Factors associated with condom use in the male population of Mexico City.

Sexually transmitted diseases (STDs) are an important public health problem, due to their medical, social and economic repercussions. Therefore, more knowledge is needed about the sexual behaviour that promotes their spread, in order to improve control and prevention strategies. Our aim was to determine the frequency of male condom use associated with sexual behaviour factors, a history of and knowledge about STDs in a sample of the male population in Mexico City. During 1994 a cross-sectional epidemiological study was carried out, using multi-stage sampling with conglomerates, in 1377 men from 15 to 49 years old. The mean age was 34.5 years (SD 7.5 years). Mean age at first sexual relations was 17.7 years (SD 2.8 years). The global proportion of condom use during the last sexual relation was 24.6%; use according to type of female sex partner in the last year was 18.8% with regular partners and 62.5% with occasional partners. The principal predictors of male condom use, identified through statistical modelling, were: younger age (<25 years), middle and high education level (>9 years), middle and high socioeconomic level and type of sexual partners (occasional and regular). This population has risk factors for acquiring and transmitting some STDs, such as occasional sexual partners and a history of STDs. Characteristics which are important in relation to male condom use were identified, such as age (younger than 35), education (complete junior high school or more) and type of sexual partners (occasional and regular).

PIP: A cross-sectional epidemiological study was conducted in 1994 to determine the frequency of condom use in Mexico City among sexually active men aged 15-49 years old, and the association with sexual behavior and a history of or knowledge about STDs. The 1377 men interviewed were of mean age 34.5 years, and experienced their first sexual intercourse at mean age 17.7 years. 47% of the men reported using a condom at least once in their lives and 81.6% were married. 79.4% reported having a formal partner, 14.6% had relations with occasional partners, and 6.1% with both regular and informal partners. 26.4% used a condom during their most recent sexual intercourse, 18.8% with formal partners and 62.5% with casual partners. Condom use with formal partners was largely to prevent pregnancy, while condom use with casual partners was to prevent the transmission of STDs. Young and single men were almost twice as likely to use condoms as older married men. The main predictors of male condom use were therefore being under 25 years old, having more than 9 years of formal education, being of middle to high socioeconomic status, and type of sex partners.

Influence of HIV positive status on sexual behavior among males.

OBJECTIVE: To compare HIV seronegative (HIV-) and HIV seropositive (HIV+) males in terms of sexual behavior with female and male partners of different types. METHOD: Cross-sectional study. From August 1994 to February 1995, a sample of 236 respondents (150 HIV- and 86 HIV+) recruited from public health centers in the State of S. Paulo (Brazil), answered a questionnaire, including questions on demographic aspects, HIV and AIDS related knowledge, sexual orientation, use of alcohol and other drugs, sexual behavior with regular and casual female and male partners, and perceived risk of HIV infection. Sexual behavior with regular and casual female and male partners within the previous three months, was investigated. RESULTS: A lower proportion of HIV+ engaged in sexual contact with regular female partners (p < .01) and in vaginal intercourse with this type of partner (p < .01). A lower proportion of HIV+ engaged in overall sexual activity (p < .001) and reported lower frequency of penetrative sexual practices (p < .05). A high level of condom use with female and male partners was identified with no significant differences being found between the two serostatus groups. Some risky sexual behavior was identified, however, especially with regular partners, suggesting that some men were continuing to practice unsafe sex. CONCLUSIONS: The high level of condom use identified suggests that safer sex advice has been taken up. Condom use was not universal, however, and some men continue to place themselves at risk, especially with regular partners. Prevention programs should strive not only to encourage HIV- to practice safer sex, but also to encourage HIV+ to do so in order to prevent further transmission of the virus.

PIP: Findings are presented from a cross-sectional study comparing the sexual behavior of HIV-seronegative and HIV-seropositive men with male and female sex partners, with particular focus upon the practice of safer sex in both groups of men. The 150 HIV-seronegative and 86 HIV-seropositive participating males were recruited between August 1994 and February 1995 from public health centers in the state of Sao Paulo, Brazil, where they responded to a questionnaire. The men were 15-69 years old, of mean age 30 years. 78% were single, 14.4% were married/living together, 6.4% were separated/divorced, and 1.3% were widowers. 36% defined themselves as heterosexuals, 11.4% as bisexuals, and 36.4% as homosexuals, while 16.1% used other expressions. Compared to HIV-seronegative men, a smaller proportion of HIV-seropositive men had sexual contact with regular female partners and engaged in vaginal intercourse with that type of partner. Similarly, a smaller proportion of HIV-seropositive men engaged in overall sexual activity and reported a lower frequency of penetrative sexual practices. A high level of condom use with male and female sex partners was identified with no significant differences being found between the 2 serostatus groups. However, some risky sexual behavior was identified, especially with regular partners, suggesting that some men were continuing to have unsafe sex. HIV prevention programs should encourage both HIV-seronegative and HIV-seropositive men to practice safer sex.

Reproductive health programs for men.

