risk of HIV transmission among gay and bisexual men. HIV prevention and intervention should concurrently target both these behaviors.     

In a minority of gay men,sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex

The aim of this analysis was to examine gay men's sexual risk practice to determine patterns of risk management. Ten cross-sectional surveys of gay men were conducted six-monthly from February 1996 to August 2000 at Sydney gay community social, sex-on-premises and sexual health sites (average n = 827). Every February during this period, five identical surveys were conducted at the annual Gay and Lesbian Mardi Gras Fair Day (average n = 1178). Among the minority of men who had unprotected anal intercourse which involved ejaculation inside with a serodiscordant regular partner, there was a clear pattern of sexual positioning. Few regular couples were both receptive and insertive. Most HIV-positive men were receptive and most HIV-negative men were insertive. Among the minority of men who had unprotected anal intercourse which involved ejaculation inside with casual partners, there was also a pattern of sexual positioning. Whereas many casual couples were both receptive and insertive (especially those involving HIV-positive respondents), among the remainder HIV-positive men tended to be receptive and HIV-negative men tended to be insertive. These patterns of HIV-positive/receptive and HIV-negative/insertive suggest strategic risk reduction positionings rather than mere sexual preferences among a minority of gay men. If so, they point not to complacency but to an ever more complex domain of HIV prevention.     

The pleasure principle: the effect of perceived pleasure loss associated with condoms on unprotected anal intercourse among immigrant Latino men who have sex with men

Sexual pleasure has been identified as an important consideration in decision-making surrounding condom use. We examined the impact of perceived pleasure loss associated with condom use on recent history of insertive and receptive unprotected anal intercourse (UAI) among Latino men who have sex with men (MSM) living in the United States. A total of 482 Dominican, Colombian, and Brazilian immigrant MSM were surveyed regarding sexual attitudes and practices via computer-assisted self-interviewing technology with audio enhancement (ACASI). Participants rated the pleasure they derived from protected and unprotected anal intercourse in each position (insertive and receptive) and also reported their HIV status, relationship status, and recent sexual history. Men who had engaged in both positions, with and without condoms (n=268), perceived a greater pleasure loss associated with condoms during anal intercourse in the insertive versus receptive position. Logistic regression analyses controlling for HIV status, relationship status, and age revealed that men who perceived greater pleasure loss from condoms were more likely to have engaged in UAI over the past 3 months (n[insertive]=297; n[receptive]=284). Findings indicate that the pleasure loss associated with condoms may be a key deterrent for their use in either sex position among Latino MSM. Therefore, pleasure needs to be prioritized in the development of condoms and other sexual safety measures as well as in the promotion of their use.     

HIV-associated risk factors among young Canadian Aboriginal and non-Aboriginal men who have sex with men.

Young Aboriginal men face marginalization distinct in cause but similar in pattern to those seen among men who have sex with men (MSM) and may be at increased risk for HIV infection. We compared sociodemographic characteristics and risk taking behaviours associated with HIV infection among MSM of Aboriginal and non-Aboriginal descent. Data for this comparison were gathered from baseline questionnaires completed by participants in a cohort study of young MSM. Data collection included: demographic characteristics such as age, length of time residing in the Vancouver region, housing, employment, income and income sources; mental health and personal support; instances of forced sex and sex trade participation and; sexual practices with regular and casual male sex partners. Data were available for 57 Aboriginal and 624 non-Aboriginal MSM. Aboriginal MSM were significantly less likely to be employed, more likely to live in unstable housing, to have incomes of <$10,000 and to receive income assistance than non-Aboriginals (all P<0.01). Aboriginals also had higher depression scores (P<0.01), were more likely to report non-consensual sex (P=0.03), sexual abuse during childhood (P=0.04) and having been paid for sex (P<0.01). In the past year they were no more likely to have had sex with a male partner they knew to be HIV positive, to have had more than 50 male partners or to have unprotected anal insertive or receptive intercourse with their male partners (all P>0.05). Our data indicate that among MSM, Aboriginal men are at increased risk of antecedent risk factors for HIV infection including sexual abuse, poverty, poor mental health and involvement in the sex trade.     

