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Actual versus perceived HIV status, sexual behaviors and predictors of unprotected sex among young gay and bisexual men who identify as HIV‐negative, HIV‐positive and untested

Hays, Robert B.1,2; Paul, Jay1; Ekstrand, Maria1; Kegeles, Susan M.1; Stall, Ron1; Coates, Thomas J.1


Objectives: To compare the prevalence and predictors of HIV sexual risk behavior among young gay and bisexual men who perceived themselves to be HIV-negative, HIV-positive, or who were untested.

Design: Population-based sample of young gay and bisexual men.

Methods: Using multi-stage probability sampling, 408 gay and bisexual men aged 18–29 years in San Francisco were recruited and interviewed, and blood samples for HIV-testing from 364 participants were obtained.

Results: HIV prevalence was 18.7%, although 25% of the men who were HIV-positive did not know it. Thirty-seven per cent reported engaging in unprotected anal intercourse during the past year, including 59% of the men who knew they were HIV-positive, 35% of the men who perceived themselves HIV-negative and 28% of the untested men. Logistic regressions found similar predictors of unprotected intercourse for HIV-negatives and HIV-positives, including sexual impulsivity, substance use, sexual enjoyment and communication problems.

Conclusions: The high rates of unprotected intercourse, particularly among the HIV-positive men, attest to the urgent need for HIV-prevention interventions for young gay and bisexual men. The findings suggest that many of the important variables to target in interventions are similar for both HIV-positive and HIV-negative men.

1Center for AIDS Prevention Studies, University of California, San Francisco, USA.

2Requests for reprints to: Robert B. Hays, Center for AIDS Prevention Studies, University of California, 74 New Montgomery, Suite 600, San Francisco CA 94105, USA.

Sponsorship: Funded by contract N01-A1-82515 from the National Institute of Allergy and Infectious Diseases and by Center Grant MH42459 from the National Institute of Mental Health.

Date of receipt: 28 January 1997; revised: 4 June 1997; accepted: 9 June 1997.

© Lippincott-Raven Publishers.