Continuing unsafe sex: assessing the need for AIDS prevention counseling

To assess the need for acquired immunodeficiency syndrome (AIDS) prevention counseling for gay and bisexual men who were continuing to engage in unsafe sex, a nonprobability telephone survey--the data may not be generalizable to the population--was conducted in Seattle during March 1987. In a 4-week period, 141 callers phoned in response to local publicity and completed a 30-minute anonymous interview. This paper focuses on 106 male respondents who were behaviorally defined as gay (that is, sex during the past year exclusively with partners of the same sex, N = 74) or bisexual (sex with both men and women, N = 32). The modal respondent was a never-married white male in his thirties who had some college education and was employed full-time in a white collar occupation. The gay men were more likely than the bisexual men to report that their family members and friends knew of their sexual orientation and to indicate that they were able to discuss their concerns about unsafe sex with someone close to them. Gay men were also more likely to use condoms and to have engaged in anonymous sex during the 3 months before the interview. More gay men had engaged in unprotected receptive anal intercourse (27 percent) than had bisexual men (13 percent), and in considerably more insertive anal intercourse (42 percent versus 22 percent). Of the gay men interviewed, 73 percent indicated that they needed help in changing their high-risk sexual behaviors compared with 61 percent of bisexuals. However, respondent preferences for the context of counseling (for example, sexual preference of the counselor,group versus individual counseling, type of agency) differed on the basis of the respondent's self definition of sexual preference. Bisexual men expressed a preference for individual therapy delivered by a private practitioner who is a heterosexual. The authors conclude that men who are at risk of AIDS due to ongoing unsafe sex will require a diversity of counseling options.