MSM in HIV-Prevention Trials are Sexual Partners With Each Other: An Ancillary Study to the EXPLORE Intervention

The EXPLORE study evaluated a behavioral intervention to prevent HIV seroconversion among men who have sex with men (MSM). The present ancillary study enrolled 345 EXPLORE participants at one study site (Boston) and assessed high-risk sexual behavior with other EXPLORE participants. It also assessed sexual intentions across other EXPLORE participants, HIV-negative individuals, and unknown HIV serostatus partners. Thirty-one percent reported having sex with another EXPLORE participant: 27% unprotected receptive oral sex with ejaculation (UO), 30% unprotected insertive anal sex (UIA), and 34% reported unprotected receptive anal sex (URA). Significant relationships between intentions to engage in UO, UIA, and URA, and type of partner emerged with intentions to engage in UO, UIA, and URA higher in HIV-negative partners, other EXPLORE participants, and unknown-HIV serostatus partners. Future HIV-prevention studies recruiting MSM at increased sexual risk of HIV infection should address participants potentially becoming sexual partners with each other.     

Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men

Previous studies have indicated an association between childhood sexual abuse (CSA) and adult sexual risk behaviour among women and among men who have sex with men (MSM). However, no studies to date have tested the hypothesis that a history of CSA predicts sexual behaviour carrying risk of transmission of HIV to others, i.e. in a known HIV-positive cohort. The present study tested this hypothesis among a sample of 456 HIV-positive MSM recruited from community venues in New York and San Francisco. CSA history was found to be significantly associated with past (in the last 90 days) unprotected anal sex acts, both insertive (33% versus 20%, p < 0.05) and receptive (43% versus 27%, p < 0.02), with partners of HIV-negative or unknown serostatus. Further, several potential mediators of this effect were tested, and three found to be predicted by CSA history. Each of these potential mediators was associated with sexual risk behaviour, but differentially: anxiety and hostility were significantly associated with insertive acts, while anxiety, hostility and suicidality were associated with receptive acts. Mediation analyses supported the hypothesis that these factors significantly (albeit partially) accounted for the association of CSA with receptive anal intercourse. Nonsignificant mediation effects were found for insertive sex, suggesting the operation of unmeasured mediating variables. These results highlight the importance of mental health services for individuals who have been sexually abused, both for personal and for public health benefit, and also indicate a need for further research into mediators of CSA effects on transmission-related behaviour.     

Condom use and 'withdrawal': exploring gay men's practice of anal intercourse

Some gay men who have unprotected anal intercourse avoid ejaculation-they practise 'withdrawal'. Using data collected in 1997 from a sample of Sydney gay men (n=625), we explored the relation between men's practice of ejaculation and their use of condoms. We also investigated whether men who had unprotected withdrawal but not unprotected ejaculation were more likely to think unprotected withdrawal was safe, liked condoms less, liked anal intercourse more, or were more sexually adventurous. Considering separately insertive and receptive anal intercourse with regular and with casual partners, we found that the majority of men who practised unprotected withdrawal also practised unprotected ejaculation. Of those whose only unprotected sex was withdrawal ('true withdrawers'), most never used condoms (they did not also have protected sex with ejaculation). True withdrawers were compared with men who had unprotected ejaculation, who always used condoms, who had no anal sex and who had no partners. Those who were true withdrawers with casual partners were more likely to believe withdrawal was safe; no group effects were found with regular partners. No significant differences in condom attitudes were found. True withdrawers with regular partners liked anal intercourse less than other men, but true withdrawers with casual partners were indistinguishable from those who had unprotected ejaculation. True withdrawers did not differ in sexual adventurousness from other men who had anal intercourse. Most withdrawers avoided anal sex with ejaculation rather than use condoms. Converting them into reliable condom users may be a considerable challenge for health promotion.     

High HIV infection prevalence in a group of men who have sex with men

Brazil is characterized by a concentrated AIDS epidemic, it has a prevalence of less than 1% in the general population. However, there are higher rates in specific populations, especially in men who have sex with men. The study's aim was to analyze the association between sociodemographic characteristics, sexual practices, sexual behaviors and the HIV infection in a group of men who have sex with men. Secondary data was collected between June 2014 and September 2015 in a research of cross-sectional design in the city of Rio de Janeiro, Brazil. Volunteers answered an online computerized questionnaire and took HIV test. Chi-squared distribution and multiple logistic regression was used. There were 341 participants. Most of them were racially mixed, single, average age of 30.6 years and with a higher education level. The HIV prevalence was 13.9%. Two logistic models were fit (insertive or receptive anal intercourse). Both models showed an association with HIV among those who had a HIV positive sexual partner (Odds Ratio ≈ 2.5) and a high self-perception of acquiring HIV (Model 1: Odds Ratio ≈ 7/Model 2: Odds Ratio ≈ 10). Low condom usage in receptive anal intercourse with casual partners had a direct association with HIV seropositivity, whereas insertive anal intercourse with casual partners with or without condoms were inversely related. The study identified a high prevalence of HIV infections among a group of men who sex with men with a high self-perception risk of acquiring HIV. The findings also showed a relation with sociodemographic and sexual behavior variables.     