PIP: The Groupe de Lutte Anti-SIDA (GLAS) (Group in Struggle Against AIDS) is an HIV prevention program in Port-au-Prince, Haiti, which taught HIV prevention to almost 20,000 mainly male workers aged 15-49 years. Before ending in 1996, GLAS offered one, hour-long session introducing HIV and other sexually transmitted diseases (STDs), and how to prevent them; instruction on how to use condoms; an open-ended discussion hour in which workers who had attended the first 2 sessions could ask questions about beliefs and rumors related to HIV/AIDS and STDs; and intensive psychological support groups using the transactional analysis (TA) educational approach to personal growth and change. The TA approach focuses upon teaching adults how to abandon self-defeating strategies, typically learned during childhood, and how to develop attitudes for managing life's problems. It promotes clear, direct communication. Participation in GLAS's program helped men understand the benefits of adopting HIV/STD risk reduction behavior.^ieng

Psychosexual characteristics of male university students in Brazil.

Male freshmen (N = 268) at the State University of Campinas (UNICAMP) in the state of Sao Paulo in Brazil responded to a questionnaire concerning aspects of their sexuality from the onset of adolescence. Topics such as physical changes, first ejaculation, masturbation, homosexual manifestations, and sexual practices were investigated, as well as present attitudes toward virginity, intercourse, birth control, abortion, and prevention of AIDS. The quality of the relationship established with parents and the possibilities for dialogue about sex in the family circle were also surveyed. The majority of the subjects revealed satisfactory development in most areas of their sexuality, as well as a good relationship with their parents. Nevertheless, great difficulty was found in dialogue about sex within the family circle. Of these young men, 32% were still virgins at the end of their freshman year, but a considerable number of those already sexually active reported behavior which was inappropriate for the prevention of pregnancy and AIDS. The results are analyzed using psychoanalytic theories of psychosexual development.

PIP: A random sample of 268 male freshmen of mean age 19.6 years at the State University of Campinas in the state of Sao Paulo, Brazil, responded to a questionnaire in 1990 on aspects of their sexuality from the beginning of their adolescence. Topics such as physical changes, first ejaculation, masturbation, homosexual manifestations, and sexual practices were investigated, as well as present attitudes toward virginity, intercourse, birth control, abortion, and AIDS prevention. The quality of their relationships with parents was also surveyed. The sample comprised 31% of the entering students for that year. 32% were living with their parents. Most respondents reported satisfactory development in most areas of their sexuality, as well as a good relationship with their parents. However, they found it very difficult to discuss sex within their family circles. 32% were still virgins at the end of their freshman year. 28% and 20% had homosexual manifestations during childhood/early adolescence and currently, respectively, including fantasies, attraction to men/boys, physical contact with men/boys, and sexual intercourse with men/boys. 38% of the sexually active men reported taking no measures to prevent pregnancy and HIV transmission.

AIDS knowledge and sexual behavior among Mexican gay and bisexual men.

Little knowledge exists about AIDS and Human Immunodeficiency Virus (HIV) infection among Latin American gay males. In Latin America, sexual transmission from man to man is the leading cause of HIV infection. In Mexico, which ranks third in number of AIDS cases in the Americas, more than three-quarters of the cases are due to sexual transmission; among these cases, 35% and 23.7% are due to homosexual and bisexual male practices, respectively. A sample of 200 individuals from Juarez, Mexico, a city on the U.S. border, was interviewed. Information about their AIDS knowledge, sexual behavior, and condom use was obtained. Factory workers and individuals who meet sexual partners in the streets reported more sexual partners than workers in service or professional occupations and those who meet their partners in bars and discos. Number of sexual partners and respondents' age were inversely associated with condom use. Implications for HIV prevention are discussed.

PIP: Two hundred gay and bisexual men of mean age 26.4 years from Juarez, Mexico, were interviewed by the Mexican Federation of PRivate Associations for Community Development (FEMAP) about their AIDS knowledge, sexual behavior, and condom use. 88% were single and never married. 66% self-identified as being gay, 29% as bisexual, and 2% as transvestites; 10% reported having sex for money. 14% had had at least one sexually transmitted disease and 57% were negative about condom use. Having an average 4.46 sex partner/month, most respondents were knowledgeable about HIV transmission routes, AIDS symptoms, and HIV antibody tests. 75% and 77.5%, respectively, reported practicing receptive anal intercourse and insertive anal intercourse. They used condoms an average of 6.47 times in their most recent ten sexual encounters. By profession and social behavior, factory workers and individuals who recruit sex partners from the street reported having more sex partners than service and professional workers and those who meet their partners in bars and discos. Further, the number of sex partners and respondents' age were inversely associated with condom use. These findings clearly highlight the failure of knowledge about HIV to bring about change in sexual behavior among certain subpopulations in the study area. Since homosexuality remains unaccepted in Mexican society, the author suggests targeted peer education and small-group session prevention efforts which do not confront mainstream social structure and values.