The relationship between gender role conflict and condom use among black MSM

Gender role conflict may influence condom use among black MSM. We examined relationships between the Gender Role Conflict Scale (GRCS), social/demographic variables and condom use among 456 black MSM. Higher total GRCS scores did not predict unprotected insertive anal intercourse (UIAI) or unprotected receptive anal intercourse (URAI) with men, but were associated with unprotected vaginal or anal intercourse (UVI/UAI) with women among bisexually active participants (n?=?69). Higher perceived HIV risk reduced the likelihood of both UIAI and URAI with men. Internet recruitment venues, sexual discrimination experiences, higher numbers of sex partners and UVI/UAI with women all increased the likelihood of UIAI with men, while education (college/technical school or college degree) was associated with URAI with men. Future sexual health interventions for black MSM should emphasize broader social/demographic and alternative gender role variables with male sexual partners, while traditional GRCS variables may prove useful among those with female sexual partners.     

Association of human T lymphotropic virus type III antibodies with sexual and other behaviors in a cohort of homosexual men from Boston with and without generalized lymphadenopathy

Forty asymptomatic homosexually active men seen at a Boston community health center and 39 men with generalized lymphadenopathy were interviewed and filled out detailed epidemiologic questionnaires. Twenty percent of the asymptomatic men and 92 percent of those with lymphadenopathy had antibodies to human T lymphotropic virus type III (HTLV-III). None of the men have subsequently had the acquired immune deficiency syndrome (AIDS). Seropositivity was associated with receptive anal intercourse and oral exposure to ejaculate, a history of hepatitis B, anal gonorrhea, or intestinal parasites, but no other sexually transmitted diseases, and did not correlate with the use of recreational drugs. More of the seropositive men had multiple partners from New York City. An association with seropositivity was less evident in relation to the numbers of partners from San Francisco or Los Angeles, since the whole cohort generally had fewer contacts with partners from these cities. The data suggest that educational programs among homosexual men attempting to decrease AIDS risk should focus on decreasing the number of partners, receptive anal intercourse, oral exposure to ejaculate and other intimate rectal contact, and sexual contact with men from areas of increased HTLV-III seroprevalence.     

Gay men report high rates of unprotected anal sex with partners of unknown or discordant HIV status.

OBJECTIVE: To examine patterns and factors that correlate with unprotected anal intercourse (UAI) practices among San Francisco gay men, including UAI with partners of unknown or different HIV antibody status. DESIGN: A longitudinal cohort recruited for the San Francisco Young Men's Health Study in 1992; re-assessed annually. Participants and methods: A sample of 510 unmarried gay men who were 18 to 29 years at baseline were originally recruited as part of a larger population and referral-based sample. Subjects participated in four consecutive waves of data collection. RESULTS: The prevalence of reported unprotected anal intercourse (UAI) increased from 37% to 50% between 1993-1994 and 1996-1997. Almost half of all men who reported UAI in 1996-1997 indicated that it occurred with a partner of unknown or discordant HIV antibody status. This high-risk practice correlated with greater numbers of male sex partners, use of nitrite inhalants, sex in commercial sex environments, perceived difficulty controlling sexual risk-taking, and negative emotional reactions following UAI. CONCLUSIONS: These data on increasing rates of sexual risk-taking further confirm trends in sexual behavior previously suggested by rising rates of rectal gonorrhea in this population. Additional and sustained prevention efforts are urgently needed in light of the very high background rates of HIV infection found among gay men in San Francisco.     

Practices of receptive and insertive anal sex among transgender women in relation to partner types,sociocultural factors,and background variables

It is urgent to develop efficacious HIV prevention programs to curb the reported extremely high HIV prevalence and incidence among transgender women (male-to-female transgender persons) who reside in large cities in the USA. This study aimed to describe unprotected receptive anal sex (URAS) and unprotected insertive anal sex (UIAS) among high-risk transgender women in relation to partner types, psychosocial factors, and background variables. Based on purposive sampling from the targeted communities and AIDS service organizations in San Francisco and Oakland, a total of 573 transgender women who had a history of sex work were recruited and individually interviewed using a structured survey questionnaire. Significant correlates with URAS with primary, casual, and commercial sex partners were found (e.g., needs for social support, frequency of social support received, exposure to transphobia, self-esteem, economic pressure, norms toward practicing healthy behaviors, and self-efficacy toward practicing safe sex). Multiple logistic regression analyses revealed that transgender women who had engaged in URAS with commercial partners were more likely to have higher levels of transphobia or lower levels of the norms or self-efficacy to practice safe sex. Among the participants who did not have vaginoplasty (preoperative transgender women), 16.4% had engaged in insertive anal sex (IAS) with commercial partners in the past 30 days. The participants who were HIV positive and had engaged in IAS were more likely to be African-American or Caucasians, coinfected with sexually transmitted infections, or identified themselves as homosexual. Practices of IAS among transgender women have not been thoroughly investigated in relation to sexual and gender identity. UIAS with homosexual and bisexual men in addition to URAS may be a cause for high HIV incidence among transgender women. An HIV prevention intervention study must be developed and evaluated, which aims to reduce HIV-positive and -negative transgender women's URAS and UIAS.     

Versatility and HIV Vulnerability: Patterns of Insertive and Receptive Anal Sex in a National Sample of Older Australian Gay Men

According to mathematical modeling, HIV is more likely to spread through a population of men who have sex with men when high numbers practice versatile anal sex roles, that is, engage in both insertive (IAI) and receptive anal intercourse (RAI). Yet, actual patterns of versatility remain largely unknown, particularly among older men who currently face growing rates of HIV. In this study, 1,135 Australian gay men aged 40 years and older completed a national online survey of their sexual health and behavior over the past 12 months. Of men who had anal intercourse, 62 % engaged in both IAI and RAI. Factors associated with being versatile included younger age (P = 0.01), higher income (P = 0.009), and larger numbers of sexual partners (P = 0.003). Among men with multiple sexual partners, 20 % were highly versatile, that is, reported similar numbers of IAI and RAI partners. Having HIV (P = 0.003) and living in a rural area (P = 0.04) were significantly associated with being highly versatile. These data point to high rates of versatility among older Australian gay men, with implications for mathematical predictions of change in HIV epidemics and for the design of future HIV prevention strategies.     

Risk factors for HIV infection among men who have sex with men

OBJECTIVES: Risk factors for HIV acquisition were examined in a recent cohort of men who have sex with men (MSM). DESIGN: A longitudinal analysis of 4295 HIV-negative MSM enrolled in a randomized behavioral intervention trial conducted in six US cities. METHODS: MSM were enrolled and assessed for HIV infection and risk behaviors semi-annually, up to 48 months. RESULTS: In multivariate analysis, men reporting four or more male sex partners, unprotected receptive anal intercourse with any HIV serostatus partners and unprotected insertive anal intercourse with HIV-positive partners were at increased risk of HIV infection, as were those reporting amphetamine or heavy alcohol use and alcohol or drug use before sex. Some depression symptoms and occurrence of gonorrhea also were independently associated with HIV infection. The attributable fractions of high number of male partners, use of alcohol or drugs before sex, and unprotected receptive anal intercourse with unknown status partners and the same with presumed negative partners accounted for 32.3, 29.0, 28.4 and 21.6% of infections, respectively. CONCLUSIONS: The challenge is to develop strategies to identify men in need. Interventions are needed to help men reduce their number of sexual partners, occurrences of unprotected anal intercourse, alcohol or drug use before sex and address other mental health issues.     

Effect of HIV antibody disclosure on subsequent sexual activity in homosexual men

During a prospective study of the natural history of AIDS, 1001 homosexual or bisexual men were offered the opportunity to learn their HIV antibody status. Six hundred and seventy (67%) of the population who elected to do so were similar to the 331 (33%) people who declined in a number of baseline characteristics. All were counselled to practice safe sex. To determine whether disclosure of HIV serologic status affects subsequent sexual behavior, we examined changes at four time-points in three sexual activities during the previous 6 months: the number of male partners with whom the participant had (1) sexual intercourse, (2) unprotected anal receptive intercourse, and (3) unprotected anal insertive intercourse. All activities decreased strikingly over the 18-month study period. Following disclosure, the mean number of partners dropped to 47% of the baseline number in people remaining unaware of their antibody status, to 45% in people told that they were seropositive, and to 55% in people told that they were seronegative. The mean number of partners for younger seropositives declined less than that for older seropositives. The mean number of partners with whom unprotected anal receptive intercourse was practiced declined to 57% of baseline in unaware people, 42% in aware seropositives, and 62% in aware seronegatives. The mean number of partners with whom unprotected anal insertive intercourse was practiced declined to 52% of baseline in unaware people, 42% in aware seropositives and 59% in aware seronegatives. Disclosure of a negative test result led to a significantly smaller decline in these sexual activities.(ABSTRACT TRUNCATED AT 250 WORDS)